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A&P 302 Respiratory Lecture Notes:

The Respiratory System Function:


Pulmonary ventilation
External respiration
Transport of respiratory gases --- X has a problem with this definition
Internal respiration --- X has a problem with this definition

Function Pulmonary Ventilation:


Is movement of air into the lungs

Function External Respiration:


Movement of Oxygen (O2) to the blood
Movement of Carbon Dioxide (CO2) from the blood
Done in conjunction with RBCs

Function Transport of Respiratory Gases:


Transport of oxygen from the lungs to the periphery --- X
Transport of carbon dioxide from the periphery to the lungs --- X
Has a problem with is definition because its the circulatory system
that does the moving

Function Internal Respiration:


Movement of oxygen from blood to tissue
Movement of carbon dioxide from the tissue to the blood I.e. giving off O2 and
taking up CO2 but again he thinks thats more the circulatory systems
job.

The Respiratory System Functional Anatomy:


Nose
Nasal cavity
Pharynx
Larynx
Trachea
Bronchi
Lungs
Alveoli

Nose and Nasal Cavity Function:


Provides an airway for respiration
Moistens and warms entering air
Filters and cleans air
Resonating chamber for speech
Houses olfactory receptors
Nose is anything external
Nasal cavity is anything internal
Warming air is important!
o In patients with Hypothermia they ultimately die because their heart stops beating
o The air needs to be warmed because the lungs are in such close proximity to the
heart. If clod air is breathed in enough, it could affect the heart.

Nose and Nasal Cavity Distinction:


Nose anything internal
Nasal cavity anything external

Nose Anatomy:
Root the area between the eyebrows
Bridge
Dorsum nasi anterior margin
Apex
Philtrum vertical groove below the apex --- WILL BE ON TEST!
o Embryologically the two halves of the faces grow together
vertically. If this doesbt happen properly a cleft lip will occur.
Nostril or external nares the openings of the nose
Alae lateral coverings of the nares
Nares nostril
Alae wings

Nose Skeletal Framework:


Superiorly the nasal and frontal bone
Laterally the maxillary bone
Inferiorly hyaline cartilage
o Lateral cartilage --- X DONT KNOW
o Septal cartilage --- X
o Alar cartilage --- X
o Just know that cartilage and bone comes together

Nasal Cavity Location:


Lies posterior to the external nose
Nasal Cavity Anatomy:
Divided by the nasal septum
o anteriorly formed by the septal cartilage
o posteriorly by the vomer and ethmoid bone
Roof - ethmoid and sphenoid bones
Floor hard and soft palate
Vestibule just superior to the nostrils

Nasal Cavity Vestibule:


Vibrissae hairs
Mucosa
o Olfactory Receptors for olfaction
o Respiratory Respiratory mucosa is found in several different
places

Vestibule Olfactory Mucosa:


Contains Smell receptors
Vestibule Oral Mucosa:
Pseudostratified ciliated columnar epithelium
Goblet cells produce mucus helps clean the air, particles stick to it
Mucous glands secrete mucus
Serous glands secrete watery fluid

Respiratory Mucosa Function:


Mucus production (helps clean mucous traps dirt)
Air warming and turbulence

Respiratory Mucosa Mucus Production:


Produces a quart of fluid containing lysozymes per day (Lysozymes are there for
protection helps break up bacteria)
Produces defensins (an antibiotic like compound)
Cilia push the mucus to the back of the throat to be swallowed
The court of fluid the mucus produces is swallowed each day why pts
with GI issues may have to get NG tubes to drain that fluid that isnt
being filtered.

Respiratory Mucosa Air Warming/Turbulance:


Area increased by the superior, middle, and inferior conchae
Each conchae has an inferior meatus that causes air turbulence
3 shelves are called conchae like upside down gutters
Flow of blood and air is similar if blood or air is going in straight line
its called laminar flow
In blood vessels you WANT laminar flow, but you DONT want it in the
nasal cavity, you want turbulence (like going in circle), so that the
surface area of the respiratory mucosa is increased and it can catch
more stuff

The Respiratory System The Pharynx: KNOW THE SPEICAL FEATURES


Nasopharynx
Oropharynx
Laryngopharynx

The Pharynx Nasopharynx:


Location posterior to the nasal cavity and superior to the soft palate
Serves as an air passage ONLY!!

The Nasopharynx Structures:


Adenoids - (adenoids and tonsils are taken out for recurrent pharyngitis in kids
and for snoring in adults)
Pharyngotympanic (auditory or eustachian) tube (keeps the middle ear to
the back of the throat open also allows for better air waves)
Infection of the Pharyngottympanic (auditory or Eustachian) tube is
known as Otitis midia.
o Children are more susceptible because the angles of their tubes are straighter and
therefore dont drain as well
o Bottle propping can cause it

The Pharynx The Oropharynx:


Location from the soft palate to the epiglottis
Serves as air AND food passage!!
The Oropharynx is the only part that is visible

The Oropharynx Structures:


Palatine tonsils lateral walls (what is removed during a
tonsillectomy)
Lingual tonsils base of the tongue
Fauces the archway between the uvula and epiglottis
Just mostly remember the top one

The Pharynx The Laryngopharynx:


Location from the epiglottis to the larynx
Serves as an air and food passage

The Larynx Function:


Maintain an open airway
Switching mechanism to route food AND air
Voice production
The hyoid bone is the ONLY bone that doesnt articulate with another

The Larynx Location:


Superiorly attaches to the hyoid bone and opens into the laryngopharynx
Inferiorly joins the trachea
Extends from the level of C4 to C6

The Larynx Structure:


Composed of hyaline cartilage except for the epiglottis
Has nine cartilage components
Epiglottis is made up of elastic cartilage, everything else is made up of
hyaline cartilage
You can feel the thyroid cartilage
THE PICTURE WILL BE ON PRACTICAL, ESP THE THYROID CARTILAGE OR
LARYNGEAL PROMINENCE

The Larynx Cartilage Components:


Thyroid cartilage
o laryngeal prominence
Cricoid cartilage
Epiglottis

The Larynx Components of Speech:


Vocal ligaments attach the arytenoid cartilage to the thyroid cartilage
Vocal cords or true vocal cords mucosa folds that cover the vocal ligaments

Glottis opening between the TRUE vocal cords


It is NOT a structure, its an opening
The Larynx Components:
Vestibular folds or false vocal cords
o Superior to the vocal cord
o Close larynx while swallowing
o Not involved in speech production
o Glottis covers the pharynx while the false vocal cords cover the
larynx when swallowing

The Trachea Location:


Descends from the larynx
Ends by dividing into the primary bronchi

The Trachea Tissue Layers:


Mucosa
Submucosa
Adventitia

The Trachea Mucosa:


Pseudostratified epithelium with goblet cells (PCCE) Respiratory
epithelium
Ciliated
Thick lamina propria

The Trachea Submucosa:


Connective tissue layer
Contains seromucous glands produce mucus sheets
In smokers the cilia is lost (which in part gives them the cough), when
they STOP smoking the cilia return but they are very sensitive at first
which can make the coughing worse initially

The Trachea Adventitia:


Connective tissue layer
Reinforced with 16 20 C-shaped rings open part of the C abuts
the esophagus

The Trachea Muscle:


Open part of the C contains the trachealis muscle
Contraction of the trachealis causing air to rush through (coughing)!
Why do you have cartilage in the trachea? Because you get air into the
lungs by creating a vacuum. The trachea would collapse without
cartilage.
o The muscle allows for contraction, when coughing the
constriction creates pressure and allows the dirt in the lungs to
be properly expelled
o The picture above: The bottom of the picture is Anterior, while
the top is Posterior
o The trachea sits on top of the esophagus

The Trachea Carina:


Y-shaped end of the trachea
Highly sensitive irritation causing violent coughing
AT the end of the Y between the lungs is the Carina
Violent coughing starts when the substances hits the carina

The Bronchi Divisons:


Primary or main in medicine they use the term main stem bronchus
Secondary or lobar
Tertiary or segmental
The bronchi and trachea together = bronchial tree

The Bronchi Primary: oN SLIDE 43


Right is shorter, wider, and more vertical than the left
WILL Be on test!
Starts at approximately T7
The right lung is wider because the heart is more to the left (which
makes the left lung skinner)
o And the liver is under the diaphragm on the right, which is why
its shorter
This is important because anytime something goes into the lung
(aspiration), it is more likely to go into the right ling.
Irregular plates of cartilage
Epithelium changes from pseudostratified columnar to columnar to
cuboidal
o The cell type changes so that it is easier for Oxygen
and Carbon Dioxide to pass
Smooth muscle progressively INCREASES (as you go down the
bronchus)

The Bronchi Secondary:


3 branch off the right
2 branch off the left
Branches go to each individual lobe
2 branches = 2 lobes
3 branches = 3 lobes

The Bronchi Tertiary:


Divide progressively into smaller airways
There are about 23 levels of branches
Once they reach a diameter of smaller than 1mm they are called
bronchioles KNOW!
Terminale bronchioles are less than 0.5mm in diameter !!

The Bronchi Termination:


Terminal bronchioles feed into respiratory bronchioles
Respiratory bronchioles go into alveolar ducts
Alveolar ducts lead to alveolar sacs
NTK the pathway air takes
Air sac = alveoli
How do you get air in and out? Air gets in by the lungs creating a
vacuum (dropping pressure inside, so its less outside) to get air out the
pressure inside the lung has to be higher than outside.
How?
- By 1) the elastic bands around the alveoli, alveoli are like a
balloon, the elastics helps push the air out and
- 2) the alveolar sacs have a thin layer of fluid (Surfactant) which
causes surface tension causing them to collapse (create pressure)

The Lungs Anatomy:


Cone shaped
Costal surface anterior, lateral, and posterior surface that is in contact with the ribs
Apex narrow tip of the lung

Hilus on the mediastinal surface, where the arteries, veins, and bronchus enter the lung
o Also called roots
Divided into lobes
Hilus area where everything enters (nerves, bronchi, blood vessels,
and its the only spot they go through.
The Lungs Lobes:
Right 3 lobes
o Upper, middle, and lower
o Divided by the oblique and horizontal fissure
The thing to remember are the fissures. They separate the lobes from
each other.
Clinical fact: On an xray there will be a little bit of fluid on the fissures,
you have to be able to tell whether or not the amount of fluid is
abnormal or not

Left 2 lobes
o Upper and lower
o Divided by the oblique fissure
The Lungs Subdivisions:
Bronchiopulmonary segments
o Pyramid shaped
o Separated by a connective tissue septa
o Each has its own blood supply
EXTREMELY IMPORTANT!
If small debris is blocking one of these small segments, all the others
should work. This prevents blood flow from being blocked.
Lung disease can be divided into 2 categories:
- Obstructive It doesnt prevent air from coming in, it Prevents it
from coming OUT. And if the air cant escape theres no room to
put more air in when the pt breathes.
- Restrictive The lungs cant expand, not seen very often.
Two major categories of obstructive disease:
o Asthma
o COPD: there are 2 types
Chronic bronchitis
Emphysema
Emphysema:
o Alveoli loose their wall and they fuse to become very
big.
o They then cant constrict (the natural recoil of the lungs
is gone)
Chronic bronchitis and Asthma are very similar. There are 2
mechanism that cause problems:
o Bronchospasm bronchi constrict
o Mucus plugging most prominent feature in both.
Mucus plugs get into the small airways of the
bronchi.
It blocks air from going *OUT*, not in.
o Barrel chest
Difference between Asthma and COPD?
o Functionally they are the SAME.
o But Asthma responds better to bronchodilators
o And with Asthma you can get back to normal, not
possible with COPD
o Pt who has chronic bronchitis will have a very
DUSKY color (and barrel chest), called blue
bloaters
o Pt with emphysema will have good color, but will
be breathing shallow, called pink puffers
o Scleroderma connective tissue around rib cage
becomes too thick. Type of restrictive disease

Lobules
o Smallest unit seen with the naked eye
o Served by a large bronchiole
Lobules
o The connective tissue that separates individual lobules becomes blackened in
smokers
The Lungs Terminal Divisons:
Respiratory membrane
Alveolar walls

The Lungs Respiratory Membrane:


Fusion of the alveolar and capillary walls
Gas on one side, blood on the other side
Membrane is less than paper thin
The respiratory membrane has to be n to diffuse/transfuse oxygen and
carbon dioxide

Alveolar Walls Components:


Type I cells
Type II cells

Alveolar Wall Type I Cells:


Squamous epithelial cells
Surrounded by a flimsy basal lamina
Source of angiotensin converting enzyme
TYPE 1 is the Alveolar cell, it gives lining to the alveoli
The angiotensin converting enzyme = ACE like ACE inhibitor meds.
o The kidneys produce Renin and the Liver produces Angiotensinogen, Angiotensin
II is the final product and it helps keep the BP up.
o ACE cleaves Angiotensin I into Angiotensin II

Alveolar Wall Type II Cells:


Cuboidal cells
Scattered amongst type I cells
Secrete a fluid containing Surfactant
TYPE 2 is the Greater alveolar cell (in the picture)
Surfactant is very important! It breaks down the surface tension
so that the alveoli doesnt completely collapse d/t the pressure
Natural recoil d/t to:
1) elastic fibers the supports the alveoli
2) and surface/fluid tension
In premature infants the critical factor on whether they make it or not
is if they are producing Surfactant or not. If they dont the lungs/alveoli
wont stay contracted.

Alveoli Significant Features:


Surrounded by fine elastic fibers
Alveolar pores connect adjacent alveoli
Alveolar macrophages (dust cells)

The Lungs Blood Supply:


Pulmonary
Bronchial
2 blood supplies to the lungs
The aorta has its own blood supply from the outside because its too
thick
The same goes for the lungs there has to be a separate blood supply
to feed the tissue that isnt close enough to the oxygenated blood.

The Blood Supply Pulmonary:


Deoxygenated blood travels through the pulmonary artery
Blood then enters the pulmonary capillary network that surrounds the alveoli
Coming from the heart is the pulmonary artery the ONLY artery that
carries deoxygenated blood
It takes deoxygenated blood to the lungs so that is can be oxygenated
then it returns to the heart via the Pulmonary veins
Pulmonary veins are the ONLY veins that carry oxygenated blood
What determines if an artery is an artery and a vein is a vein has to do
with the lumen (walls) of the vessel. Arteries are much thicker and have heavy
muscle!

Blood Supply Pulmonary:


Oxygenated blood returns to the heart
Large volume, low pressure
Moves a large volume of blood at a low pressure!
The low pressure is critical if there is elevated pressure in the lungs
= Pulmonary hypertension or more specifically Primary Pulmonary
Hypertension (PPH), which is FATAL
There is only one way to cure PPH do a complete heart and lung
transplant

Blood Supply Bronchial:


Low volume, high pressure
Provides systemic blood to lung tissue
Enters the lungs from the aorta through the hilus
Returns via pulmonary veins

The Lungs Nervous Innervation:


Pulmonary Plexus
o Sympathetic (epinephrine, bronchial dilation)
o Parasympathetic (bronchial constriction)
o Visceral sensory (allows us to judge when we put enough air in our
lungs)
Enters the lungs at the root

The Lungs Pleura:


Doubled layer serosa
Parietal pleura covers the thoracic wall and superior face of the diaphragm and
around the heart
Visceral pleura covers the lung
Produces pleural fluid
Pleural cavity slitlike area between the pleurae containing fluid
Mucosa vs Serosa = mucosa lines cavities open to the exterior,
the Serosa line things that are covered
Between the two layers is the pleural cavity
Pneumothorax collapsed lung
- How to fix it? Put a covering over the gold, then connect a tube to a new hole that
has a lot of suction to create that pressure again so the lung will reinflate
You should not see fluid in a chest xray (except for the tiny bit in the
fissures)
If there is a little bit of fluid = tap it
If there is a lot of fluid = drain it
If your draining, what is the LAST thing a needle
pierces though to get to the parietal cavity? The
Parietal pleura

The Lungs Mechanics of Breathing:


Pressure relationships
Pulmonary ventilation
o Inspiration
o Expiration
Atelectasis when there isnt enough Surfactant. It is NOT the same
Pneumothorax.
In Atelectasis the vacuum is STILL there.
Are you taking in the exact amount of air in each breath? NO, about
once a minute you take a deeper breathe to prevent Atelectasis.
Mechanics of Breathing Pressure Relationships:
Intrapulmonary pressure (pressure in the lung itself)
Intrapleural pressure (negative pressure in between the lungs and the
weall)

Pressure Relationships Intrapulmonary Pressure:


Pressure inside the alveoli
Rises and falls with breathing
Always eventually equalizes with outside pressure
In order to bring air in there must be a vacuum, the pressure has to
LESS than it is on the inside and vice versa for getting air out
Which means that at some point between breathing in and out the
pressure has to equalize

Pressure relationships Intrapleural Pressure:


Fluctuates with breathing phases
Remains about 4mmHg less than intrapulmonary pressure
o Lungs natural tendency to recoil (natural recoil of the lungs)
o Surface tension of the alveolar fluid
o Ranges from -3 to -6, but it is usually around a -4

Pulmonary Ventilation Inspiration:


Action of the diaphragm
Action of the intercostal muscles
How to decrease pressure in the lungs? By expanding the thorax!
Increasing the size of the thoracic cavity (done with the diaphragm
mostly) increases with Negative pressure
Inspiration Diaphragm:
Contraction of the diaphragm causes it to flatten and move inferiorly
Causes the height of the thoracic cavity to increase
As it flattens out it is pulling down which increases the height
of the thoracic cavity

Inspiration Intercostal Muscles:


Contraction lifts the rib cage and pulls the sternum superiorly
Expands the thoracic anteroposterior plane
o Volume further increased by accessory muscle in exercise, COPD, etc
Increase muscles the size of the thoracic cavity
Accessory muscles engage them with the tripod position
Since you are using muscles when you breathe, it takes energy

Expiration Types:
Passive - Passive expiration does NOT use energy
Forced
If your using energy, how do you get air out? The natural recoil of the
lungs

Expiration Passive:
Based on lung recoil
Inspiratory muscle relax and resume their normal length

Expiration Forced:
Contraction of abdominal wall muscle
o Forces abdominal organs superiorly
o Depresses the rib cage

The Lungs Factors Influencing Ventilation:


Airway Resistance
Alveolar Surface Tension
Lung Compliance
WILL BE ON TEST!!!!

Pulmonary Ventilation Airway Resistance:


Nonelastic source is from the pulmonary passageways
Flow is directly related to the difference in pressure
o Important principle for lungs and blood vessels.
o Say for instance you have 757 mmHg of pressure outside, that
means to get air IN the pressure inside has to be LOWER than
that.
o You can drop pressure by taking in a smaller breath to get mmHg
down to 747 and then you take a deeper breathe and get it down
to say, 737 mmHg.
o There will be MORE airflow when there is a difference of 20 (757
737 = 20) than if there were just 10.
Flow is inversely related to resistance
The more narrow the tube the more resistance you have
Airway resistance is coming from the nonelastic pulmonary
pathways

Pulmonary Ventilation Surface Tension:


Caused by alveolar fluid
o Produced by Type II alveolar cells
o Liquids are more strongly attracted to each other than to gases
Increases the elasticity of the alveoli
Not going to spend much time on it
Lung Compliance Diminishing Factors: KNOW!
Reduced resilience of the lungs it doesnt expand well, which means it
also doesnt constrict well
Blocks in the smaller passages usually d/t mucus plugging (as with
COPD, asthma, or cystic fibrosis) use the pulmonary toilet with cystic
fibrosis
Reduced production of surfactant as seen with premature infants
Decreased flexibility of the thoracic cage Thoracic cage cant expand
(like when a pt has Scleroderma or broken ribs)

The Lungs Pulmonary Parameters: Volumes and Capacities will NOT be on


the test!!
Respiratory Volumes
Respiratory Capacities
Dead Air Space

Pulmonary Parameters Respiratory Volumes:


Tidal volume (TV) amount of air that moves into and out of the lungs with each normal
breath
o What youre taking in with a normal breath
Inspiratory reserve volume (IRV) the amount of air that can forcibly be inspired above
tidal volume
o Youve taken a normal breath, now how much more can you take
in
Expiratory reserve volume (ERV) amount of air that can be evacuated from the lungs
after a tidal respiration
o Letting air out naturally
Residual volume (RV) what is left when ERV is expended
o The air that is let that you can never let out
With COPD what is the change in RV and IRV? RV INCREASES and IRV
DECREASES
Pulmonary Parameters Respiratory Capacities:
Always consists of two or more volumes
Inspiratory capacity (IC) = TV + IRV
o Total amount of air that can be inspired after tidal expiration
Functional residual capacity (FRC) = RV + ERV
o Amount of air remaining in the lungs after tidal expiration
Vital capacity (VC) = TV + IRV + ERV
o Total amount of exchangeable air
Total lung capacity sum of all lung volumes
You use the parameters to determine if someone has a restrictive or
obstructive disease

Pulmonary Parameters Dead Space:


Volume of air in conducting zone conduits
Air that is in a spot where Oxygen and Carbon dioxide movement does
not occur
Internal respiration does NOT take place here
The Lungs Control of Respiration:
Medullary Respiratory Center
Pons Respiratory Center

Control of Respiration Medullary Respiratory Center:


Inspiratory center appears to be the pacesetting respiratory center
Sends impulses through the phrenic and intercostal nerves
Control of Respiration Pons Respiratory Center:
Fine tunes breathing to prevent over inflation
Continuous stream of impulses when signals are strong, the period of inspiration
shortens

The Lungs Factors Influencing Rate:


Pulmonary Irritant Reflex
Inflation Reflex
Higher Brain Centers
Chemical factors
o Carbon dioxide
o Oxygen
o pH

Factors Influencing Rate Pulmonary Irritant Reflex:


Accumulated mucus, inhaled debris, and noxious fumes cause constriction of the
passageways
Causes cough when stimulated in the trachea

Factors Influencing Rate The Inflation Reflex:


Stretch receptors in the passageways and pleura send impulses when the lung is inflated
When the lung recoils, the impulses stop and inspiration is again stimulated

Factors Influencing Rate Hypothalamic Controls:


Through the limbic system
o Gasp when we touch something cold and clammy
o Breath holding when angry
o Rise in body temperature causes a rise in respiratory rate
Factors Influencing Rate Cortical Control:
Cortical control overrides brainstem control
Factors Influencing Rate Carbon Dioxide:
Most potent and tightly controlled
As carbon dioxide rises respiratory rate rises

Factors Influencing Rate Oxygen:


Must fall significantly to have an effect on respiratory rate
Mechanism is relied upon in patients with lung disease and chronically high carbon
dioxide levels
Develop a new set point for carbon dioxide

Factors Influencing Rate pH:


A rise in pH ______ respiratory rate
A drop in pH _______ respiratory rate