OXYGENATION DISORDERS: GAS EXCHANGE AND

RESPIRATORY FUNCTIONS

GLOSSARY
 apnea: temporary cessation of breathing
 bronchophony: abnormal increase in clarity of
transmitted voice sounds heard when auscultating the
lungs
 bronchoscopy: direct examination of the larynx,
trachea, and bronchi using an endoscope 
 cilia: short, fine hairs that provide a constant
whipping motion that serves to propel mucus and
foreign substances away from the lung toward the
larynx 
 crackles: soft, high-pitched, discontinuous popping
sounds during inspiration caused by delayed
reopening of the airways
OVERVIEW ANATOMY AND PHYSIOLOGY:
 dyspnea: subjective experience that describes RESPIRATORY SYSTEM
difficulty breathing; shortness of breath
 Composed of:
 egophony: abnormal change in tone of voice that is 1. The upper respiratory tract (known as the upper airway)
heard when auscultating the lungs 2. The lower respiratory tract (the lungs) 
 fremitus: vibrations of speech felt as tremors of the
chest wall during palpation Gas exchange involves:
 hemoptysis: expectoration of blood from the 1. delivering oxygen to the tissues through the bloodstream 
2. expelling waste gases, such as carbon dioxide, during
respiratory tract
expiration
 hypoxemia: decrease in arterial oxygen tension in the
blood Upper Respiratory Tract
 hypoxia: decrease in oxygen supply to the tissues and  P- paranasal sinuses
cells     pharynx
 obstructive sleep apnea: temporary absence of  L -  larynx 
breathing during sleep secondary to transient upper
airway obstruction
 A- adenoids

 orthopnea: shortness of breath when lying flat;  T- tonsils

   trachea
relieved by sitting or standing
 oxygen saturation: percentage of hemoglobin that is  Nose
bound to oxygen
FUNCTIONS OF UPPER AIRWAYS
 physiologic dead space: portion of the
tracheobronchial tree that does not participate in gas
 Transport of gases to the lower airways
exchange  Protection of the lower airways from foreign matter
 pulmonary diffusion: exchange of gas molecules  Warming, filtration and humidification of inspired air
(oxygen and carbon dioxide) from areas of high
concentration to areas of low concentration
 pulmonary perfusion: blood flow through the
pulmonary vasculature
 respiration: gas exchange between atmospheric air
and the blood and between the blood and cells of the
body
 rhonchi: low-pitched wheezing or snoring sound
associated with partial airway obstruction, heard on
chest auscultation
 stridor: harsh high-pitched sound heard on
inspiration, usually without need of a stethoscope,
secondary to upper airway obstruction 
 tachypnea: abnormally rapid respirations
 tidal volume: volume of air inspired and expired with
each breath during normal breathing
 ventilation: movement of air in and out of the airways
 wheezes: continuous musical sounds associated with
airway narrowing or partial obstruction
  
 A. Pharynx (Throat)
o tubelike structure that connects the nasal
NOSE and oral cavities to the larynx
 Passageway for air o 3 regions (nasal, oral and laryngeal)
 Filters impurities Nasopharynx – posterior to the
nose; above soft palate
 Humidifies and warms the air
Oropharynx – houses
 External Portion faucial/palatine tonsils
o Supported by nasal bones Laryngealpharynx- extends
o 1364 cartilage from hyoid bone to cricoid
o Nares (nostrils) cartilage
B. Tonsil and Adenoids (Pharyngeal Tonsils)
 Internal Portion o Located in the roof of the nasopharynx
o Hollow cavity o important links in the chain of lymph
o Left and right nasal cavities; nodes 
separated o guarding from invasion of organisms
 Nasal Cavity: divided into 3 passageways by LARYNX
projection of turbinate bones   a cartilaginous epithelium-lined organ that connects
o Mucus membrane surface of the nasal the pharynx
passages  major function of the larynx is vocalization
o Nasal mucosa that traps dust and
organisms
 it also protects the airway from foreign substances and
facilitates coughing
o Contact with sensitive nerves that detects
odors, provoke sneezing consists of the following:
 Epiglottis: a valve flap of cartilage that covers the
opening to the larynx during swallowing
 Glottis: the opening between the vocal cords in the
larynx
 Thyroid cartilage: the largest of the cartilage
structures; part of it forms the Adam’s apple
 Cricoid cartilage: the only complete cartilaginous
ring in the larynx (located below the thyroid cartilage)
 Arytenoid cartilages: used in vocal cord movement
with the thyroid cartilage
 Vocal cords: ligaments controlled by muscular
movements that produce sounds; located in the lumen
of the larynx

PARANASAL SINUSES
 include four pairs of bony cavities
 these air spaces are connected by a series of ducts that
drain into the nasal cavity
 frontal, ethmoid, sphenoid, and maxillary
 prominent function of the sinuses is to serve as a
resonating chamber in speech
 a common site of infection

Lower Respiratory Tract

 L- Lungs
 B- Bronchi and Bronchioles
 M- Mediastinum
 P- Pleura
 A - Alveoli
PHARYNX, TONSILS, and ADENOIDS

FUNCTIONS OF LOWER AIRWAYS
 Clearance Mechanism
o Lined with cilia and goblet cells;
microscopic hair-like projections which
have rapid, coordinated unidirectional
upward motion
o Cilia sweep out debris and excessive
mucous membrane from the lungs
  Immunologic responses
o Cell-mediated immunity in the alveoli
 Pulmonary Protection from Injury
o Respiratory Epithelium- Mucus and
surfactant production
o Mucociliary system- innate defense
mechanisms of the lungs (remove inhaled
insoluble particles)
LUNGS
 are paired elastic structures enclosed in the thoracic
cage
 an airtight chamber with distensible wall
 Each lung is divided into lobes
 Each lobe is further subdivided into two to five
segments
PLEURA
 Serous membrane that lined the lungs and wall of
thoracic cavity 
o visceral pleura covers the lungs
o parietal pleura lines the thoracic cavity,
lateral wall of the mediastinum,
diaphragm, and inner aspects of the ribs
!!! serve to lubricate the thorax and the lungs and permit smooth
motion of the lungs within the thoracic cavity during inspiration
and expiration
MEDIASTINUM
 in the middle of the thorax
 between the pleural sacs that contain the two lungs
 It extends from the sternum to the vertebral column
and contains all of the thoracic tissue outside the lungs
(heart, thymus, the aorta and vena cava, and
esophagus)
BRONCHI and BRONCHIOLES
A. Bronchi
 these structures facilitate effective postural drainage in
the patient 
 these bronchi are surrounded by connective tissue that
contains arteries, lymphatics, and nerves
B. Bronchioles
 Branches of segmental bronchi
 have no cartilage in their walls 
 Their patency depends entirely on the elastic recoil of
the surrounding smooth muscle and on the alveolar
pressure
 contain submucosal glands, which produce mucus that
covers the inside lining of the airways
C. Terminal Bronchioles
 Branch of bronchioles
 which do not have mucous glands or cilia
 become respiratory bronchioles, which are considered
to be the transitional passageways between the
conducting airways and the gas exchange airways
ALVEOLI
 300 million alveoli
 Oxygen and carbon dioxide exchange takes place in
the alveoli
 three types of alveolar cells. 
 Type I and type II cells make up the alveolar
epithelium
o Type I cells account for 95% of the
alveolar surface area and serve as a barrier
between the air and the alveolar surface;
o Type II cells account for 1370 only 5% of
this area but are responsible for producing
type I cells and surfactant. 
o Alveolar macrophages are phagocytic
cells that ingest foreign matter and, as a
result, provide an important defense
mechanism
RESPIRATORY MUSCLE
  diaphragm and the external intercostal muscles are
the primary muscles used in breathing
 They contract when the patient inhales and relax when
the patient exhales
 The respiratory center initiates each breath by sending
messages to the primary respiratory muscles over the
phrenic nerve
RESPIRATORY CENTERS
A. MEDULLA OBLONGATA
B.
RESPIRATORY CENTERS
 Involuntary respiration is controlled by the respiratory
centers of the upper brainstem
 contain central chemoreceptors that detect pH levels
in the blood 
 send signals to the respiratory centers of the brain to
adjust the ventilation rate to change acidity by
increasing or decreasing the removal of carbon
dioxide 
 there are also peripheral chemoreceptors in other
blood vessels that perform this function as well, which
include the aortic and carotid bodies.
 there are also peripheral chemoreceptors in other
blood vessels that perform this function as well, which
include the aortic and carotid bodies.
 Primary respiratory center
 main function is to send signals to the
muscles that control respiration to cause
breathing to occur
 it contains the central chemoreceptors
which are stimulated by high carbon
dioxide levels in the blood 
 HIGH carbon Dioxide level in the blood;
primary chemical stimulation for breathing
PONS 
  is to control the rate or speed of involuntary
respiration
 Two main functional regions:
1. Pneumotaxic Center
o responsible rhythmic quality of breathing
o primarily to limit inspiration to finely
control the respiratory rate
o It decreases Tidal Volume
2. Apneustic Center
o responsible for deep, prolonged
inspiration; stimulate inspiration
o sending signals to the inspiratory muscles
to contract
o it increases Tidal Volume
 FUNCTIONS OF THE RESPIRATORY SYSTEM 
 Oxygen/Carbon Dioxide Transport 
 Respiration (gaseous exchange)
 Ventilation (movement of gases in and out of the
lungs)
 Pulmonary Diffusion (exchange of gases from an
area of higher concentration to area of lower
concentration)
 Perfusion (availability and movement of blood for the
transport of gases, nutrients, and metabolic waste
C. Carotid and Aortic Bodies products)
 peripheral chemoreceptors in the carotid and aortic
bodies take up the work of breathing when central
chemoreceptors in the medulla oblongata are damaged
 it responds to consistently high carbon dioxide
levels in the blood
 it responds to Low oxygen concentration in the
blood
 it responds to high Blood Pressure
D. Muscles and Joints
 Proprioreceptors
o a sensory receptor which receives stimuli
from within the body, especially one that
responds to position and movement
 Exercise Increases respiratory rate