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An Illustrative case
Mr. A, a 65-year old man, is diagnosed having EMPHYSEMA by his doctor. He is a heavy smoker for nearly 45 years.
Structure impaired
Can be detected in: Radiograph Lung tomography Post mortem
Respiration
Ventilation: Movement of air into and out of lungs External respiration: Gas exchange between air in lungs and blood Transport of oxygen and carbon dioxide in the blood Internal respiration: Gas exchange between the blood and tissues
Lower tract
Larynx, trachea, bronchi, lungs
Pharynx
Common opening for digestive and respiratory systems Three regions
Nasopharynx Oropharynx Laryngopharynx
Larynx
Functions
Maintain an open passageway for air movement Epiglottis and vestibular folds prevent swallowed material from moving into larynx Vocal folds are primary source of sound production
Vocal Folds
Trachea
Windpipe Divides to form
Primary bronchi Carina: Cough reflex
Tracheobronchial Tree
Conducting zone
Trachea to terminal bronchioles which is ciliated for removal of debris Passageway for air movement Cartilage holds tube system open and smooth muscle controls tube diameter
Respiratory zone
Respiratory bronchioles to alveoli Site for gas exchange
Tracheobronchial Tree
Lungs
Divisions
Lobes, bronchopulmonary segments, lobules
Ventilation
Movement of air into and out of lungs Air moves from area of higher pressure to area of lower pressure Pressure is inversely related to volume
VENTILATION
During ventilation AIRFLOW because of Pressure Gradients. FLOW = P / R 1. Air flow in response to a pressure gradient. 2. Flow decreases as resistance increases
Inspiration
During inspiration, the thoracic volume increases when skeletal muscles of the rib cage and diaphragm contract pressure inside lung become lower than the pressure of atmosphere pressure gradient air flow into lung.
Thoracic Volume
Pleural pressure
Negative pressure can cause alveoli to expand Pneumothorax is an opening between pleural cavity and air that causes a loss of pleural pressure
Alveolar Pressure
This is the pressure, measured in cm H20, within the alveoli, the smallest gas exchange units of the lung. Alveolar pressure is given with respect to atmospheric pressure, which is always set to zero. Thus, when alveolar pressure exceeds atmospheric pressure, it is positive; when alveolar pressure is below atmospheric pressure it is negative.
Compliance
Measure of the ease with which lungs and thorax expand
The greater the compliance, the easier it is for a change in pressure to cause expansion A lower-than-normal compliance means the lungs and thorax are harder to expand
Conditions that decrease compliance
Pulmonary fibrosis Pulmonary edema Respiratory distress syndrome
SURFACTANT
Surfactant decreases the surface tension created by the thin fluid layer between alveolar cells and the air. Surfactant decrease WORK of BREATHING.
Airway resistance
Parameters that contribute to resistance is: 1. The length of the system ( L ). 2. The viscosity of substance flowing through the system () 3. The radius in the system ( r )
R = L / r4
Pulmonary Volumes
Tidal volume
Volume of air inspired or expired during a normal inspiration or expiration
Residual volume
Volume of air remaining in respiratory passages and lungs after the most forceful expiration
Pulmonary Capacities
Inspiratory capacity
Tidal volume plus inspiratory reserve volume
Vital capacity
Sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume
Ventilation-perfusion coupling:
WORK of BREATHING
DIFFUSION
FICK law of diffusion: V = A/T x D ( P1 P2 ). D=Sol / MW V= rate of diffusion A=area T=thickness D=diffusion constant Sol=solubility MW= molecular weight
Carbon dioxide
Moves from tissues into tissue capillaries Moves from pulmonary capillaries into the alveoli
TRANSPORT OF GAS
Gas transport to blood is important for survival of life. The Law of MASS ACTION plays an important role in this process. Changes in O2 or CO2 concentration disturbs the equilibrium of reactions, shifting the balance between substrate and products.
Bohr effect:
Temperature effects:
Cl
Movement
Rhythmic Ventilation
Starting inspiration
Medullary respiratory center neurons are continuously active Center receives stimulation from receptors and simulation from parts of brain concerned with voluntary respiratory movements and emotion Combined input from all sources causes action potentials to stimulate respiratory muscles
Increasing inspiration
More and more neurons are activated
Stopping inspiration
Neurons stimulating also responsible for stopping inspiration and receive input from pontine group and stretch receptors in lungs. Inhibitory neurons activated and relaxation of respiratory muscles results in expiration.
Modification of Ventilation
Cerebral and limbic system
Respiration can be voluntarily controlled and modified by emotions
Chemical control
Carbon dioxide is major regulator
Increase or decrease in pH can stimulate chemo- sensitive area, causing a greater rate and depth of respiration
Oxygen levels in blood affect respiration when a 50% or greater decrease from normal levels exists
Modifying Respiration
Herring-Breuer Reflex
Limits the degree of inspiration and prevents overinflation of the lungs
Infants
Reflex plays a role in regulating basic rhythm of breathing and preventing overinflation of lungs
Adults
Reflex important only when tidal volume large as in exercise
Effects of Aging
Vital capacity and maximum minute ventilation decrease Residual volume and dead space increase Ability to remove mucus from respiratory passageways decreases Gas exchange across respiratory membrane is reduced
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