IR AT OR Y

THE RESP
SYSTEM
MUNGCAL, DHARLY
NETTE
RTRP
Introduction

 Overview of the normal lung

structure
 The bony thorax and chest wall
 Respiratory muscles
 Airway
 Alveolar- Capillary Exchange Units
 RESPIRATORY
SYSTEM
 Functional division of
Respiratory system

 Conducting
Zone

 Respiratory
Zone
Conducting airways
 Allows air in and out of the
gas exchange structure of
the lung
 Anatomical deadspace
 Nose to terminal
bronchioles
  Surrounds the nostrils and one third of
the nasal cavity.
 The narrowest part of the entire airway is
the nasal valve (internal ostium) located
1.5 from the nares.
 Nasal septum divides the nasal cavity
whose lateral wall has bony projections
Nose on each side forming the superior, medial
and inferior turbinates or conchae which
creates turbulence as air passes through
the nose.
 The nostrils are covered by skin; inside
the anterior one third of the nasal cavity is
covered by a squamous and transitional
epithelium overlying a rich capillary
complex.
 Mucosa – the epithelium is composed of four major
cell types. The dominating cell type is the ciliated cell.

 Cilia – found behind the front edge of inferior turbinate,

the posterior part of nasal cavity and lining of
paranasal sinuses.
 These cells move in repetitive
patterns and assist in propelling
debris and secretions toward the
larynx where they can be
expectorated.
 Goblet cells are the secretory cells interspersed among the
pseudostratified columnar epithelium.
 The concentration of the Goblet cells is similar in
the nose to that found in the trachea and main
bronchi.
 Secretes fluid than do the submucosal glands.
 Not innervated by the parasympathetic nervous
system.
 Full goblet cells are associated with the
fragmentation of the normally tight junctions, which
may affect the absorption of aerosolized drugs.
 Produce a small amount of mucus and are
associated with plasma exudation during
inflammation.
 Submucosal glands – there are two types;
the anterior serous and seromucous.
 They play a role in watery
rhinorrhea.
 Have a larger secretory capacity.
 Most nasal secretions comes from
the nasal glands than the goblet
cells.
 Mucociliary escalator
 Secretions form the submucosal glands cover the ciliated
epithelium of the airway.
 These relatively thin secretions form the watery sol layer,
through which the cilia normally beat.
 As water evaporates from the sol layer and more viscous
secretions are secreted by the goblet cells, the thicker the gel
layer forms.
 This thicker gel layer floats on a layer of thin secretions that
continue to be secreted from the glands, replenishing the sol
layer.
 This gel layer traps and holds dust pollen, contaminants and
microorganisms.
 The cilia beat in a coordinated, wave like motion through the
sol layer, with the tips of the cilia to the gel layer, propelling it
towards the pharynx, where it is swallowed or expectorated.
The normal respiratory mucosa is 100ml/day, which is
commonly expelled from the respiratory tract and
swallowed, often without notice.
• THE MORE PROXIMALLY THAT INHALED PARTICLES ARE
DEPOSITONED, THE MORE QUICKLY THEY ARE REMOVED. THE
DEEPER THAT PARTICLES ARE DEPOSITED, THE LONGER IS
THE TIME REQUIRED FOR THE LUNGS TO CLEAR THE
PARTICLE.

SITE OF DEPOSITION TIME OF REMOVAL

NOSE <30 MINS

BRONCHI HOURS

ALVEOLI DAYS TO WEEKS

 FUNCTION OF THE NOSE
 A slit-like shape of nasal cavity that provides close contact
between inhaled gas and the mucosa.

 The mucous glands and goblet cells have a high secretory

capacity to provide water to the air.

 Rich vascular beds in the submucosa, with atriovenous

anastomoses, supply a large volume of blood to heat the air.

 Sinusoid contractions provide changes in passage width in

response to system needs.
  Is a fibromuscular, funnel-shaped
cavity about 5 inches long
extending from the base of the
skull to the esophagus.
PHARYNX
 Divided into three:
 Nasopharynx
 Oropharynx
 Laryngopharynx
or hypopharynx
 NASOPHARYNX
 Lies behind the nasal cavities with its
roof formed by bones and skull and
above the soft palate, which divides it
from the other parts of the pharynx
during swallowing.
 The Eustachian tubes opens into the
nasopharynx, connecting the tympanic
cavities to the atmosphere, equalizing
pressure into the eardrums.
 OROPHARYNX
 Lies behind the mouth below the soft
palate, extending back to the larynx.
 The tonsils are the lymphatic tissue on
the lateral walls of the oropharynx that
act as part of circular band of lymphoid
tissue and as a filter to protect the
respiratory tract against infection.
 LARYNGOPHARYNX
 Lies below the hyoid bone and behind the
larynx.
 The larynx connects the pharynx and
trachea.
 Its opening is at the base of the tongue.
 It is broad superiorly and shaped like a
triangular box.
 “PHONATION”
  Consist of 9 large cartilages connected with
intrinsic and extrinsic muscles and
ligaments.
 Its shape is maintained by the thyroid
cartilage and cricoid cartilage.
 Thyroid cartilage – Adam’s apple, is the
largest structure of larynx.
 Cricoid cartilage –forms a complete ring of
LARYNX cartilage
 Epiglottis – attached to the superior border
of the thyroid cartilage and acts as a hinged
lid to protect the airway from aspiration
during swallowing.
 Arytenoid, cuneiform and corniculate
cartilages are paired cartilage.
 Forms two pairs of folds:
 True vocal cords
 False vocal cords

 Both are involved in coughing and sneezing.

 The larynx is key in three ways:
 The epiglottitis and larynx interact to
protect the airway during swallowing.
 The vocal cords are key to an effective
cough.
 The larynx responds to foreign matter
in the airway with laryngospasm to
keep inhaled matter from going further
into the airway.
  Two main bronchi
 Left Bronchus – longer
than the right, coming off
at a greater angle
 Right main bronchus –
shorter, wider and more
Branching of in line with the trachea.

the airways
 The main bronchi divides into the lobar and segmental
brochi.
 Each airway branches into two or more airways, with a
smaller individual internal diameter than the parent
airway.
 Large bronchi are lined with psuedostratified columnar
epithelium with a large number or mucous glands.
 Irritant receptor in these airways can generate cough
reflex with vagal stimulation resulting in bronchospasm
and mucous secretions.
 There are 10 divisions if bronchi from the trachea, each
with cartilage in its wall.
 In the main bronchi, the cartilage is less ring shaped
and more irregular than that in the trachea.
 Each subsequent generation of bronchi contains less
cartilage.
 These branches into small airways without cartilage
called bronchioles.
 The epithelial lining in the airways changes from the larger
central to smaller distal airways.
 As the airways gets smaller, the columnar cells becomes
shorter, with fewer basal cells, goblet cells and mucous
glands.
 By terminal bronchioles, there are no goblet cells or glands
and fewer cilia.
 Clara cells are scattered between the ciliated cells and are
though to contribute to the surface lining layer of bronchioles
(like the alveolar type II cells)
  Lungs are divided into five
lobes
 Each lobe is set by its own
lobar bronchus.
 Each lobe is further divided
into the bronchopulmonary
Lung structural segment which are the
smallest anatomic units
unit capable of being removed from
the lung intact.
 Bronchopulmonary segments-
contains lobules that are about
1cm in diameter.
 Lobules are generally pyramidal In shape.
 Each lobule contains of five acini.
 Acinus is the area of the lung parenchyma that is fed by a
single respiratory bronchiole. It is composed of alveolar
ducts, alveolar sacs, alveoli and alveoli pores.
 The difference between terminal and respiratory bronchioles
is the presence of individual alveoli bidding out from the walls
of the airways.
 Pores of Kohn and Canals of Lambert connects the alveoli
both within and across the terminal respiratory units.
 Pores of Kohn are holes in the alveolar walls that provide
channels for gas movement between contigous alveoli.
 Canals of Lambert – connect alveoli supplied by different
terminal airways.
 These passageways allow for Collateral ventilation
between alveoli that are feb from the same and different
bronchioles.
 Alveoli are composed of several distinct type of cells
 Type I pneumocytes is a squamous epithelial cell with a thin
cell wall and relatively large surface area that forms 95% of
the alveolar surface and is the primary conducting interface
for gas transport.

 Type II pneumocytes are granulated cuboidal cells, rich in

microvilli. They are more numerous than the type I cells but
constitute only 5% of alveolar surface. Production source of
surfactant.

 Type III pneumocytes are the alveolar macrophages, which

provide the primary protection of the alveoli against pollutants,
particulates and bacteria.
 Macrophage are the primary phagocytes of the alveoli. These
cells phagocytes bacteria and particulates.

 Macrophage with large amounts of foreign particles are

frequently found in lung lymph nodes, where they remain
permanently.
  Gas exchange between alveolar
gas and pulmonary capillaries
occurs in the A/C membrane.

 It is composed of many different

layers through which O2 and CO2
diffuse.

Alveolar-  They outermost layer is very thin

film of fluid composed primarily of
capillary surfactant that forms into tubular
myelin matrix.

exchange unit  Each sides are not equal in

thickness and chemical content.
 THE
BONY
THORA
X Ref X-Ray
 Thoracic cage
 Sternum, ribs and thoracic
vertebrae make up the bony
thorax.
 It forms a protective, cone-shaped
cage of slender bones around the
organs of thoracic cavity.

Ref X-Ray
 Sternum
 “breastbone”
 Is a typical flat bone and the result of the fusion of three bones- the
manubrium, body and xiphoid process.
 It is attached to the seven pairs of ribs.
 The sternum has 3 important bony landmarks:
 Jugular notch (concave upper border of manubrium),
can be palpated easily, generally it is at the level of 3 rd
thoracic vertebra.
 Sternal angle is the results where the manubrium and the
body meet at a slight angle to each other, so a transverse
ridge is formed at the level of the the second ribs.
 Xiphisternal joint , the joint where the sternal body
and xiphoid process fuse, lies at the level of ninth
thoracic vertebra.

Ref X-Ray
 Ribs
 Twelve pairs of ribs from the walls of the bony thorax.
 True ribs – first seven pairs, attached directly to the
sternum and costal cartilage.
 False ribs – the next five pairs, either attach
indirectly to the sternum or are not attached to the
sternum at all.
 Floating ribs – lack the sternal attachments.
 Intercoastal spaces – spaces between ribs, are filled with the
intercoastal muscles that aid in breathing.

Ref X-Ray
  Changes in thoracic cavity dimension
during breathing are the product of
tension developed by various skeletal
muscles.

 Diaphragm and Intercoastal muscles

RESPIRATOR  Primarily muscles of ventilation.

Y MUSCLES  They are active both while at

rest and when the individual
exhibits stress-induces
increases in breathing.
 Diaphragm
 Is a thin, musculotendinous, dome-shaped structure that
separates the thoracic and abdominal cavities.
 It orginates form the chest and abdominal wall and converges
in a central tendon at the top of its dome.
 The posterior portion arises from the first three lumbar
vertebrae.
 Highest point the dome of the right hemidiaphragm reaches
in a healthy individual is in the 8th ribs
 The lateral coastal portions arise from
the inner surface ribs 7 through 12 and
transverse abdominal muscles on
each side.
 During quiet breathing, the diaphragm
is responsible approximately 75% of
the change in thoracic volume.
 During maximal inspiration, the
diaphragm is pulled approximately
10cm.
 Exhalation results when diaphragmatic
tension decreased and diaphragm
returns to its relaxed position
 The diaphragm is pulled down 1 to 2 cm
during tidal breathing
 Functionally, the diaphragm is divided into left and right
hemidiaphragm.
 Each hemidiaphragm is innervated by a phrenic nerve
that arises from branches of spinal nerves C3, C4 and
C5.
 Although the diaphragm is the primary ventilatory
muscle, it is not essential for survival.
 The costrophrenic angle is the acute angle formed by
the costal pleura joining the diaphragmatic pleura
  Overview of the Normal
Circulatory System
 Blood
 The heart
 Pulmonary and systemic
CIRCULATOR vascular system
 Distribution of pulmonary
Y SYSTEM blood flow
 BLOOD
 It is the only fluid tissue in the body.
 Erythrocytes, Leukocytes and platelets
 Hematocrit - blood fraction
 Plasma
 90% water
 Liquid part of the blood
 Over 100 different substances are dissolves (nutrients,
respiratory gases,hormones, etc)
 Erythrocytes
 Red blood cells
 Carries oxygen in blood to all cells of the body.
 “bags of hemoglobin”
 Hemoglobin – an iron bearing that transports bulk of
oxygen that is carried in the blood.
 Polycythemia
 Abnormal increase in erythrocyte
 leukocytes
 White blood cells
 Far less numerous than RBC
 Body defense against disease
 Forms a protective, moveable army that help defend
the body against damage by bacteria, viruses and
parasites.
 Lykocytosis high WBC
 Leukopenia low level of WBC
 Neutrophils – most numerous number of WBC. Avid
phagocytes at sites of acute infection and are
particularly partial to bacteria and fungi.

 Eosinophils - allergies, infections by parasitic worms

ingested in food or entering via skin.

 Basophils – rarest, histamine-containing granules.

 Lymphocytes – immune response

 Monocytes – they change into macrophages when they

migrate into tissues, chronic infections such as
tuberculosis.
 Platelets
 Blood clotting
 Clinging the torn area
 Help control blood loss from broken blood vessels.
 The heart
 A hollow, four-chambered muscular organ.

 Size of a fist

 Positioned obliquely in the middle of

compartment of mediastinum of the chest
behind sternum.

 Pumps blood throughout the body via

circulatory system
 Approximately, two thirds of the heart lies on
the left of midline of the sternum between the
second through 6th ribs.

 Apex of the heart is formed by the LV and lies

above the diaphragm at the level of 5th
intercoastal space.

 Base of the heart is formed by the atria. Lying

below the 2nd ribs.
 Four chambers
Two upper chambers
 the atria

Two lower chambers

 the ventricles
 A wall muscle called the septum seperates
the two sides of the heart.
 Pericardium
 A double walled sac enclosing the heart.
 The heart consist of three layers of pericardium.

 The outermost wall is the epicardium

 The middle layer, myocardium, contains the
muscle that contracts.
 The inner layer, endocardium is the lining that
contacts the blood.
 The tricuspid valve and the mitral valve make up
the atrioventricular (AV) valves.

 Connects the atria and ventricles.

 Prevents backflow
 The pulmonary semi-lunar valve separates the
RV from the pulmonary artery.
The heart circulates blood through
two pathways:

 Pulmonary circuit

 Systemic circuit
 Pulmonary circuit
 Deoxygenated blood
leaves the RV via pul.
artery and travels to the
lungs, then returns as
oxygenated blood to the
LA via pul. vein
 Systemic circuit
 Oxygenated blood leaves
the body via LV to the
aorta, and from there
enters the arteries and
capillaries where it
supplies the body's
tissue.
 An adult heart beats about 60 to 100 times per
minute.

 Newborns hearts beats faster that adults.

 6 quarts (5.7L) of blood

LUNG FUNCTION

 Normal Lung Function

 Ventilation
 Diffusion Capacity
 Lung Circulation
 Gas transport and Acid base
status of the Lung
 V/Q relationships
 Lung compliance
VENTILATION
PRESSURE DIFFERENCE BETWEEN THE
LUNGS
The difference between pressures of lungs and
atmospheric pressure is called the pressure gradient

The pressure gradient is responsible for the following:

Moving of air in and out of the lungs
Maintaining the lungs in an inflated state
 Deadspace Ventilation
 Wasted ventilation
 Three types:
 Anatomic deadspace – conducting airways
 Alveolar deadspace – contributer to wasted
ventilation, it occurs when the ventilated
alveoli are not adequately performed
perfused by pulmonary circulation
 Physiologic deadspace – is the sum of
anatomic and alveolar deadspace. In normal
ventilation, physiologic deadspace
approximates the anatomic deadspace.
 LUNG COMPLIANCE
 How readily the elastic force of the lungs to accept a
volume of inspired air.

 It is defined as volume change (lung expansion) per

unit of change (work of breathing) in the pressure
difference across the structure.

 Abnormally high or low compliance impairs the

patient’s ability to maintain efficient gas exchange. Low
compliance typically makes lung expansion difficult.

 High compliance induces incomplete exhalation, air

trapping and reduced CO2 elimination.
AIRWAY RESISTANCE
 DIFFUSION CAPACITY
 Movement of gas from higher concetration to lower
concentration.

 Gas movement between lungs and tissues.

 For O2 there is a stepwise downward “cascade” of

partial pressures from the normal atmospheric
pressures.

 The diffusion gradient for CO2 is the opposite of the

diffusion gradient for O2.
GAS TRANSPORT
 Gas transport and acid base status
 O2 travels from the alveolar space to pulmonary capillaries.

 CO2 moves from the pulmonary blood space to alveolar air

spaces.

 At the tissue level, the direction of gas movement is reversed.

Factors affecting gas diffusion
 Gas phase
 is the diffusion of gas through gas.
Diffusion of gas is affected by low
molecular weight of gas and by the
relatively short diffusion path from the
point of transition from the tidal to
diffusive ventilation, occurring at the
level of terminal bronchiole.
 Membrane phase
 Diffusion of gas through alveolar
epithelium and capillary
endothelium membrane.
 Aqueous phase
 Interstitial fluid, plasma and
erythrocyte.
 CO2 has a higher fluid solubility
than O2.
 Larger volume of CO2 can diffuse
through fluid with a lower pressure
gradient.
 CO2 also has a fast reaction with
hemoglobin, allows larger volumes
of gas to load and unload at both
lung and tissue level.
 HYPOXIA
HYPOXIA VS HYPOXEMIA
VENTILATION/ PERFUSION RELATIONSHIP
 Deadspace is waste ventilation:
 V>Q = V/Q>1

 Shunt is waste perfusion

 Q>V = V/Q <1

 Silent unit is no V and Q

 In case of dead space, ventilation exceeds perfusion,
and the level of CO2 in the airway is decreased. The
decreased level of CO2 increases smooth muscle
response, causing bronchoconstriction, reducing the
airway caliber and regional ventilation.

 With shunt, the lack of ventilation result in alveolar

hypoxia, stimulating pulmonary vasoconstriction and
reducing perfusion.