INTRODUCTION
OF
RESPIRATORY SYSTEM
Respiration and Respiratory system
Def: Respiration is a physiological process by
which the transport of O2 from atmosphere
to the body cell for oxidation of the ingested
food material and elimination Co2 and other
volatile metabolic end product from the cell
to the atmosphere.
Phase of respiration:
Inspiration: Active process which means in
take O2 or air into the lungs 2 sec.
Expiration: Passive process –output of air
from lungs to atmosphere 3 sec.
Types of Respiration:
External Respiration : Intake and removal of O 2 and Co2
from body is called external respiration.
It includes:
Pulmonary ventilation: Inflow and out flow of air between
alveoli and atmosphere. The respiratory organ of gas
exchange organ (The lungs and ventilator pump
respiratory muscles thorax).
The primary role of respiratory to maintain a constant
internal environment by O2 to tissues and execrating Co2.
The secondary role of respiratory system:
Acid base homeostasis.
Protecting body against inhaled particles (bacteria,
polles).
Filtering the blood that enters in to systemic
circulating.
Endocrine effect.
Diffusion of O2 Co2 between alveoli and blood.
Transport of O2 to the cell and Co2 from the cells to the
lungs.
Regulation of respiration.
Internal respiration: The utilization of O2 and production
of Co2 by cell and the gaseous exchange between the cells
and their fluid.
Respiratory rate: It is the total number of respiratory
per unit of time.
Average : Both Male and Female 12-18 breath/ minute
At birth – 14-60 b/ minute
1st year – 25-35 b/ minute
Rate of respiration is usually proportional to the level of
metabolism.
Functional anatomy : Two lungs
Division of respiratory tract:
Upper respiratory treat: From nose to the focal
fold. It consist of [vascular mucous membrane
with ciliated epithelium]
Nose
Nasopharynx
Oropharynx
Larynx upto vocal fold.
Lower respiratory tract:
It is lined with ciliated epithelium as far as T. Bronchioles.
Larynx below the vocal fold.
Trachea
Two bronchi
Bronchioles
Terminal Bronchioles
Respiratory Bronchioles
Alveolar duct
Atria
Air Sac
Alveoli
Respiratory tract: The organ which allow the entrance of air in to
the lungs and exchange of the blood in the air passage from nose
to the pulmonary alveoli.
Nose: Humidification and Filtration of inspridair collectively called
conditioning of air.
Humidification: Heat and moisten the air thus prevent
dehydration of epithelium of respiratory tract.
Filtration: Over 90% of particles grater than 10µm in diameter
are removed in the nostril or nasopharynx.
Protection: Nosal secretion contair many protective protect in the
form anibodies 1y$ 0.2yms
The trachea, Bronchi and bronchioles:
The trachea is 10-12 cm in length. It divides
in to right and left Bronchi. The right bronchi
is more vertical than left. The right and left
bronchus is decided in to sub request in lobar
segmental subsequent bronchi. There are 25
division in all between the trachea and
alveoli.
1st seven divisions the bronchi:
Well consist of cataloged and smooth muscle.
Epithelial lining with cillea, goblet cells.
Endocrine cell Kulchitsky or APUD
(Amine precusor and uptake decarboxylation
containing 5-hydroxytamine)
Next 16-18 division the bronchioles have:
No cartilage, muscular layer progressively
becomes thinner.
A single layer of collated cell but very few
goblet cell.
Granulated claret cell produce a surfactant
like substance.
Then bronchioles finally divide within
acinuses in to smaller respiratory bronchioles
that have alveoli arising from the surface.
The alveoli: There are 300 million alveoli in each
lung. Alveoli are the structural and functional unit
of lungs. Thus total surface area 40-80 m 2
The Epilhelial lining of –
Type I pheumoytes
Type II pheumocytes cell secretes surfactant
Alveolar machrophage – dust cell
APUD cell
Mast cell plasma cel, lymphocyte
The lungs : Two in number:
The lungs are spongy (elastic) structure dark brown in
color due to deposition carbon particles. The right lungs
have tree lobes and left has two. Each lobe is composed
of two tree bronchopulmonary segment. It is again
divided in to individual lobules 1cm in diameter alveoli.
Function of lungs:
Ventilate the blood demands of body (O2 consumption
CO2 excretion).
Respiratory function:
Gaseous transport (between aleveoli, blood and
tissue).
Excretion of volatile substance (acetone, NH3
alcohol, water vapor)
Tempe ration regulation: heat loss through
expiratory.
Maintenance of acid -base balance (done by
adjusting the amount of CO2 eliminate. Any change
ph causes alteration in the rate and depth of
breathing. [Link] of water balance.
The non respiratory function:
Surfactant production (prevent collapse lungs)
Conversion of angiotension-1 to angiotension-2 by and
angiotension converting enzymes.* Large amount ACE is
present on the surface of pulmonary capillary endothelium.
Fibrinolylic activity (Lysis of any blood in the pulmonary
circulation.
Filtralion: The pulmonary capillary bed may act as a filter
preventing particles from reaching the systemic circulation.
Prostaglandins synthesis and removed.
Act as reservoir for left ventricle.
The air ways of the lungs:
Gas exchange take place across the alveoli capillary membrane on
inspiration flows through the upper respiration tract and reaches
alveoli. This pathway is subdivided by 23 generation From the
functional point to two zones.
Conducting zone: The area of the air ways where no gas exchange
takes place is called conducting zone (thickness of wale) or
anatomical dead space. Volume of air 150 ml. It consist of 1 st 16
subdivision , nose, mouth, pharynx, larynx, trachea, bronchi, up to
terminal bronchioles.
Respiratory zone: The area of air ways where gas exchange taken
place between blood and alveoli. Last seven subdivisions of air ways.
Respiratory bronchioles, Alveolar duct, Alveolar sac and alveoli.
Anatomy
In the pulmonary circulation, almost all the blood in
the body passes via the pulmonary artery to the
pulmonary capillary bed, where it is oxygenated and
returned to the left atrium via the pulmonary vein
The bronchial circulation nourishes the trachea
down to the terminal bronchioles and also supplies
the pleura and hilar lymph nodes.
It should be noted that lymphatic channels are more
abundant in the lungs than in any other organ
Lungs function: (Metabolic and
endocrine function):
Synthesized and used in the lung surfactant.
Synthesized or stored and released in to the
blood prostaglandins, histamine, kallikrein.
Partially removed from the blood
prostaglandin, adenine nucleotides, nepl,
bradykinin, serotonin.
Anglo ensign I-Ace –Angiotension II
ANATOMY OF BLOOD FLOW IN THE UNG
In the pulmonary circulation, almost all the blood in
the body passes via the pulmonary artery to the
pulmonary Both
capillary bed,circulation
the pulmonary where itandistheoxygenated and
returned tobronchial
the left atrium
circulation
in the lung.
via the
contribute topulmonary.
blood flow
The bronchial circulation nourishes the trachea down
to the terminal bronchioles and also supplies the
pleura and hilar lymph nodes.
It should be noted that lymphatic channels are more
abundant in the lungs than in any other organ v
Respiratory Mechanism and Mechanics
The inflow and outflow of gas in unit time depend on various
factors that determine lung volume. These factory are –
Forced generated by the respiratory muscles.
Pulmonary complance.
Elastic recoil tendency of the lungs.
Air way resistance.
Muscle of inspiration (In quite inspiration):
The diaphragm 75% .of the change in intrathoracic volume
during quite inspiration contraction of the diaphragm pulls the
lower surface of the lung downward.
External Intercostals muscle: When the external intercostals
contract they elevate the lower ribs. This pushes the sternum
outward and increase anterior posterior diameter of the chest.
.
In force full inspiration (Additional muscle):
Sternocleido mastoid – which lift upward on the
sternum.
Scaleni – Which lift the 1 st two ribs.
Anterior serrati-Which lift of the ribs.
Scalenious posterior
Latissimus dorsi
NB:1 atmospheric pressure=760mm Hg=0 mm of
H2O so -1cm is less then 1 atmospheric pressure.
Mechanism of inspiration:
Signal from respiratory center
Phrenic nerve ----------------------------- Inter costal nerve
Diaphragm contracts &downward External inter costal muscle contracts ,elevation of rib
movement of diaphgm
Increase transverse &ant :post length
Increase vertical diameter Intra alveoler pr decrease(0 cm water to -1cm water
Chest wall expand Which is less then atmospheric pressure)
Negative intrapleural pressure decrease
(from -5cm water to-7.5 cm water)
Visceral pleura comes in contact with parietal pleura,so lung expand Air enter in to
lungs Inspiration occurs.
Expiration: It is a passive process. It does not involve muscle except forceful expiration. It occurs due to elastic recoil tendency of lung& chest
wall and elastic forces exerted by the surface tension of the fluid lies inside the wall of the alveoli and lung air spsces
Signal from respiratory center
Phrenic nerve ----------------------------- No Impulse by the Inter costal nerve
Diaphragm relaxes goes upward Relaxation of inspiratory muscle
Decrease vertical diameter(chest cavity) Depression of rib
lungs recoil pulls the chest back to expiratory position
Increase intra alveolar pressure (+ 1cm of water)
Air flows out of the lungs
Expiration occurs
Lung Function Test
(1)To asses the mechanism of
ventilation(Respiration)
All volume & capacities measure by
spiromerter except RV,FRC ,TLC measure by
Hilium dilution method ,nitrogen wash out
method
FEV1
PEFR(peak expiratory flow rate)
Maximum breathing capacities
Maximum ventilation capacities
FEV1/FVC ratio
Minute respiratory volume
Alveolar gas composition
a)Otis Rahn method
b)Helden pristley method
3)To asses efficiency of gas exchange at
alveolar level
Diffusion capacities of O2 & CO2
Transfer co-efficent
Ventilation perfusion ratio
2)Measurement of O2 consumption and CO2
production
O2=250 ml/min
CO2=200 ml/min
Dead space volume (nitrogenmeter)
4)Measurement of blood gases by oximetry
5)To asses the efficiency of lung in relation to
exercise ETT(trade mill exercise)
6)To asses the chest expansibility by
measuring tape
Importance
To asses the function of lung and tissue
To diagnose any respiratory disease
To monitor prognosis of treatment
Intra-alveolar pressure :
Pressure of the air inside the alveoli
It is equal to the atmospheric pressure ( 0 cm
H2 o) in between breath.
During inspiration, it falls below the
atmospheric pressure (- 1 cm H2o)
During expiration, it rises above the
atmospheric pressure (+1 cm H2o)
Intrapleural pressure
Pressure of fluid in the thin space between
the lung pleura and chest wall pleura.
Atmospheric pressure is considered as “ o “
reference pressure.
Intrapleural pressure is approximately -5 cm
H2O At the beginning of inspiration.
During inspiration , it becomes more
negative (-7.5 cm H2o)
During expiration, it is less negative (-5 cm
H2O ).
Always negative (Expressed
relative to atmospheric pressure)
Transpulmonory pressure
It is difference between intra-alveolar&
intrapleural pressure
It prevents the collapse o f the lungs by
oppose ing the elastic recoil tendency of the
lung that tends to collapse the lung.
In inspiration ,it increase & helps to expand
lung
In expiration ,it decrease &helps to contract
lungs.
Spirometry:the process for studing pulmonary ventilation by
recording the volume of air flow into & out of the lung iscalled
Pulmonary capacities
In describing events in the pulmonary cycle, it is
sometimes desirable to consider two or more of the
volumes together. Such combinations are called
pulmonary capacities. The important pulmonary
capacities, which can be described as follows:
The inspiratory capacity
The functional residual capacity
The vital capacity
The total lung capacity
All pulmonary volumes and capacities are about 20 % to 25
% less in women than in men, and they are greater in
large and athletic people than in small and asthenic people.
continution
The inspiratory capacity equals the tidal volume plus the inspiratory
reserve volume. This is the amount of air (about 3500 milliliters) a person
can breathe in, beginning at the normal expiratory level and distending
the lungs to the maximum amount.
The functional residual capacity equals the expiratory reserve volume
plus the residual volume. This is the amount of air that remains in the
lungs at the end of normal expiration (about 2300 milliliters).
The vital capacity equals the inspiratory reserve volume plus the tidal
volume plus the expiratory reserve volume. This is the maximum amount
of air a person can expel from the lungs after first filling the lungs to their
maximum extent and then expiring to the maximum extent (about 4600
milliliters).
The total lung capacity is the maximum volume to which the lungs can
be expanded with the greatest possible effort (about 5800 milliliters); it is
equal to the vital capacity plus the residual volume
Vital capacity
Vital capacities=tidal volume+IRV+ERV
500+3000+1100=4600 ml 0r 4.6 L
Factors affecting vital capacity:
Air way resistance
Force of contraction of respiratory muscle
Elastic recoil tendency of lung
Others=age,sex ,surface area (proportional to
surface area) Size,Posture.
Pulmonary volume
Four pulmonary lung volumes that, when
added together, equal the maximum volume
to which the lungs can be expanded.
The significance of each of these volumes is
the following:
The tidal volume
The inspiratory reserve volume
The expiratory reserve volume
The residual volume
Continution
1. The tidal volume is the volume of air
inspired or
expired with each normal breath; it amounts to
about 500 milliliters in the adult male.
2. The inspiratory reserve volume is the extra
volume
of air that can be inspired over and above the
normal tidal volume when the person inspires
with full force; it is usually equal to about
3000 milliliters
continution
3. The expiratory reserve volume is the
maximum
extra volume of air that can be expired by
forceful expiration after the end of a normal
tidal expiration; this normally amounts to about
1100 milliliters.
4. The residual volume is the volume of air
remaining in the lungs after the most forceful
expiration; this volume averages about
1200 milliliters.
Pulmonary ventilation
It means inflow& outflow of air between the
atmosphere and lung alveoli.
Pulmonary ventilation=Respiratory rate x
tidal volume.
=12/minx5ooml
=6ooml.
Alveolar Ventilation (VA):
volume of air reaches the gas exchange zone
(Alveoli) per min.
Rate of alveolar ventilation is the total volume of
new air entering the gas exchange area (alveoli)
each min.
Equal to respiratory rate times the amount of
new air that enters the gas exchange area per
min.
continution
VA =[ (VT – VD)× Respiratory rate]
= (500- 150 ) × 12
= 35o × 12
= 4200 ml/ min
Lung compliance
The expansibility of lungs & thorax is called
compliance.
The volume increase in the lung for each
unit increase in alveolar pressure or each
unit decrease in pleural pressure .
The normal total compliance of the lungs
together averages 200ml/cm of H2O
pressure . It means every times the alveolar
pressure is increased by 1 cm of lungs water
the lungs expand 200ml.
Factors that cause abnormal compliance
Any condition that destroy the lung
tissue ,causes it to become fibrotic or
edematous the bronchioles impedes lung
expansion and contraction causes lungs
compliance
deformities of chest such as kyphosis severe
sclerosis decrease chest compliance
Fibrotic pleurisy ,paralyzed or fibrotic
muscle reduces the lung compliance.
Dead space
Def: the amount of air that enters the
respiratory passage but does not take part in
the gaseous exchange is called dead space. It
Is about 150ml
Types : a) Anatomical dead space- the
amount of air that is from nose to terminal
bronchioles where no gas exchange take
place is called anatomical dead space
Continution
b)Physiological dead space : Anatomical
dead space and alveolar dead space together
make physiological dead space
In normal person , the anatomical&
physiological dead spaces are nearly equal
because all alveoli are functional .But in a
person with partially functional or
nonfunctional alveoli in some parts of the
lungs the physiologic dead space become
greater than anatomic dead space
Ventilation perfusion ratio
The ratio of alveolar ventilation to alveolar
blood flow is called is called VPR. It is about
0.8
Surfactant
- A surface active agent in water- reduce
surface tension of water
- Secreted by special surfactant secreting cells
of alveoli(type II alveolar epithelial cell)
- Chemically a mixture Phospholipids, proteins
and ions.(Dipalmitoylphosphatidycholine)
- It begins to secrets at the beginning of the
28th
- Week of intrauterine life.
- Premature newborn babies do not have
sufficient\ have little surfactant in the alveoli.
Lungs have tendency to collapse
Have respiratory insufficiency
- Infant Respiratory Distress
syndrome/ Hyaline Membrane Disease
Importance
It prevents the collapse of the lung by
reducing the surface tension of the fluid
lining
Of the epithelium
Helps to prevent pulmonary odema
Helps to expand the lung of the new born babies
Increase lung compliance
Stabilizes size of alveoli
Lack of surfactant
In
Infant Respiratory distress Syndrome(IRDS)
Hyaline membrane disease
Premature babies those who are born before
The 28th week of intrauterine life have lack of
surfactant. Due to deficiency of surfactant
lung cant not expand properly& babies can
not inspire easily. So premature babies
suffer from respiratory distress.