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Published by: Sidharth Sekhar Patra on Sep 04, 2010
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Respiratory System Anatomy




  Expiration is a passive relaxation of the inspiratory muscles and the lung recoils. muscles.  air rushes in into the lungs to reduce a pressure difference.  forced inspiration is further assisted by the scalene. sternocleidomastoid.  . quadratus lumborum & abdominals).  increased thoracic pressure forces air out of the lungs  forced expiration is an active process of the internal intercostal muscles (latissimus dorsi.Pulmonary ventilation  Inspiration is an active process of the diaphragm and the external intercostal muscles. and pectoralis muscles.

Pulmonary ventilation .

.Pulmonary diffusion which is the exchange of oxygen and carbon dioxide between the lungs and the blood.  It removes carbon dioxide from returning venous blood. where it is used for oxidative energy production. It serves two major functions:  It replenishes the blood s oxygen supply which is depleted at the level.

the capillary wall. and .  air we breathe = 79% (N2).03% (CO2) = 760mmHg  differences in the partial pressures of the gases in the alveoli and the gases in the blood create a pressure gradient. 21% (O2). through the respiratory membrane.  Partial pressure of gases  the individual pressures from each gas in a mixture together create a total pressure. gradient.  gas exchange occurs between the air in the alveoli. and their basement membranes.  .Pulmonary diffusion Respiratory membrane composed of the alveolar wall. to the red blood cells in the blood of the pulmonary capillaries.

Pulmonary diffusion .

hyper- .ASTHMA Asthma is a disease of airway inflammation and airflow obstruction characterized by the presence of intermittent symptoms including wheezing. and cough together with demonstratable bronchial hyper-responsiveness. shortness of breath. chest tightness.

boys > girls Production of IgE antibodies in response to exposure to allergens .Etiology: Common in children.

Proactive factors:  Physiologic and pharmacologic mediators of normal smooth muscle contraction Histamine  Methacholine   Physiochemical agents Exercise: hyperventilation with cold and dry air  Air pollutants: nitrogen dioxide  Viral resp infection: influenza A  Ingestants: aspirin. wood dust  . dust. NSAIDs   Allergens Low molecular weight chemicals: penicillin  Organic molecules: animal danders. enzymes.

Cellular inflammatory events:  Epithelial cells activation or injury  Lymphocytes activation  Mast cells and eosinophils activation .

Pathophysiology:  Increased  Airway airflow resistance due to inflammation  Airway narrowing  Smooth muscle hyper-responsiveness hyper Mucus hyper secretion  Additional broncho-constrictor stimuli broncho Stimulation of bronchial irritant receptors .

Clinical features:  Cough  Wheezing  Dyspnea with chest tightness  Tachypnea and tachycardia  Pulsus paradoxus  Hypoxemia  Respiratory acidosis .

dressing. showering.The New York Heart Association classification of breathlessness No symptoms with ordinary activity.g. running up hills. fast bicycling. cross-country skiing crossClass II Symptoms with ordinary activity.g. making beds. walking up stairs. e.g. carrying large amounts of shopping Class III Symptoms with mild exertion. e. breathlessness only occurring with severe exertion. bathing. Class IV Symptoms at rest Class I . e.

vasculitis. coal dust Causes Frothy Haemoptysis Black Black specks in mucoid secretions . carcinoma. cardiac disease Smoke inhalation (fires. but not frank pus Thick.SPUTUM ANALYSIS Description Saliva Mucoid Mucopurulent Purulent Clear watery fluid Opalescent or white Slightly discoloured. trauma. tobacco. pneumonia Haemophilus Pseudomonas Pneurnococcus. old blood (dark brown) Chronic bronchitis without infection. mycoplasma Klebsiella Pulmonary oedema Infection (tuberculosis. bronchiectasis). viscous: Yellow Dark green/brown Rusty Red currant jelly Pink or white Ranging from Wood specks to frank blood. heroin). also coagulation disorders. infarction. cystic fibrosis. asthma Bronchiectasis.

Diagnosis:  Chest examination Nasal polyps or increased amounts of nasal secretions  Skin changes: atopic dermatitis or eczema  spirometry measures  blood test  chest x ray  .

are the best choice for relieving bronchodilators. which are bronchodilators. sudden attacks of asthma and for preventing attacks from being triggered by exercise. OTHER DRUGS. BETABETA-RECEPTOR AGONISTS.Treatment      METHYLXANTHINES. which resemble natural body hormones. LEUKOTRIENE MODIFIERS. Leukotriene modifiers are a new type of drug that can be used in place of steroids. for older children or adults who have a mild degree of asthma that persists. block inflammation and are extremely effective in relieving symptoms of asthma. STEROIDS. The chief methylxanthine drug is theophylline. Cromolyn and nedocromil are antiantiinflammatory drugs that are often used as initial treatment to prevent asthmatic attacks over the long term in children. . These drugs. These drugs.

PT management:  Relaxation techniques  Breathing exercises  Assisted coughing  Spirometer exercises  Postural drainage  Prevention of exposure to irritants .

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