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BASKORO SETIOPUTRO

Basic functions of the respiratory


system:
Gas exchange supply oxygen to aerobic tissues in the body
and remove carbon dioxide as a waste product
1. Pulmonary ventilation - the physics of getting air in- to
and out- of the lungs (ventilation).
2. External respiration - gas exchange between the lungs
and blood (oxygen loading and CO2 unloading).
3. Transport of respiratory gases - movement of blood (thus
gases) from the lungs to the cell and tissues.
4. Internal respiration gas exchange between the
capillaries and the tissues (oxygen unloading and CO2
loading).
Functional anatomy of the
respiratory system:
Conducting
Zone:Rigid conduits for
air to reach site of gas
exchange
nose
nasal cavity
pharynx
larynx
trachea
bronchi
Respiratory Zone: site
of gas exchange
respiratory bronchioles
alveolar ducts
The conducting zone
Nose
Airway
moistens and
warms air
filters inspired air
resonating
chamber for speech
olfaction
paranasal sinuses
frontal, sphenoid,
ethmoid and
maxillary bones
warm and moisten
air
The conducting zone
Pharynx
connects the nasal
cavity and mouth to
the larynx and
esophagus
common pathway
for food and air
(throat)
Nasopharynx
Oropharynx
laryngopharynx
The conducting zone
Laryngopharynx common passage way for food and air
Larynx voice box
The conducting zone
The conducting zone
Trachea
Windpipe
forming two
primary bronchi
at midthorax
mucosa
pseudostratified
epithelium
(goblet cells)
submucosa
connective
tissue
seromucous
glands mucous
The conducting zone
Adalah tabung fleksibel dengan panjang kira-kira 10 cm dengan
lebar 2,5 cm.
Trachea berjalan dari cartilago cricoidea kebawah pada bagian
depan leher dan dibelakang manubrium sterni, berakhir setinggi
angulus sternalis (taut manubrium dengan corpus sterni) atau
sampai kira-kira ketinggian vertebrata torakalis kelima dan di
tempat ini bercabang menjadi dua bronckus (bronchi).
Trachea tersusun atas 16 - 20 lingkaran tak- lengkap yang berupan
cincin tulang rawan yang diikat bersama oleh jaringan fibrosa dan
yang melengkapi lingkaran disebelah belakang trachea, selain itu
juga membuat beberapa jaringan otot.
The conducting zone
Bronchi
Bronchial tree
left and right primary
bronchi
formed by divisions of
the trachea
secondary bronchi
(lobar)
inside the lungs
3 on the right
2 on the left
tertiary bronchi
(segmental)
20-25 orders of
branching air ways
bronchioles (under 1
mm in diameter
The conducting zone
Bronchioles
bronchioles (under 1 mm in diameter)
terminal bronchioiles (less than 0.5 mm)
The conducting zone
Cartilage:
rings
irregular plates
no cartilage in bronchioles
replaced by elastic fibers
Epithelium:
pseudostratified (ciliated)
columnar (ciliated)
cuboidal in terminal bronchioles (no cilia)
Smooth Muscle:
increases as tubes get smaller
The respiratory zone
Respiratory Zone:
Respiratory bronchioiles
Alveoli (300 million)
Alveolar ducts
Alveolar sacs
Gas Exchange:
respiratory membrane
The respiratory zone
Respiratory Zone:
Respiratory membrane (air-blood barrier) or (Alveolar-
capillary membrane) is composed of:
simple squamous epithelial cells (Type I cells)
cobweb of pulmonary capillaries
Primary function is gas exchange
Type II cells (cuboidal)surfactant
elastic fibers
alveolar pores allow for pressure equalization between
alveoli
alveolar macrophages(dust cells)
Lungs and Pleural Coverings
Pleural Coverings:
double layered serosa
parietal pleura lines the thoracic wall
pulmonary or visceral pleura which covers the lung surface
pleural cavity is the space between the two layers
pleural fluid fills the cavity
Blood Supply and Innervation of
the Lungs
Blood supply:
Pulmonary circulation
Bronchial circulation
Pulmonary arteries from the right side of the heart supply blood to
the lungs.
pulmonary arteries branch profusely along with the bronchi
pulmonary capillary networks surrounding alveoli
pulmonary veins form post alveoli to carry oxygenated blood back to
the heart
Bronchial arteries come from the aorta and enter the lung at the
hilus
the bronchial arteries run along the branching bronchi and supply
lung tissue except the alveoli
bronchial veins drain the bronchi but most moves into the
pulmonary circulation
Blood Supply and Innervation of
the Lungs
Innervation:
parasympathetic motor fibers (some sympathetic fibers)
visceral sensory fibers
Enter the lung through the pulmonary plexus on the lung
root
parasympathetic fibers constrict the air tubes
sympathetic fibers dilate air tubes
respiratory.sw f
Overall function
Movement of gases
Gas exchange
Transport of gas (oxygen and carbon dioxide)
Respiratory Control System

Cerebral Cortex

Mechanoreceptors Respiratory center-Medulla Chemoreceptors


Nerve Impulses
Spinal Cord
Force, Nerve Impulses
displacement Respiratory Muscles

Lung & Chest Wall


Ventilation
Respiratory membrance
Diffusion
Pco2, Po2, pH
Perfusion-----> Blood
Respiratory Centers
Located in brain stem
Dorsal & Ventral Medullary group
Pneumotaxic & Apneustic centers
Affect rate and depth of ventilation
Influenced by:
higher brain centers
peripheral mechanoreceptors
peripheral & central chemoreceptors
Controls of rate and depth of
respiration
Arterial PO2
When PO2 is VERY low, ventilation increases
Arterial PCO2
The most important regulator of ventilation, small
increases in PCO2, greatly increases ventilation
Arterial pH
As hydrogen ions increase, alveolar ventilation
increases, but hydrogen ions cannot diffuse into CSF as
well as CO2
EXERCISE
Neural signals (rate & depth)
PCO2 (PO2 and pH)
Cardiac Output
Maximal Hb saturation
Dilate airways
Muscles of Ventilation
Inspiratory muscles-
increase thoracic cage volume
Diaphragm, External Intercostals, SCM,
Ant & Post. Sup. Serratus, Scaleni, Levator Costarum
Expiratory muscles-
decrease thoracic cage volume
Abdominals, Internal Intercostals, Post Inf. Serratus,
Transverse Thoracis, Pyramidal
Movement of air in/out of lungs
Considerations
Pleural pressure
negative pressure between parietal and visceral pleura
that keeps lung inflated against chest wall
varies between -5 and -7.5 cmH2O (inspiration to
expiration
Alveolar pressure
subatmospheric during inspiration
supra-atmospheric during expiration
Transpulmonary pressure
difference between alveolar P & pleural P
measure of the recoil tendency of the lung
peaks at the end of inspiration
PULMONARY VENTILATION
BOYLES LAW
Gas pressure in closed container is inversely
proportional to volume of container
Pressure differences and Air flow
Pressures
Atmospheric pressure 760 mm Hg
Intrapleural pressure 756 mm Hg pressure between
pleural layers
Intrapulmonary pressure varies, pressure inside
lungs
Inspiration/Inhalation
Diaphragm & Intercostal muscles
Increases volume in thoracic cavity as muscles contract
Volume of lungs increases
Intrapulmonary pressure decreases
Expiration/Exhalation
Muscles relax
Volume of thoracic cavity decreases
Volume of lungs decreases
Intrapulmonary pressure increases (763 mm Hg)
Forced expiration is active
Abm1s3_1.rm
Factors that influence pulmonary
air flow
F = P/R
Diameter of airways, esp. bronchioles
Sympathetic & Parasympathetic NS
Surface Tension
Lung collapse
Surface tension tends to oppose alveoli expansion
Pulmonary surfactant reduces surface tension
Patterns of Breathing
Eupnea
normal breathing (12-17 B/min, 500-600 ml/B)
Hyperpnea
pulmonary ventilation matching metabolic
demand
Hyperventilation ( CO2)
pulmonary ventilation > metabolic demand
Hypoventilation ( CO2)
pulmonary ventilation < metabolic demand
Patterns
Tachypnea
of breathing (cont.)
frequency of respiratory rate
Apnea
Absense of breathing. e.g. Sleep apnea
Dyspnea
Difficult or labored breathing
Orthopnea
Dyspnea when recumbent, relieved when upright.
e.g. congestive heart failure, asthma, lung failure
Static Lung Volumes
Tidal Volume (500ml)
amount of air moved in or out each breath
Inspiratory Reserve Volume (3000ml)
maximum vol. one can inspire above normal
inspiration
Expiratory Reserve Volume (1100ml)
maximum vol. one can expire below normal
expiration
Residual Volume (1200 ml)
volume of air left in the lungs after maximum
expiratory effort
Static Lung Capacities
Functional residual capacity (RV+ERV)
vol. of air left in the lungs after a normal expir., balance
point of lung recoil & chest wall forces
Inspiratory capacity (TV+IRV)
max. vol. one can inspire during an insp effort
Vital capacity (IRV+TV+ERV)
max. vol. one can exchange in a resp. cycle
Total lung capacity (IRV+TV+ERV+RV)
the air in the lungs at full inflation
spirograph.sw f
Matching Alveolar air flow with
blood flow
Pulmonary vessels
Vessels can constrict in areas where oxygen flow is low
Respiratory passageways
Airways can dilate where carbon dioxide levels are high
Gas Exchange
Partial Pressure
Each gas in atmosphere contributes to the entire
atmospheric pressure, denoted as P
Gases in liquid
Gas enters liquid and dissolves in proportion to its
partial pressure
O2 and CO2 Exchange by DIFFUSION
PO2 is 105 mmHg in alveoli and 40 in alveolar capillaries
PCO2 is 45 in alveolar capillaries and 40 in alveoli
Partial Pressures
Oxygen is 21% of atmosphere
760 mmHg x .21 = 160 mmHg PO2
This mixes with old air already in alveolus to arrive at
PO2 of 105 mmHg
Partial Pressures
Carbon dioxide is .04% of atmosphere
760 mmHg x .0004 = .3 mm Hg PCO2
This mixes with high CO2 levels from residual volume
in the alveoli to arrive at PCO2 of 40 mmHg
Gas Transport
O2 transport in blood
Hemoglobin O2 binds to the heme group on
hemoglobin, with 4 oxygens/Hb
PO2
PO2 is the most important factor determining whether
O2 and Hb combine or dissociate
O2-Hb Dissociation curve
Gas Transport
pH
CO2
Temperature
Gas Transport
CO2 transport
7% in plasma
23% in carbamino compounds (bound to globin part of
Hb)
70% as Bicarbonate
Carbon Dioxide
CO2 + H2O <->H2CO3<->H+ + HCO3-
Enzyme is Carbonic Anhydrase
Chloride shift to compensate for bicarbonate moving
in and out of RBC
Defenses of Respiratory System
Respiratory membrane represents a major source
of contact with the environment with a separation
of .5 microns between the air & the blood over a
surface area of 50-100 sq. meters
The average adult inhales about 10000 L air/day
Inert dust
Particulate matter
Plant & animal

Gases
Fossil fuel combustion

Infectious agents
Viruses & bacteria
Defense Mechanisms
Protect tracheobronchial tree & alveoli from injury
Prevent accumulation of secretions
Repair
Depression of Defense Mechanisms
Chronic alcohol is associated with an increase
incidence of bacterial infections
Cigarette smoke and air pollutants is associated
with an increase incidence of chronic bronchitis
and emphysema
Occupational irritants is associated with and
increased incidence of hyperactive airways or
interstitial pulmonary fibrosis
Upper respiratory tract
Nasal passages protect airways and alveolar structures
from inhaled foreign materials
Long hairs (vibrassae) in nose (nares) filters out larger
particles
Mucous coating the nasal mucous membranes traps
particles (>10 microns)
Moisten air 650 ml H2O/day
Nasal turbinates
Highly vascularized, act as radiators to warm air
Cough
Cough
From trachea to alveoli sensitive to irritants
Afferents utilize primarily CN X
Process
2.5 L of air rapidly inspired
Epiglottis closes and vocal chords close tightly
muscles of expiration contract forcefully which causes
pressure in lungs to rise to 100 mm Hg
Epiglottis and vocal chords open widely which results in
explosive outpouring of air to clear larger airways at speeds of
75 100 MPH
Sneeze
Sneeze reflex
Associated with nasal passages
Irritation sends signal over CN V to the medulla
Response similar to cough, but in addition uvula is depressed
so large amounts of air pass rapidly through the nose to clear
nasal passages
With sneeze and cough velocity of air escaping from the
mouth & nose has been clocked at speeds of 75-100
MPH
Mucociliary elevator
Clears smaller airways
Mucous produced by globlet cells in epithelium and
small submucosal glands
Ciliated epithelium which lines the respiratory tract
all the way down to the terminal bronchioles moves
the mucous to the pharynx
Beat 1000 X/minute
Mucous flows at about speed of 1 cm/min
Swallowed or coughed out

Cough is ineffective at clearing smaller airways b/c


cant generate sufficient velocity due to large total X-
sectional area
Immune reaction in the lung
Alveolar macrophages
Capable of phagocytosing intraluminal particles
Antibodies associated with the mucosa
IgG- lower respiratory tract
IgA- dominate in upper respiratory tract
IgE- predominantly a mucosal antibody