The Respiratory System

Raymund Christopher R. dela Pea, RN, RM, MAN

Clinical Faculty
UNP-College of Nursing

Functions
1.
2.
3.
4.
5.

Gas exchange
Regulation of blood ph
Voice phonation
Olfaction
Innate immunity

Anatomy
Upper Respiratory tract
Nose, nasal cavity, pharynx and associated
structures

Lower Respiratory tract

Larynx, trachea, bronchi, and lungs

Upper Respiratory Tract

Anatomy

Upper Respiratory Tract

Nose and Nasal Cavity
Epithelial lining
Stratified squamous epithelium with coarse
hair, traps dust particles and humidifies air.
Pseudostratified ciliated columnar epithelium
with goblet cells

Upper Respiratory Tract

Nose and Nasal Cavity

Upper Respiratory Tract

Nose and Nasal Cavity
Nares (nostrils), external opening
Choane, openings into the pharynx
Nasal septum, divides the cavity in to left and
right halves
Hard palate, floor of the nasal cavity
Conchae, prominent bony ridges on the
lateral wall of each nasal cavity
Increase surface area

Upper Respiratory Tract

Nose and Nasal Cavity

Upper Respiratory Tract

Paranasal Sinuses
Paranasal sinuses, air filled spaces with in
the bone (skull)
Maxillary, frontal, ethmoidal and sphenoidal
Open into the nasal cavity
Reduce weight, produce mucus and act as
resonating chambers
Susceptible to infection and inflammation

Nasolacrimal duct

Upper Respiratory Tract

Paranasal Sinuses

Upper Respiratory Tract

Paranasal Sinuses

Upper Respiratory Tract

Paranasal Sinuses
1.Sinus frontalis
2.Cellulae ethmoidales
3.Septum nasi
4.Concha nasalis inferior
5.Processus alveolaris
mandibulae with teeth
6.Sinus maxillaris
7.Margo infraorbitalis
8.Linea innominata
9.Lamina orbitalis ossis
ethmoidalis
10.Margo supraorbitalis

Upper Respiratory Tract

Pharynx
Common passageway for air and solid particles.
Leads to the respiratory and digestive systems.
3 regions:
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx

Upper Respiratory Tract

Pharynx

Upper Respiratory Tract

Pharynx (Nasopharynx)
Superior part of the pharynx,
from the choane to the
level of the uvula.
Soft palate, floor of the
nasopharynx
Auditory tubes opens into
the nasopharynx
Pharyngeal tonsils

Upper Respiratory Tract

Pharynx

Upper Respiratory Tract

Pharynx (Oropharynx)
From the uvula to the
epiglottis
Palatine tonsils, lateral
walls near the border oral
cavity and oropharynx
Lingual tonsils, surface on
the posterior part of the
tongue

Upper Respiratory Tract

Pharynx

Upper Respiratory Tract

Pharynx (Laryngopharynx)
Posterior to the larynx and
extend from the tip of the
epiglottis to the
esophagus

Lower Respiratory Tract

Lower Respiratory Tract

Larynx
Connected superiorly to
the pharynx and inferiorly
to the trachea.
Consist of 3 unpaired and
6 pair cartilages

Lower Respiratory Tract

Larynx (Function)
Open passageway, prevent swallowed
material from the larynx
Primary source of sound production.

Lower Respiratory Tract

Larynx (Function)
Air moving past vocal cords causes vibration.
The greater the amplitude (greater force of
air) of vibrations the louder the sound.
The frequency of vibrations determines pitch.
Higher pitched tones are produced only when the
anterior portions vibrate and progressively lower
tones as the length of the involved cords
increases

Lower Respiratory Tract

Larynx (Unpaired Cartilages)
Thyroid cartilage (Adams apple), superiorly
attached to the hyoid bone
Cricoid cartilage, base of the larynx
Epiglottis, made of elastic cartilage. Its inferior
margin is attached to the thyroid cartilage
anteriorly and it superior part projects freely
toward the tongue

Lower Respiratory Tract

Larynx (Unpaired Cartilages)

Lower Respiratory Tract

Larynx

Lower Respiratory Tract

Larynx (Epiglottis)
During swallowing, the larynx elevates and
the epiglottis moves posteriorly to cover the
opening of the pharynx

Lower Respiratory Tract

Larynx (Epiglottis)

Lower Respiratory Tract

Larynx (Paired Cartilages)
Posterior side of the pharynx
Cuneiform cartilage, superiorly located
Corniculate cartilage, middle
Arythenoid cartilage, inferiorly located and
articulated with the cricoid cartilage

Lower Respiratory Tract

Larynx

Lower Respiratory Tract

Larynx (Vocal Cords)
Ligaments
Vestibular folds (false
vocal cords)
Vocal cords (true vocal
cords)

Lower Respiratory Tract

Larynx (Vocal Cords)

Lower Respiratory Tract

Trachea
Membranous tube that
consists of dense
connective tissue and
smooth muscle reinforced
with C shaped cartilage
Trachealis muscle
contraction of this smooth
muscle narrows the
diameter of the trachea

Lower Respiratory Tract

Trachea
Primary bronchi trachea divides to form two
smaller tubes.
Carina the most inferior tracheal cartilage,
which separates the opening into the two
primary bronchi. It is very sensitive to
mechanical stimulation and foreign objects
reaching it will produce a powerful cough.

Lower Respiratory Tract

Trachea

Lower Respiratory Tract

Trachea

Lower Respiratory Tract

Trachea

Lower Respiratory Tract

Tracheobronchial Tree
Beginning with the trachea, all respiratory
passageways
Main bronchi lobar bronchi (2 left, 3 right)
segmental bronchi (bronchopulmonary segments)
bronchioles terminal bronchiole
respiratory bronchioles alveolar duct alveoli

Conducting zone: From the trachea to the

terminal bronchioles
Respiratory zone: Extends from terminal
bronchioles to alveoli

Lower Respiratory Tract

Tracheobronchial Tree

Lower Respiratory Tract

Tracheobronchial Tree

Lower Respiratory Tract

Tracheobronchial Tree

Lower Respiratory Tract

Tracheobronchial Tree

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)
The tissue surrounding the alveoli contain
elastic fibers that allow the alveoli to expand
and recoil.
Type I pneumocytes form 90% of alveolar
wall, gas exchange
Type II pneumocytes secretory cells that
produce surfactant

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)
Respiratory membrane of the lungs is where
gas exchange between air and blood takes
place.
To facilitate the diffusion of gases

Thin layer of fluid lining the alveolus

Alveolar epithelium simple squamous epithelium
Basement membrane of the alveolar epithelium
Thin interstitial space
Basement membrane of capillary endothelium
Capillary endothelium simple squamous
epithelium

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)
a = alveoli, with thin
interalveolar septa
between them
b = smooth muscle in
its wall
c = blood vessel, filled
with r.b.c.'s
d = bronchiole

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)

Lower Respiratory Tract

Tracheobronchial Tree (Alveoli)

Lower Respiratory Tract

Lungs
Principal organs of respiration
Hilum region on the medial surface for entry
and exit of blood vessels, lymphatic vessels,
nerves, and primary bronchus
Root of the lung all structures passing
through the hilum
Right lung has three lobes.
Left lung has 2 lobes.

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Lower Respiratory Tract

Lungs

Muscles of Respiration
Diaphragm dome shaped, attaches to the
inner circumference of the inferior thoracic
wall.
Inspiration diaphragm, external intercostals
pectoralis minor, and scalenes.
Expiration diaphragm, abdominal muscles
and internal intercostals.

Muscles of Respiration

Muscles of Respiration

Muscles of Respiration

Respiratory Physiology (Ventilation)

The process of moving air into and out of the
lungs.
The flow of air into the lungs requires a
pressure gradient from the outside of the
body to the alveoli.
Airflow from the lungs requires a pressure
gradient in the opposite direction.
Movement of air into and out of the lungs results
from changes in thoracic volume, which causes
changes in alveolar pressure

Respiratory Physiology (Ventilation)

Respiratory Physiology (Ventilation)

Atmospheric Pressure (Patm) - pressure
exerted by the air surrounding the body. At
sea level its equal to 760mmHg. For our
purposes, we'll assume it to be constant and
assign it a value of 0mmHg.

Respiratory Physiology (Ventilation)

Intrapulmonary Pressure (Palv) - pressure
exerted by the air within the alveoli. It rises
and falls during inspiration and expiration, but
it always equalizes with atmospheric
pressure.

Respiratory Physiology (Ventilation)

Intrapleural Pressure (Pip) - pressure within
the pleural cavity. It is always lower than both
atmopsheric pressure and intrapulmonary
pressure.

Respiratory Physiology (Ventilation)

Respiratory Physiology (Ventilation)

Respiratory Physiology (Ventilation)

Respiratory Physiology (Ventilation)

Respiratory Physiology (Ventilation)

Respiratory Physiology
Lung recoil - causes the alveoli to collapse and
it results from
1. Elastic recoil caused by the elastic fibers in
alveolar walls.
2. Surface tension of the film of fluid that lines the
alveoli.

Respiratory Physiology
Surfactant - mixture of lipoprotein molecules
form a layer over the surface of the fluid
within the alveoli to reduce surface tension.
Significantly reduces the tendency of the lungs to
collapse.

Respiratory Physiology (Gas Exchange)

The factors that influence the rate of gas
diffusion across the respiratory membrane
include
1. Thickness of the membrane.
Increasing membrane thickness decreases
diffusion

Ex. Pulmonary edema, TB, Pneumonia

Respiratory Physiology (Gas Exchange)

Pulmonary edema

Respiratory Physiology (Gas Exchange)

Pulmonary edema

Respiratory Physiology (Gas Exchange)

Pulmonary edema
CXR
51 year old male
with shortness of
breath.
bilateral parahilar
infiltrates

Respiratory Physiology (Gas Exchange)

2. Surface area
Healthy normal individuals 70 square meters
Decreases in area caused by diseases
Ex. Emphysema, lung ca.

Respiratory Physiology (Gas Exchange)

Emphysema

CXR
65 y/o female with a
120 pack year history
of tobacco use.

hyperaerated lungs
flattened diaphragms
narrow heart shadow
widened rib spaces
decreased vascular
markings

Respiratory Physiology (Gas Exchange)

3. Partial pressure difference
The difference between the partial pressure
of the gas in the alveoli and the partial
pressure of gas in the blood of the pulmonary
capillaries.
Pressure gradient diffuses from high to low.

Respiratory Physiology (Gas Exchange)

Partial Pressure Difference

Respiratory Physiology (Gas Transport)

1. Molecular oxygen is carried in blood
98.5% bound to hemoglobin
1.5% in plasma.

Binds in a reversible fashion.

2. Carbon dioxide is transported in three major

ways
7% is transported dissolved in plasma.
23% transported in combination with blood proteins.
70% transported in the bicarbonate form.

Binds in a reversible fashion.

Respiratory Physiology (Gas Transport)

3.Haldane effect hemoglobin that has
released its oxygen binds more readily to
carbon dioxide than hemoglobin that has
oxygen bound to it.
4. Chloride shift Bicarbonate ion concentration
inside RBCs are lowered by exchanging
them for chloride ions. As bicarbonate ions
are produced, carrier molecules in RBC
membranes move bicarbonate ions out of the
RBCs and chloride ions into the cell.

Respiratory Physiology (Gas Transport)

4. Chloride shift Bicarbonate ion concentration
inside RBCs are lowered by exchanging
them for chloride ions. As bicarbonate ions
are produced, carrier molecules in RBC
membranes move bicarbonate ions out of the
RBCs and chloride ions into the cell.

Regulation of Respiration (CNS)

CNS
Medullary respiratory system dorsal portion
of medulla oblongota, and ventral portion.
Although the dorsal and ventral respiratory groups
are bilateral, cross communication does exist, so
that respiratory movements are symmetrical

Regulation of Respiration (CNS)

Dorsal respiratory system is most active
during inspiration but is responsible for
stimulation of the diaphragm.
Ventral respiratory group is active during both
inspiration and expiration. Stimulate the
external and internal intercostals, and
abdominal muscles.
Pontine Respiratory group neurons in the
pons, some are active in expiration or
inspiration and/or both.

Regulation of Respiration (CNS)

Regulation of Respiration
(Cerebral and Limbic System Control)
Possible to voluntarily or involuntarily to
control rate of breathing through the cerebral
cortex.
Apnea absence of breathing.
Voluntary apnea increases a greater and
greater urge to breathe due to increasing
PCO2 levels.

Regulation of Respiration
(Chemical Control of Ventilation)
The Chemoreceptors involved with the
regulation of respiration responds to changes
in hydrogen ion concentration and PO2, or
both.
Chemosensitive areas are located in the
medulla oblongota.
Peripheral Chemoreceptors are found in the
carotid and aortic bodies.

Regulation of Respiration (Effect of pH)

Chemosensitive area of the medulla
oblongota is bathed in cerebrospinal fluid and
is sensitive to changes in pH.
The chemosensitive area reacts indirectly to
change in blood pH.
Carbon dioxide levels change pH.
Respiratory system plays an important role in
acid-base balance.

Regulation of Respiration
(Effect of Carbon Dioxide)
The major regulator of respiration.
Hypercapnia greater than normal levels of
carbon dioxide in the blood.
Hypocapnia lower than normal carbon
dioxide levels.

Regulation of Respiration
(Effect of Carbon Dioxide)

Regulation of Respiration (Effect of Oxygen)

Hypoxia decrease in oxygen levels below
normal levels.
The effect of oxygen concentration in the
blood has a small role in regulation of
respiration.

O2-Hemoglobin Dissociation Curve

Describes the percentage of hemoglobin saturated with oxygen at
any given PO2