ANATOMY AND PHYSIOLOGY

Function of Lungs in Respiratory System

• Gas Exchange

When we inhale, the air enters through the nasal cavity, traveling down via the pharynx, larynx,
and trachea to enter the lungs via the two primary bronchi. Then it reaches the alveoli, the small
air sacs in the lungs where the gas exchange occurs, through the bronchioles.

The one-cell thick walls of the alveoli have an intricate network of blood capillaries. As the
oxygen-rich air reaches these alveoli, the blood flowing through the capillaries takes up the
oxygen in the method of diffusion occurring across the thin walls of the alveoli and the
capillaries (the process in which a substance moves from an area of low concentration to an area
of high concentration). Similarly, the carbon dioxide carried by the blood from the different
organs and tissues of the body are absorbed by the alveoli so they can be excreted along with the
exhaled air

Lungs

• The spongy air-filled conical organs occupying most of the thoracic (chest) cavity in
humans are known as the lungs. It is one of the primary respiratory organs where

The gas exchange occurs after the inhaled air enters the lungs via the trachea, through the
bronchi and bronchioles

• The lungs are located a little toward the posterior part of the human body, just below the
collarbone, extending down to the diaphragm, the muscular partition that separates the
chest and abdominal cavities. The left and right lungs are situated on the two sides of the
body with the heart, another vital organ in the thoracic cavity, located a little in front of,
and at the middle of them. They are also surrounded by the rib cage, along with other
organs in the chest cavity.

Structure and Anatomy of the Lungs

• Apex is the superior part of the lungs, with its highest point located above the first rib,
extending through the superior opening of the thoracic cavity, into the inferior floor of
where the neck starts.

• Base is the concave lower surface of the lung that rests over the diaphragm.

• Right Lung. The right lung is divided into the superior (upper), middle and inferior
(lower) lobes. These are further separated into ten segments.

• Left Lung. The left lung is a little smaller than the right one (to make space for the heart),
and is divided into the superior (upper) and inferior (lower) lobes. Even though there are
only two lobes, the upper lobe has a projection, referred to as the lingula that serves as an
equivalent to the middle lobe of the right lung.

• Fissures of the Lung. Both the left and right lungs have an oblique fissure separating the
superior lobes from the inferior lobes, while in the right lung there is a horizontal fissure
to keep the middle and superior lobes apart.

Surfaces and Borders of the Lung

• Pleura and Pleural Cavity

A pleura is a two-layered serous (fluid-filled) membrane that covers the lungs, providing a
cushion to protect it from trauma and also to facilitate the process of respiration. There are two
pleurae in the human body, covering the two lungs.

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• Mediastinum: The Space Between the Two Lungs

The area around the middle of the thorax, between the right and left pleural sacs, is known as the
mediastinum. The space is divided into the inferior and superior mediastinum. The inferior
mediastinum is larger between the two and further separated into the posterior, middle, anterior
and mediastinum.

• Diaphragm

It is the convex or dome-shaped sheet of muscle that both the lung bases rest upon. The
diaphragmatic surface of both the lungs has a concave shape to accommodate the shape of the
diaphragm. One of the vital muscles in the respiratory system, it separates the chest cavity from
the abdominal cavity.

Respiratory Area of the Lungs (Lung Parenchyma)

The structures in the lungs directly responsible for the function of respiration collectively form
the lung parenchyma. It includes the bronchial tubes, blood vessels, alveoli, and alveolar ducts.
• Bronchi and Bronchioles. As the windpipe reaches the lungs, it divides into the left and
right primary bronchus, which then enters the left and right lung respectively. Once
inside the lungs, the bronchi divide into narrower tubes called bronchioles, while this
again branch into terminal bronchioles, the smallest respiratory tubes in human lungs.
This intricate structure in each lung is called the bronchial tree. Both bronchi and
bronchioles are encircled with hyaline cartilage rings to help them maintain their shape.
• Alveoli. Tiny air-filled sacs, alveoli are the primary functioning units of the lungs, the
actual site of gas exchange. A healthy person has 300 to 700 million alveoli (480 million
in average), meaning there are around 150 to 350 million alveoli in each lung.

The inner walls of the alveoli are lined with a thin layer of water and surfactant, known as the
pulmonary surfactant, a protein-lipid mixture secreted by type II alveolar cells/ It plays a crucial
role in reducing the surface tension of the alveoli to prevent them from collapsing during gas
exchange. This, in turn, helps the lungs to maintain their shape.
• Vasculature of the Lungs. Each lung has one pulmonary artery and two pulmonary veins.
The pulmonary artery carries deoxygenated blood to the lungs where it receives oxygen
and then is carried back into the heart by the pulmonary vein.
There are usually two bronchial arteries on the left and one on the right, to supply the lung roots,
visceral pleura, bronchi, and other supporting lung tissues with oxygen-rich blood. The bronchial
veins drain the bronchi and the structures in the hilum, as well as some other supporting
structures

The significant lung volumes/capacities:

• Inspiratory reserve volume (IRV): Volume that can be breathed after a normal inspiration
• Tidal volume (TV): Volume inspired and expired with each breath
• Expiratory reserve volume (ERV): Volume that can be expired after a normal breath
• Residual volume (RV): Volume remaining in lung after maximal expiration (cannot be
measured by spirometry)
• Inspiratory capacity (IC): Volume that can be breathed after normal exhalation
• Functional residual capacity (FRC): Volume remaining in the lungs after normal
expiration
• Vital capacity (VC): Maximum volume able to be expired after maximal inspiration •
Total lung capacity (TLC): Volume of air in the lungs after maximal inspiration
• Forced expiratory volume (FEV1): Volume that can be expired in 1 second of maximum
forced expiration.
 PATHOPHYSIOLOGY

MODIFIABLE:
Environmental Factors NON- MODIFIABLE:
Age
(Direct or Indirect contact to host)
Life Style Gender
Genes
 Respiratory droplet production (cough,
sneeze, talking, breathing) by human host
or animal vector infected with SARS CoV 2
exposure.

Virus enters the airway (Mucus

membrane contact through eyes, nose
and mouth) then attaches to the alveoli

Virus adheres to ACE-2 receptors on body

cells, mimics ACE-2, and gains access into
cell.

Replicated virus travels to other cells, Activation of Immune

killing host cells contributing to Defense
disease symptoms
⬆️Inflammatory Cytokines, inducing
Alveolar/ Capillary damage hypothalamus to release
CXR: Bilateral ground prostaglandins
glass opacities and Fluid accumulation in
interstitial infiltrates interstitium and alveoli ⬆️Body temperature (Fever) as
immune system fights infection
Poor tissue perfussion
(⬇️exchange of CO2 and O2 ) Body Malaise

SOB/DYSPNEA Hypoxemia
Neutrophils moves to lungs
Compensatory mechanisms of and releases reactive oxygen
organs species and cytokines

⬆️cardiac output Airway Irritation :

⬆️respiratory rate Cough