ANATOMY

AND
PHYSIOLOGY
MODULE 18
(Respiratory System - I)

Prepared by:

MARICEL L. DATOY, RN, MAN, LPT

Instructor
Maricel L. Datoy, RN, MAN, LPT
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Introduction
Cells require oxygen to break down nutrients to release energy and produce ATP, and
must excrete the carbon dioxide that results. Obtaining oxygen and removing carbon dioxide
are the primary functions of the respiratory system.
The entire process of gas exchange between the atmosphere and cells is called
respiration. The events of respiration include: (1) movement of air into and out of the lungs—
commonly called breathing or ventilation; (2) gas exchange between the blood and the air in the
lungs (external respiration); (3) gas transport in blood between the lungs and body cells; and (4)
gas exchange between the blood and the cells (internal respiration). The process of oxygen
utilization and carbon dioxide production at the cellular level is called cellular respiration.
Your body’s cells continually use oxygen (O2) for the metabolic reactions that release
energy from nutrient molecules and produce ATP. At the same time, these reactions release
carbon dioxide (CO2). Because an excessive amount of CO2 produces acidity that can be toxic
to cells, excess CO2 must be eliminated quickly and efficiently.
The cardiovascular and respiratory systems cooperate to supply O2 and eliminate CO2.
The respiratory system provides for gas exchange—intake of O2 and elimination of CO2—and
the cardiovascular system transports blood containing the gases between the lungs and body
cells.

Objectives
At the end of the lesson, the students should be able to:
1. Discuss the functional anatomy of the respiratory system
2. Understand the function of the respiratory passages
3. Describe the physiologic anatomy of respiratory
4. Discus the pressure and blood flow distribution in lungs
5. Discuss the pulmonary capillary dynamics

Definition of Terms
o Respiration, the entire process of gas exchange between the atmosphere and cells
o Pulmonary Ventilation, tide like movement of air into and out of the lungs
o Cellular respiration, process of oxygen utilization and carbon dioxide production at the
cellular level
o Ventilation is the rate at which gas enters or leaves the lung.
o Nasal Cavity, a hollow space behind the nose
o Nasal cavity is a hollow space behind the nose.
o Pharynx, or throat, helps produce the sounds of speech.
o Larynx conducts air in and out of the trachea, also houses the vocal cords.
o The trachea or windpipe is a tubular passageway for air.

Maricel L. Datoy, RN, MAN, LPT

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Discussion:

Unit 18
Respiratory System

The respiratory system consists of the nose, pharynx (throat), larynx (voice box),
trachea (windpipe), bronchi, and lungs. Its parts can be classified according to either structure or
function. Structurally, the respiratory system consists of two parts: (1) the upper respiratory
system includes the nose, pharynx, and associated structures. (2) The lower respiratory system
includes the larynx, trachea, bronchi, and lungs. Functionally, the respiratory system also
consists of two parts.
The conducting zone consists of a series of interconnecting cavities and tubes both
outside and within the lungs. These include the nose, pharynx, larynx, trachea, bronchi,
bronchioles, and terminal bronchioles; their function is to filter, warm, and moisten air and
conduct it into the lungs.
The respiratory zone consists of tissues within the lungs where gas exchange occurs.
These include the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli; they are the
main sites of gas exchange between air and blood.

FUNCTIONS OF RESPIRATORY SYSTEM:

1. Provides for gas exchange—intake of O2 for delivery to body cells and elimination of
CO2 produced by body cells.
2. Helps regulate blood pH
3. Contains receptors for the sense of smell, filters inspired air, produces vocal sounds
(phonation), and excretes small amounts of water and heat.

Figure 18.1: Organs and

associated structures of the
respiratory system (Upper
and Lower Respiratory
Tract) The upper
respiratory system includes
the nose, pharynx, and
associated structures; the
lower respiratory system
includes the larynx, trachea,
bronchi, and lungs.

Maricel L. Datoy, RN, MAN, LPT

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 A. Nose
 Bone and cartilage support the nose internally.
 Its two nostrils are openings through which air can enter and leave the nasal cavity.
Many internal hairs guard the nostrils, preventing entry of large particles carried in the
air.

B. Nasal Cavity
 The nasal cavity is a hollow space behind
the nose
 It also includes an extensive network of
blood vessels.
 As air passes over the mucous membrane,
heat leaves the blood and warms the air,
adjusting the air’s temperature to that of
the body.
 Incoming air is moistened as water
evaporates from the mucous lining.
 The sticky mucus that the mucous
membrane secretes entraps dust and other
small particles entering with the air.
 The nasal septum, composed of bone and
cartilage, divides the nasal cavity into
right and left parts.
Maricel L. Datoy, RN, MAN, LPT
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 C. Paranasal Sinuses
 Are air-filled spaces within the frontal, ethmoid, sphenoid, and maxillary bones of the
skull and opening into the nasal cavity.
 Mucous membranes line the sinuses and are continuous with the lining of the nasal
cavity.
 The paranasal sinuses reduce the weight of the skull and are resonant chambers that affect
the quality of the voice.

A painful sinus headache can result from blocked drainage caused by an infection
or allergic reaction.

D. Pharynx
 The pharynx, or throat, is behind the oral cavity, the nasal cavity, and the larynx for food
moving from the oral cavity to the esophagus
 Air passing between the nasal cavity and the larynx. The pharynx also helps produce the
sounds of speech.
E. Larynx
 Is an enlargement in the airway at the top of the trachea and below the pharynx
 It conducts air in and out of the trachea and prevents foreign objects from entering the
trachea.
 It also houses the vocal cords.
 The larynx is composed of a framework of muscles and cartilages bound by elastic tissue.
 The largest of the cartilages are the thyroid (“Adam’s apple”), cricoid, and epiglottic
cartilages.
 The upper folds are called false vocal cords because they do not produce sounds
 Air forced between the vocal cords causes them to vibrate from side to side, which
generates sound waves. Changing the shapes of the pharynx and oral cavity and using the
tongue and lips transform these sound waves into words.

Figure: Larynx. (a)

Anterior (b) posterior
views of the larynx

Maricel L. Datoy, RN, MAN, LPT

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 Figure: The vocal
cords as viewed
from above with
the glottis (a)
closed and (b)
open. (c)
Photograph of the
glottis and vocal
folds.

F. Trachea
 The trachea or windpipe, is a flexible cylindrical tube about 2.5 cm in diameter and 12.5
centimeters in length
 It extends downward anterior to the esophagus and into the thoracic cavity, where it splits
into right and left bronchi.
 The open ends of these incomplete rings are directed posteriorly, and smooth muscle and
connective tissues fill the gaps between the ends. These cartilaginous rings prevent the
trachea from collapsing and blocking the airway.

G. Bronchial Tree
 consists of branched airways leading from the trachea to the microscopic air sacs in the
lungs
 These ducts lead to thin-walled out pouchings called alveolar sacs. Alveolar sacs lead to
smaller microscopic air sacs called alveoli which lie within capillary networks. This
muscular layer persists even in the smallest bronchioles, but only a few muscle fibers are
in the alveolar ducts.
 The branches of the bronchial tree are air passages whose mucous membranes filter
incoming air and distribute the air to alveoli throughout the lungs.

Combined, two adult lungs have about 300 million alveoli, providing a total
surface area nearly half the size of

SAQ#2: What is the function of the cartilaginous rings in the tracheal wall? (5
points)

Maricel L. Datoy, RN, MAN, LPT

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Table 18.1: SUMMARY OF THE RESPIRATORY SYSTEM

Part Description Function

Nose Part of face centered above Nostrils provide entrance to nasal cavity;
mouth, in and below space internal hairs begin to filter incoming air
between eyes
Nasal Cavity Hollow space behind nose Conducts air to pharynx; mucous lining
filters, warms, and moistens incoming air
Paranasal Hollow spaces in certain skull Reduce weight of skull; serve as resonant
Sinuses bones chambers
Pharynx Chamber behind nasal cavity, Passageway for air moving from nasal cavity
oral cavity, and larynx to larynx and for food moving from oral
cavity to esophagus
Larynx Enlargement at top of trachea Passageway for air; prevents foreign objects
from entering trachea; houses vocal cords
Trachea Flexible tube that connects Passageway for air; mucous lining continues
larynx with bronchial tree to filter particles from incoming air
Bronchial Branched tubes that lead from Conducts air from trachea to alveoli; mucous
tree trachea to alveoli lining continues to filter incoming air
Lungs Soft, cone-shaped organs that Contain air passages, alveoli, blood vessels,
occupy a large portion of the connective tissues, lymphatic vessels, and
thoracic cavity nerves of the lower respiratory tract

Mechanics of Pulmonary Ventilation:

Pulmonary ventilation is commonly referred to as breathing. It is the process of air

flowing into the lungs during inspiration (inhalation) and out of the lungs
during expiration (exhalation). Air flows because of pressure differences between the atmosphere
and the gases inside the lungs.
The air moves through the passages because of pressure gradients that are produced
by contraction of the diaphragm and thoracic muscles.
Pulmonary ventilation involves three different pressures:
 Atmospheric pressure
 Intraalveolar (intrapulmonary) pressure
 Intrapleural pressure

Atmospheric pressure is the pressure of the air outside the body. Intraalveolar pressure is
the pressure inside the alveoli of the lungs. Intrapleural pressure is the pressure within the
pleural cavity. These three pressures are responsible for pulmonary ventilation.

 Inspiration
Inspiration (inhalation) is the process of taking air into the lungs. It is the active phase of
ventilation because it is the result of muscle contraction. Inspiration draws air into the lungs.

Maricel L. Datoy, RN, MAN, LPT

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Figure: Summary of events of in Inhalation

 Expiration
Expiration (exhalation) is the process of letting air out of the lungs during the
breathing cycle. Expiration pushes air out of the lungs.

Figure: Summary of events of in exhalation

Muscles That Cause Lung Expansion and Contraction

The lungs can be expanded and contracted in two ways:

1. By downward and upward movement of the diaphragm to lengthen or shorten the chest
cavity, and
2. Elevation and depression of the ribs to increase and decrease the antero-posterior
diameter of the chest cavity

Maricel L. Datoy, RN, MAN, LPT

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Figure: Contraction and
expansion of the thoracic
cage during expiration and
inspiration, demonstrating
diaphragmatic contraction,
function of the intercostal
muscles, and elevation
and depression of the rib
cage.

Respiratory Volumes and Capacities

 A breath is one complete respiratory cycle that consists of one inspiration and
one’s expiration.
 Under normal conditions, the average adult takes 12 to 15 breaths a minute.
 With each inhalation and exhalation moving about 500 mL of air into and out of the lungs.
 The volume of one breath is called the tidal volume (VT).
 The minute ventilation (MV )—the total volume of air inhaled and exhaled each minute—
is respiratory rate multiplied by tidal volume:
 MV =12 breaths/min X 500 mL/breath MV= 6 L/min
 total lung capacity is the sum of vital capacity and residual volume (4800 mL _ 1200 mL _
6000 mL
 in males and 3100 mL _ 1100 mL _ 4200 mL in females
 Vital capacity is the sum of inspiratory reserve volume, tidal volume, and expiratory
reserve volume (4800 mL in males and 3100 mL in females)
 An instrument called a spirometer is used to measure the volume of air that moves into
and out of the lungs
 Process of taking the measurements of the volume of air is called Spirometry
 Lower-than-normal minute ventilation usually is a sign of pulmonary malfunction.
 Lungs usually reach their maximum in capacity in early adulthood and decline with age
after that.

SAQ#3: What is the difference between a lung volume and a lung capacity?
(5 points)

Maricel L. Datoy, RN, MAN, LPT

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PLEURAL PRESSURE AND ITS CHANGES DURING RESPIRATION:

Pleural pressure is the pressure of the fluid in the thin space between the lung pleura and the
chest wall pleura.

 This is normally a slight suction, which means a slightly negative pressure.

 The normal pleural pressure at the beginning of inspiration is about −5 cm of water,
which is the amount of suction required to hold the lungs open to their resting level.
 During normal inspiration, expansion of the chest cage pulls outward on the lungs with
greater force and creates more negative pressure, to an average of about −7.5 cm of
water

Alveolar Pressure is the pressure of the air inside the lung alveoli.

 When the glottis is open and no air is flowing into or out of the lungs,
 The pressures in all parts of the respiratory tree, all the way to the alveoli, are equal to
atmospheric pressure, which is considered to be zero reference pressure in the airways—
that is, 0 cm water pressure.
 The second curve (labeled “alveolar pressure”) demonstrates that during normal
inspiration, alveolar pressure decreases to about −1 cm of water.
 This slight negative pressure is enough to pull 0.5 L of air into the lungs in the 2 seconds
required for normal quiet inspiration.

Trans-pulmonary Pressure
 This difference between the alveolar pressure and the pleural pressure.
 It is the pressure difference between that in the alveoli and that on the outer surfaces of
the lungs,
 It is a measure of the elastic forces in the lungs that tend to collapse the lungs at each
instant of respiration, called the recoil pressure.

Figure Changes in
lung volume,
alveolar pressure,
pleural pressure,
and Trans
pulmonary
pressure during
normal breathing.

Pulmonary Circulation

Maricel L. Datoy, RN, MAN, LPT

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The lung has two circulations:
1. A high-pressure, low-flow circulation supplies systemic arterial blood to the trachea, the
bronchial tree including the terminal bronchioles, the supporting tissues of the lung, and
the outer coats (adventia) of the pulmonary arteries and veins. T
2. A low-pressure, high-flow circulation that supplies venous blood from all parts of the
body to the alveolar capillaries where oxygen is added and carbon dioxide is removed.

Physiologic Anatomy of the Pulmonary Circulatory System:

A. Pulmonary Vessels
 The pulmonary artery extends only 5 cm beyond the apex of the right ventricle and
then divides into right and left main branches that supply blood to the two
respective lungs.
 The pulmonary artery is thin, with a wall thickness one third that of the aorta.
B. Bronchial Vessels
 Blood also flows to the lungs through small bronchial arteries that originate from
the systemic circulation, amounting to about 1 to 2 percent of the total cardiac
output.
 It supplies the supporting tissues of the lungs, including the connective tissue,
septa, and large and small bronchi.
C. Lymphatics
 Lymph vessels are present in all the supportive tissues of the lung, beginning in
the connective tissue spaces that surround the terminal bronchioles, coursing to
the hilum of the lung, and then mainly into the right thoracic lymph duct.

Pressures in the Pulmonary System:

Pressure Pulse Curve in the Right Ventricle

 The pressure pulse curves of the right ventricle and pulmonary artery are shown
in the lower portion (see figure)These curves are contrasted with the much higher
aortic pressure curve shown in the upper portion of the figure.
 The systolic pressure in the right ventricle of the normal human being averages
about 25 mm Hg, and the diastolic pressure averages about 0 to 1 mm Hg, values
that are only one-fifth those for the left ventricle.

Figure 38: Pressure pulse contours

in the right ventricle, pulmonary
artery, and aorta

Maricel L. Datoy, RN, MAN, LPT

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 A. Pressures in the Pulmonary Artery
 During systole, the pressure in the pulmonary artery is essentially equal to the
pressure in the right ventricle, as also shown Figure.
 After the pulmonary valve closes at the end of systole, the ventricular pressure
falls precipitously, whereas the pulmonary arterial pressure falls more slowly as
blood flows through the capillaries of the lungs.
 As shown in Figure, the systolic pulmonary arterial pressure averages about 25
mm Hg in the normal human being, the diastolic pulmonary arterial pressure is
about 8 mm Hg, and the mean pulmonary arterial pressure is 15 mm Hg.

Figure: Pressures in the different

vessels of the lungs. D, diastolic;
M, mean; S, systolic; red curve,
arterial pulsations

Blood Volume of the Lungs:

 The blood volume of the lungs is about 450 milliliters,

 About 9 percent of the total blood volume of the entire circulatory system.
 Approximately 70 milliliters of this pulmonary blood volume is in the pulmonary
capillaries, and the remainder is divided about equally between the pulmonary arteries
and the veins.
I. The Lungs Serve as a Blood Reservoir
 Under various physiological and pathological conditions, the quantity of blood in the
lungs can vary from as little as one-half normal up to twice normal.
 Loss of blood from the systemic circulation by hemorrhage can be partly compensated
for by the automatic shift of blood from the lungs into the systemic vessels.

II. Cardiac Pathology May Shift Blood from the Systemic Circulation to the
Pulmonary Circulation
 Failure of the left side of the heart or increased resistance to blood flow through the
mitral valve as a result of mitral stenosis or mitral regurgitation causes blood to dam
up in the pulmonary circulation,

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  Increasing the pulmonary blood volume as much as 100 % and causing large
increases in the pulmonary vascular pressures.
 A shift of blood from one system to the other affects the pulmonary system greatly
but usually has only mild systemic circulatory effects.
Blood Flow through the Lungs and Its Distribution
 The blood flow through the lungs is essentially equal to the cardiac output.
 For adequate aeration of the blood to occur, it is important for the blood to be distributed
to those segments of the lungs where the alveoli are best oxygenated.
 This is achieved by the following mechanism

Decreased Alveolar Oxygen Reduces Local Alveolar Blood Flow and Regulates
Pulmonary Blood Flow Distribution:

When the concentration of oxygen in the air of the alveoli decreases below normal,
especially when it falls below 70 percent of normal (below 73 mm Hg Po2), the adjacent blood
vessels constrict, with the vascular resistance increasing more than fivefold at extremely low
oxygen levels.
This effect of low oxygen on pulmonary vascular resistance has an important function: to
distribute blood flow where it is most effective. That is, if some alveoli are poorly ventilated so
that their oxygen concentration becomes low, the local vessels constrict.
This causes the blood to flow through other areas of the lungs that are better aerated, thus
providing an automatic control system for distributing blood flow to the pulmonary areas in
proportion to their alveolar.

Effect of Hydrostatic Pressure Gradients in the Lungs on Regional

Pulmonary Blood Flow:
 Hydrostatic pressure— the blood pressure in the foot of a standing person can be as much
as 90 mm Hg greater than the pressure at the level of the heart.
 To help explain these differences, one often describes the lung as being divided into
three zones:

Zone 1: No blood flow during all portions of the cardiac cycle

o the local alveolar capillary pressure in that area of the lung never rises higher than the
alveolar air pressure during any part of the cardiac cycle

Figure: Blood flow at different levels in the lung of an upright person at rest and during exercise.
Note that when the person is at rest, the blood flow is very low at the top of the lungs; most of the
flow is through the bottom of the lung.

Maricel L. Datoy, RN, MAN, LPT

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 Zone 2: Intermittent blood flow
o only during the peaks of pulmonary arterial pressure because the systolic pressure is
then greater than the alveolar air pressure, but the diastolic pressure is less than the
alveolar air pressure
Zone 3: Continuous blood flow
o because the alveolar capillary pressure remains greater than alveolar air pressure
during the entire cardiac cycle
 Normally, the lungs have only zones 2 and 3 blood flow—zone 2 (intermittent flow) in
the apices and zone 3 (continuous flow) in all the lower areas.

Figure: Mechanics of blood flow in the three

blood flow zones of the lung: zone 1, no
flow—alveolar air pressure (PALV) is greater
than arterial pressure; zone 2, intermittent
flow—systolic arterial pressure rises higher
than alveolar air pressure, but diastolic
arterial pressure falls below alveolar air
pressure; and zone 3, continuous flow—
arterial pressure and pulmonary capillary
pressure (Ppc) remain greater than alveolar
air pressure at all times.

Pulmonary Capillary Dynamic:

Pulmonary Capillary Pressure
 No direct measurements of pulmonary capillary pressure have ever been made.
a. Length of Time Blood Stays in the Pulmonary Capillaries.
 From histological study of the total cross-sectional area of all the pulmonary capillaries, it
can be calculated that when the cardiac output is normal, blood passes through the
pulmonary capillaries in about 0.8 second.

Maricel L. Datoy, RN, MAN, LPT

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  When the cardiac output increases, this can shorten to as little as 0.3 second.
 The shortening would be much greater were it not for the fact that additional capillaries,
which normally are collapsed, open up to accommodate the increased blood flow.

SAQ# 4: What are the basic differences among pulmonary

ventilation, external respiration, and internal respiration? (15
p0ints)

Summary:

 Inhalation is initiated by the diaphragm and supported by the external intercostal muscles.
 When the diaphragm contracts, the ribcage expands and the contents of the abdomen are
moved downward, resulting in a larger thoracic volume and negative pressure (with
respect to atmospheric pressure) inside the chest.
 Exhalation is generally a passive process since the lungs has a natural elasticity; they
recoil from the stretch of inhalation and air flows back out until the pressures in the chest
and the atmosphere reach equilibrium.
 Gas exchange occurs at the alveoli, the tiny sacs that are the basic functional component
of the lungs.
 The alveoli are interwoven with capillaries that connect to the larger bloodstreams.

References:

1. Tortora, G.J. & Derrickson, B. (2009). Principles of anatomy and physiology (13th ed.).
Hoboken, NJ: John Wiley & Sons.
2. Guyton, A.C. & Hall, J.E. (2006). Textbook of medical physiology (11th ed.)
Philadelphia, PA: Elsevier Inc.
3. Scanlon, V. & Sanders, T. (2007). Essentials of anatomy and physiology (5th ed.).
Philadelphia, PA: F.A. Davis.

Maricel L. Datoy, RN, MAN, LPT

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