22 Respiratory System
22 Respiratory System
22 Respiratory System
Respiration
ventilation of lungs exchange of gases between
air and blood blood and tissue fluid
Conducting division/zone
passages serve only for airflow, nostrils/mouth to terminal bronchioles
Respiratory division
Respiratory bronchioles alveolar ducts and sacs alveoli
Nose
Functions
warms, cleanses, humidifies inhaled air detects odors resonating chamber that modifies the voice
Nasal Cavity
Animation: http://www.youtube.com/watch?v=FUa12oXwYZY Extends from nostrils to choanae (posterior naris)
ethmoid and sphenoid bones compose the roof palate forms the floor
Nasal septum divides cavity into right and left chambers called nasal fossae
inferior part formed by vomer superior part by perpendicular plate of ethmoid bone anterior part by septal cartilage
Meatuses
narrow air passage beneath each conchae narrowness and turbulence ensures air contacts mucous membranes
Epistaxis (nosebleed)
most common site is the inferior concha
Regions of Pharynx
Pharynx
Nasopharynx (pseudostratified epithelium)
posterior to choanae, dorsal to soft palate receives auditory tubes and contains pharyngeal tonsil air turns 90 downward trapping large particles (>10m)
Types of epithelia
vestibule is lined by the protective stratified squamous epithelium, because the vestibule is a cavity that opens to the outside (and needs protections). oropharynx and laryngopharynx are ducts that are shared with the digestive system, so there is a need to provide protection from abrasion with a stratified squamous epithelium. nasopharynx receives air from the nasal cavity and is not close to the outside nor is it shared with the digestive system. The nasopharynx has the same epithelium as the nasal cavity: pseudostratified ciliated columnar.
Larynx
Glottis - superior opening Epiglottis - flap of tissue that guards glottis, directs food and drink to esophagus Infant larynx
higher in throat, forms a continuous airway from nasal cavity that allows breathing while swallowing by age 2, more muscular tongue, forces larynx down
Views of Larynx
Anterior
Posterior
Midsagittal
Cricoid cartilage - connects larynx to trachea Arytenoid cartilages (2) - posterior to thyroid cartilage Corniculate cartilages (2) - attached to arytenoid
cartilages like a pair of little horns
Cuneiform cartilages (2) - support soft tissue between arytenoids and the epiglottis
Walls of Larynx
Interior wall has 2 folds on each side, from thyroid to arytenoid cartilages
vestibular folds: superior pair, close glottis during swallowing vocal cords:produce sound
Trachea
Rigid tube 4.5 in. long and 2.5 in. in diameter, anterior to esophagus Supported by 16 to 20 C-shaped cartilaginous rings
opening in rings faces posteriorly towards esophagus trachealis muscle spans opening in rings, adjusts airflow by expanding or contracting
Larynx and trachea lined with ciliated pseudostratified epithelium which functions as mucociliary escalator
Bronchial Tree
Primary bronchi (C-shaped rings)
arise from trachea, after 2-3 cm enter hilum of lungs right bronchus slightly wider and more vertical (aspiration)
Bronchial Tree 2
Bronchioles (lack cartilage)
have layer of smooth muscle pulmonary lobule: portion ventilated by one bronchiole divides into 50 - 80 terminal bronchioles terminal bronchioles
have cilia , give off 2 or more respiratory bronchioles
Alveolar ducts - end in alveolar sacs Alveoli - bud from respiratory bronchioles, alveolar
ducts and alveolar sacs
Structure of an Alveolus
compartmentalization
prevents spread of infection
Mechanics of Ventilation
Gas laws (table 22.1)
Boyles law: pressure and volume Charles law: temperature and volume Daltons law: partial pressure Henrys law: gases dissolving in liquids Law of Laplace: alveolar radius
Pressure gradients
difference between atmospheric and intrapulmonary pressure created by changes in volume of thoracic cavity
Scalene muscles
fix first pair of ribs
External intercostals
elevate 2 - 12 pairs
- at any given volume, Pip is equal and opposite to the inherent elastic recoil of the lung - under physiological conditions, Ptr is always positive
Transpulmonary pressure is more positive Ptp = Palv Pip Inflation of lungs aided by warming of inhaled air A quiet breathe flows 500 ml of air through lungs
Passive Expiration
During quiet breathing, expiration achieved by elasticity of lungs and thoracic cage (passive process)
some ATP is probably required to relax the muscle (pump Ca2+ back into SR)
As volume of thoracic cavity , intrapulmonary pressure and air is expelled After inspiration, phrenic nerves continue to stimulate diaphragm to produce a braking action to elastic recoil
Forced Expiration
Internal intercostal muscles
depress the ribs
Pneumothorax
Collection of air or gas in pleural cavity
Ptr = 0 (alveolar pressure = intrapleural pressure) loss of negative intrapleural pressure causes lungs to recoil and collapse
Resistance to Airflow
Pulmonary compliance
distensibility of the lungs; the change in lung volume relative to a given change in transpulmonary pressure decreased in diseases with pulmonary fibrosis (TB)
Bronchiolar diameter
primary control over resistance to airflow bronchoconstriction
triggered by airborne irritants, cold air, parasympathetic stimulation, histamine
bronchodilation
sympathetic nerves, epinephrine
law of Laplace: T = = PR/2 for a sphere R with internal pressure P Pulmonary surfactant (great alveolar cells) disrupts hydrogen bonds, surface tension as passages contract during expiration, surfactant concentration increases preventing alveolar collapse
Alveolar Ventilation
Dead air
(http://sprojects.mmi.mcgill.ca/resp/ventilation.htm) fills conducting division of airway, cannot exchange gases
Ventilation
Measurement Minute ventilation Alveolar ventilation Dead space ventilation Equation = Vt x f = (Vt - VD ) x f = VD x f Meaning Total volume of air entering, L/min Volume of gas reaching alveoli, L/min Volume that remains in conducting zone
Pathological dead space, e.g. in emphysema, reduces alveolar ventilation increasing depth of inspiration (i.e. the tidal volume) is more effective in elevating alveolar ventilation than an equivalent increase in breathing rate f.
Valsalva maneuver
take a deep breath, hold it and then contract abdominal muscles; increases pressure in the abdominal cavity to expel urine, feces and to aid in childbirth
Measurements of Ventilation
Spirometer
device a subject breathes into that measures ventilation
Respiratory volumes
tidal volume: air inhaled or exhaled in one quiet breath inspiratory reserve volume: air in excess of tidal inspiration that can be inhaled with maximum effort expiratory reserve volume: air in excess of tidal expiration that can be exhaled with maximum effort residual volume: air remaining in lungs after maximum expiration, keeps alveoli inflated
Inspiratory capacity
maximum amount of air that can be inhaled after a normal tidal expiration
Pons
pneumotaxic center
sends continual inhibitory impulses to inspiratory center, as impulse frequency rises, breathe faster and shallower
apneustic center
sends continual stimulatory impulses to inspiratory center
inflation reflex
excessive inflation triggers this reflex, stops inspiration
Voluntary Control
Neural pathways
motor cortex of frontal lobe of cerebrum sends impulses down corticospinal tracts to respiratory neurons in spinal cord, bypassing brainstem
Composition of Air
Mixture of gases, each contributes its partial pressure, (at sea level 1 atm. of pressure = 760 mmHg)
nitrogen constitutes 78.6% of the atmosphere, PN2 = 78.6% x 760 mmHg = 597 mmHg PO2 = 159, PH2O = 3.7, PCO2 = 0.3 mmHg
(597 + 159 + 3.7 + 0.3 = 760)
Partial pressures determine rate of diffusion of gas and gas exchange between blood and alveolus Alveolar air
humidified, exchanges gases with blood, mixes with residual air contains: PN2 = 569, PO2 = 104, PH2O = 47, PCO2 = 40 mmHg
Diffusion of O2
Henry's law: the amount of a gas absorbed by a liquid with which it does not combine chemically is directly proportional to the partial pressure of the gas to which the liquid is exposed and the solubility of the gas in the liquid O2 must dissolve in and diffuse through the thin layer of surfactant, the alveolar epithelium, the interstitium, and the capillary endothelium it then diffuses through the plasma (where some of it remains) and the majority enters the erythrocyte, and combines with Hb. oxygen is carried away from the lung by bulk blood flow and is released in the tissues (by a similar process) the reverse process occurs with CO2
Ficks law describes the rate of diffusion across the alveolar-capillary barrier
Vgas = volume of gas diffusing through the tissue barrier per time, mL/min A = surface area of the barrier available for diffusion D = diffusion coefficient, or diffusivity, of the particular gas in the barrier T = thickness of the barrier or the diffusion distance P1 P2 = partial pressure difference of the gas across the barrier
Note: This alveolar partial pressure is different for each of the three gases (different yscale on the graph for each gas): depends on its concentration in the inspired gas mixture and on how rapidly it is removed by the pulmonary capillary blood. Consider each gas as though it were acting independently of the others.
O2 initially combines with Hb, partial pressure in artery increases slowly. As Hb becomes saturated with the gas, partial pressure rapidly rises and no further transfer (diffusion) of oxygen occurs (after about 0.25 sec) Perfusion rate during exercise may be increased up to 0.25 sec in the capillary, without adverse perfusion limitation At high altitude, where alveolar O2 partial pressure is lower, diffusion rate is reduced and abnormal individuals may be subject to diffusion limitation of oxygen transfer
Diffusion of CO2
diffusivity of carbon dioxide is about 20 times larger partial pressure differential is only 5 mm Hg, compared to 60 mm Hg for oxygen as a result, CO2 takes about 0.25 sec to diffuse, similar to O2 transfer can be limited by perfusion rate (too high) or increased diffusion barrier
Oxygen transfer
Withour Hb, the physically dissolved O2 would not be sufficient to meet the tissue demands for O2 the cardiac output would have to be 83L/min !!! under extreme exercise we can get only 25L/min with Hb, our oxygen-carrying capacity increases dramatically:
20.1 mL O2/100 mL of blood (for about 15g of Hb) the binding is reversible and is determined by the partial pressure of oxygen in the plasma that will enter the erythrocyte (excluding the dissolved part)
membrane thickness
surface area
Oxygen Transport
Concentration in arterial blood
20 ml/dl, (98.5% bound to hemoglobin, 1.5% dissolved)
Binding to hemoglobin
each heme group of 4 globin chains may bind O2 oxyhemoglobin (HbO2 ), deoxyhemoglobin (HHb)
Hb saturation is determined by the partial pressure of O2 Largest affinity at highest partial pressure values
As carbaminohemoglobin (HbCO2)- 5% binds to amino groups of Hb (and plasma proteins) As dissolved gas - 5% Alveolar exchange of CO2
carbonic acid - 70% carbaminohemoglobin - 23% dissolved gas - 7%
O2 unloading
H+ binding to HbO2 deacreases its affinity for O2 this facilates the release of O2 to the tissue (Bohr effect) Hb arrives 97% saturated, leaves 75% saturated - venous reserve utilization coefficient amount of oxygen Hb has released 22%
more CO2 gives more H+, shifting eq. to the left and releasing more O2 (Bohr effect). Taking away H+ also shifts the bicarbonate eq. to the formation of more bicarbonate. Releasing more oxygen creates more HHb, which binds more CO2 for transfer (Haldane effect)
deoxyhemoglobin (Hb and its protonated form, HHb) binds CO2 better than HbO2 , Hb is a stronger base than HbO2
PO2 (mmHg)
hypercapnia PCO2 > 43 mmHg CO2 easily crosses blood-brain barrier, in CSF the CO2 reacts with water and releases H+, central chemoreceptors strongly stimulate inspiratory center corrected by hyperventilation, pushes reaction to the left by blowing off CO2 CO2 (expired) + H2O H2CO3 HCO3- + H+
Carbon Dioxide
Indirect effects
through pH as seen previously
Direct effects
CO2 (hypercapnia) may directly stimulate peripheral chemoreceptors and trigger ventilation more quickly than central chemoreceptors
Oxygen
Usually little effect Chronic hypoxemia, PO2 < 60 mmHg, can significantly stimulate ventilation
emphysema, pneumonia high altitudes after several days
Oxygen Imbalances
Hypoxia
hypoxemic hypoxia (hypoxemia) low oxygen content in the blood
usually due to inadequate pulmonary gas exchange (thicker barrier in cystic fibrosis) high altitudes, drowning, aspiration, respiratory arrest, degenerative lung diseases, CO poisoning
ischemic hypoxia - inadequate circulation anemic hypoxia anemia circulatory problem with blood circulation to the tissue histotoxic hypoxia tissue cannot utilize O2 e.g. cyanide poisons the metabolic machinery cyanosis - blueness of skin primary effect of hypoxia is tissue necrosis, organs with high metabolic demands affected first
Oxygen Imbalances
Oxygen excess
oxygen toxicity: pure O2 breathed at 2.5 atm or greater
generates free radicals and H2O2, destroys enzymes, damages nervous tissue, seizures, coma death
hyperbaric oxygen
formerly used to treat premature infants, caused retinal damage, discontinued
emphysema
alveolar walls break down, much less respiratory membrane for gas exchange, lungs fibrotic and less elastic, air passages collapse and obstruct outflow of air, air trapped in lungs
Lung Cancer
Adenocarcinoma
originates in mucous glands of lamina propria
Prognosis poor
7% of patients survive 5 years after diagnosis