CHAPTER V

ANATOMY AND PHYSIOLOGY

This chapter will discuss the anatomy and physiology of the

digestive system which it is the affected system of the disease.

URINARY SYSTEM

The kidneys are essentially regulatory organs which maintain the

volume and composition of body fluid by filtration of the blood and
selective reabsorption or secretion of filtered solutes.
The kidneys are retroperitoneal organs (ie located behind the
peritoneum) situated on the posterior wall of the abdomen on each side of
32

the vertebral column, at about the level of the twelfth rib. The left kidney is
slightly higher in the abdomen than the right, due to the presence of the
liver pushing the right kidney down.
The kidneys take their blood supply directly from the aorta via the renal
arteries; blood is returned to the inferior vena cava via the renal veins.
Urine (the filtered product containing waste materials and water) excreted
from the kidneys passes down the fibromuscular ureters and collects in
the bladder. The bladder muscle (the detrusor muscle) is capable of
distending to accept urine without increasing the pressure inside; this
means that large volumes can be collected (700-1000ml) without highpressure

damage

to

the

renal

system

occuring.

When urine is passed, the urethral sphincter at the base of the bladder
relaxes, the detrusor contracts, and urine is voided via the urethra.

Function of the Kidneys

The kidneys form urine to excrete waste products such as urea,

ammonia, and creatinine before they could accumulate to toxic levels. It
also functions to regulate the volume of blood by either excreting or
conserving water, controlling electrolyte balances by regulating the
minerals, regulating acid-base balance and also regulation of the blood
volume, electrolytes and acid-base balance in the tissue fluids.

33

Structure of the kidney

The kidneys are a pair of bean-shaped, brownish red structures

located in the upper abdominal cavity on either side of the vertebral
column, behind the peritoneum (retroperitoneal). The average adult kidney
weighs approximately 113 to 170 g (about 4.5 oz) am dos 10 to 12 cm
long, 6 cm wide, and 2.5 thick. The right kidney is slightly lower than the
left due to the location of the liver. The upper portions of the kidneys rest
on the lower surface of the diaphragm and are enclosed by the lower rib
cage. The kidneys are embedded in adipose tissue that acts as a cushion
and is in turn covered by a fibrous connective tissue membrane called the
renal fascia, which helps to hold the kidneys in place.

34

Each kidney has an indentation called the hilus on its medial side.
At the hilus, the renal artery enters the kidney, and the renal vein and
ureter emerge. The renal artery is a branch of the abdominal aorta, and
the renal vein returns blood to the inferior vena cava returns blood to the
inferior vena cava. The ureter carries urine from the kidney to the urinary
bladder.

Internal structure of kidney

In a coronal or frontal section of the kidney, three areas can be
distinguished. The lateral middle areas are tissue layers, and the medial
area at the hilus is a cavity. The outer tissue layer is called the renal cortex
which measures approximately 1 cm wide; it is made up of renal
corpuscles and convoluted tubules. These are parts of the nephron. The
inner tissue layer is the renal medulla which is approximately 5 cm and
consists of loops of Henle and collecting tubules (also parts of nephron).
The renal medulla consists of wedge-shaped pieces called renal
pyramids. The tip of the each pyramid is its apex or papilla.

The third area is the renal pelvis; this is not a layer of tissues, but
rather a cavity formed by the expansion of the ureter within the kidney at
the hilus. Funne-shaped extensions of the renal pelvis, called calyses
(calyx), enclose the papillae of the rena; pyramids. Urine flows from the

35

renal pyramids into the calyses, then to the renal pelvis and out into the
ureter.

Structure of the nephron

It is the structural and functional unit of the kidney. Each kidney

contains approximately 1 million nephrons. It is in nephrons, with their
associated blood vessels, that urine is formed. Each nephron has two
major portions: renal corpuscle and renal tubule.

36

Renal corpuscle
It consists of a glomerulus surrounded by a Bowmans capsule. The

glumerulus is a capillary network that arises from an afferent arteriole and

empties into an efferent arteriole. The diameter of the efferent arteriole is
smaller than that of the afferent arteriole, which helps maintain a fairly high
blood pressure in the glumerulus.
Bowmans capsule (or glumerular capsule) is the expanded end of
the renal tubule; it encloses the glomerulus. The inner layer of the
Bowmans capsule is made pf podocytes; the name means foot cells and
the feet of the podocytes are on the surface of the glumerular capillaries.
The arrangement of podocytes creates pores, spaces between adjacent
feet, which make this layer very permeable. The outer layer of the
Bowmans capsule has no pores and is not permeable. The space
between the inner and outer layers of the Bowmans capsule contains
renal filtrate, the fluid that is formed from the blood in the glomerulus and
will eventually become urine.

Renal Tubule
The renal tubule continues from Bowmans capsule and consists of

the following parts: proximal convoluted tubule (in the renal cortex), loop of
Henle (or the loop of nephron, in the renal medulla) and the distal
convoluted tubules from several nephrons empty into a collecting tubule.

37

Several collecting tubules then unite to form a papillary duct that empties
urine into calyx of the renal pelvis.
All parts of the renal tubule are surrounded by the peritubular
capillaries, which arise from the efferent arteriole. The peritubular
capillaries will receive the materials reabsorbed by the renal tubules.

Blood vessels of the kidney

The pathway of blood flow through the kidney is an essential part of
the process of urine formation. Blood from the abdominal aorta enters the
renal artery, which branches extensively within the kidney into smaller
arteries. The smallest arteries give rise to afferent arterioles in the renal
cortex. From the different arterioles, blood flows into the glomeruli
(capillaries), to efferent arterioles, to peritubular capillaries, to veins within
the kidney, to the renal vein, and finally to the inferior vena cave.

In this pathway there are two sets of capillaries and that it is in

capillaries that exchanges take place between blood and the surrounding
tissues. Therefore, in the kidneys there are two sites of exchange. The
exchanges that take place between the nephrons and the capillaries of the
kidneys will form urine from blood plasma.

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Ureters

Each ureter extends from the hilus of a kidney to the lower,

posterior side of the urinary bladder. Like the kidneys. The ureters are
retroperitoneal, that is behind the peritoneum of the dorsal abdominal
cavity.
The wall of the ureter is composed of smooth muscles which
contracts in peristaltic waves to propel urine toward the urinary bladder. As
39

the bladder fills, it expands and compresses the lower ends of the ureters
to prevent backflow of urine.

Urinary bladder
It is a muscular sac below the peritoneum and behind the pubic
bones. In women, the bladder is inferior to the uterus; in men, the bladder
is superior to the prostate gland. The bladder is a reservoir for
accumulating urine, and it contracts to eliminate urine.
The mucosa of the bladder is transitional epithelium, which permits
expansion without tearing the lining. When the bladder is empty, the
mucosa appears wrinkled; these folds are rugae, which also permit
expansion. On the floor of the bladder is a triangular area called trigone,
which has no rugae and does no expand. The points of the triangle are the
openings of the two ureters and that of the urethra.
The smooth muscle layer in the wall of the bladder is called
detrusor muscle. It is a muscle in the form of sphere; when it contracts it
becomes a smaller sphere, and its volume diminishes. Around the opening
of the urethra the muscle fibers of the detrusor form the opening of the
internal urethral sphincter (or sphincter of the bladder), which is
involuntary.

40

Urethra

The urethra carries the urine from the bladder to the exterior. The
external urethral sphincter is made if the surrounding skeletal muscle of
the pelvic floor, and is under voluntary control. In women, the urethra is 1

to 1.5 inches (2.5 to 4 cm) long and is anterior to vagina. In men, the
urethra is 7 to 8 inches (17 to 20 cm) long. The first part just outside the
bladder is called the prostatic urethra because it is surrounded by the
prostate gland. The next inch is the membranous urethra, around in which
the external urethral sphincter. The longest portion is the cavernous
urethra (or spongy or penile urethra) which passes through the cavernous
(or erectile) tissue of the penis. The male urethra carries both urine and
semen.

Physiology of Urinary System

41

Urinary Formation
The healthy human body is composed of approximately 60% of
water. Water balance is regulated by the kidneys and results in the
formation of urine. Urine is formed in the nephrons through a complex
three-step process: glomerular filtration, tubular reabsorption and tubular
secretion. The various substances normally filtered by the glomerulus,
reabsorbed by the tubules, and excreted in the urine include sodium,
chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid.
Within the tubule, some of these substances are selectively reabsorbed
into the blood into the filtrate as it travels down the tubule.

Glomerular Filtration
The normal blood flow through the kidneys is about 1200 ml/min.

As blood flows into the glomerulus from an afferent arteriole, filtration

occurs. The filtrated fluid, also known as filtrate or ultrafiltrate, then enters
the renal tubules. Under normal condition, about 20% of the blood passing
through the glomeruli is filtered into the nephron, amounting to about 180
L/day of filtrate. The filtrate normally consists of water, electrolytes, and
other small molecules are allowed to pass, whereas larger molecules stay
in the bloodstream. Many factors can alter this blood flow and pressure,
including hypotension, decreased oncotic pressure in the blood, and
increased pressure in the renal tubules from an obstruction.

Tubular Reabsorption and Tubular Secretion

42

The second and third steps of urine formation occur in the renal
tubules. In tubular reabsorption, a substance moves from the filtrate back
into the peritubular capillaries or vasa recta. In tubular secretion, a
substance moves from the peritubular capillaries or vasa recta into tubular
filtrate. Of the 180 L of filtrate that the kidneys produce each day, 99% is
reabsorbed into the bloodstream, resulting the formation of 1 L to 2 L of
urine each day. Although most reabsorption occurs in proximal tubules,
reabsorption occurs along the entire tubule. Reabsorption and secretion in
the tubule frequently involve passive and active transport and may require
the use of energy. Filtrate becomes concentrated in the distal tubule and
collecting ducts under hormonal influence and becomes urine, which then
enters the renal pelvis.

THE HUMAN DIGESTIVE SYSTEM

43

The digestive system consists of the digestive tract, a tube

extending from the mouth to anus. The functions of the GI tract include
secretion, digestion, absorption, motility, and elimination. Foods and fluids
are ingested, swallowed, and propelled along the lumen of the GI tract to
the anus for elimination.

Oral cavity
The
mouth or oral cavity is the first part of the digestive tract. It includes the
buccal mucosa, lips, tongue, hard palate, soft palate, teeth and salivary
glands.
The different types of teeth function to prepare for digestion by
cutting, tearing, crushing, or grinding the food. Swallowing begins after
food is taken into the mouth and chewed. Saliva secreted in response to
the presence of food in the mouth and begins to soften the food. Saliva

44

contains mucin and an enzyme called salivary amylase, which begins the
breakdown of carbohydrates.
Pharynx
The pharynx or throat, which connects the mouth with the
esophagus, consists of three parts: the nasopharynx, oropharynx, and
laryngopharynx.

Esophagus
The esophagus is a muscular tube, lined with moist stratified
squamous epithelium that extends from the pharynx to the stomach. It
transports food from the pharynx to the stomach. At the upper end of the
esophagus is a sphincter referred to as the upper esophageal sphincter.
When at rest, the UES is closed to prevent air into the esophagus during
respiration.

The

portion

of

the

esophagus

proximal

to

the

gastroesophageal junction is referred to as the lower esophageal

45

sphincter. When at rest, the LES is normally closed to prevent reflux of

gastric contents to the esophagus.

Stomach
The stomach is a glandular digestive and endocrine organ located
in the midline and left upper quadrant of the abdomen. The surface of the
stomach is covered with rugae, or folds of mucosa and submucosa that
extend longitudinally. Smooth muscle cells that line the stomach are
responsible for gastric motility. Parietal cells lining the wall of the stomach
secrete hydrochloric acid, whereas chief cells secret pepsinogen.
The stomach performs several functions. Following the ingestion of
the food, the stomach functions as a food reservoir. The primary function
of the stomach is to begin the digestive process by using both mechanical
movements and chemical secretions. The stomach also mixes or churns
the food, breaking apart the large molecules and mixing them with gastric
secretions to form chimes which the empties into the duodenum.

46

Pancreas
The pancreas is a fish shaped gland located in the upper left
abdominal quadrant between the curve of the duodenum and the spleen
and is about 6 inches in length. The pancreas consists of acinar cells,
which

secretes

enzymes

that

are

necessary

for

digestion

of

carbohydrates, fats and proteins.

Liver
The liver is the largest organ in the body and is mainly located at
the right upper quadrant of the abdomen. The liver functions I metabolism
of proteins considered vital for human life. The livers role in carbohydrate
metabolism involves storing and releasing glycogen as the bodys energy
requirements change. The liver synthesizes, breaks down and temporarily
stores fatty acids and triglycerides. The liver forms and continually
secretes bile. Bile is essential for emulsification of fat.
Gallbladder
The gallbladder is a sac about 3 to 4 inches long located on the
undersurfaces of the right lobe of the liver. Bile in the hepatic duct of the
liver flows through the cystic duct into the gallbladder, which stores until it
is needed in the small intestine. The gallbladder also concentrates bile by
absorbing water. When the fatty foods enter the duodenum, the enter
endocrine

cell

of

the

duodenal

mucosa

secrete

the

hormone

cholecystokinin, which stimulate contraction of the smooth muscle in the

47

wall of the gallbladder, which forces bile into the cystic duct then into the
common bile duct, and on into the duodenum.
Small intestine
The small intestine is the site where most of the chemical and
mechanical digestion is carried out, and where virtually all of the
absorption of useful materials is carried out. The whole of the small
intestine is lined with an absorptive mucosal type, with certain
modifications for each section. The intestine also has a smooth muscle
wall with two layers of muscle; rhythmical contractions force products of
digestion through the intestine (peristalisis). There are three main sections
to the small intestine;

The duodenum forms a 'C' shape around the head of the pancreas.
Its main function is to neutralize the acidic gastric contents (called
'chyme') and to initiate further digestion; Brunners glands in the
submucosa secrete alkaline mucus which neutralises the chyme
and protects the surface of the duodenum.

The jejunum and the ileum. The jejunum and the ileum are the
greatly coiled parts of the small intestine, and together are about 46 metres long; the junction between the two sections is not welldefined. The mucosa of these sections is highly folded (the folds
are called plicae), increasing the surface area available for
absorption dramatically.

Large intestine
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By the time digestive products reach the large intestine, almost all
of the nutritionally useful products have been removed. The large intestine
removes water from the remainder, passing semi-solid feces into the
rectum to be expelled from the body through the anus. The mucosa (M) is
arranged into tightly-packed straight tubular glands (G) which consist of
cells specialized for water absorption and mucus-secreting goblet cells to
aid the passage of feces. The large intestine also contains areas of
lymphoid tissue (L); these can be found in the ileum too (called Peyer's
patches), and they provide local immunological protection of potential
weak-spots in the body's defenses. As the gut is teeming with bacteria,
reinforcement of the standard surface defenses seems only sensible.
Rectum and Anus
The rectum is about eight inches long and serves, basically, as a
warehouse for feces. It hooks up with the sigmoid colon to the north and
with the anal canal to the south.

49

The rectum has little shelves in it called transverse folds. These

folds help keep stool in place until youre ready to go to the bathroom.
When youre ready, stool enters the lower rectum, moves into the anal
canal, and then passes through the anus on its way out. The rectum
intestine acts as a temporary storage facility for feces. As the rectal walls
expand due to the materials filling it from within, stretch receptors from the
nervous system located in the rectal walls stimulate the desire to defecate.
If the urge is not acted upon, the material in the rectum is often returned to
the colon where more water is absorbed. If defecation is delayed for a
prolonged period of time constipation and hardened feces results. When
the rectum becomes full, the increase in intrarectal pressure forces the
walls of the anal canal apart, allowing the fecal matter to enter the canal.
The rectum shortens as material is forced into the anal canal and
peristaltic waves propel the feces out of the rectum. The internal and
external sphincter allows the feces to be passed by muscles pulling the
anus up over the exiting feces.

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CARDIOVASCULAR SYSTEM

Adequate perfusion oxygenates and nourishes body tissues and

depends in part on a properly functioning cardiovascular system.
Adequate blood flow depends on the efficient pumping action of the heart,
patent and responsive blood vessels and adequate circulating blood
volume. The cardiovascular system involves the heart, blood vessels and
blood.
HEART
The heart is a hollow muscular organ located in the center of the
thorax, where it occupies the space between the lungs and the rests on
the diaphragm. The heart is composed of three layers; the inner layer or
endocardium, consists of endothelial tissue and lines the inside of the
heart and valves. The middle layer or myocardium is made up of muscle
fibers and is responsible for the pumping action. The exterior layer of the
heart is the epicardium.

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The heart pumps blood to the tissues, supplying them with oxygen
and other nutrients. The pumping action of the heart is accomplished by
the rhythmic contraction and relaxation of its muscular wall. During systole
(contraction of the muscle). The chambers of the heart become smaller as
the blood is ejected. During diastole (relaxation of the muscle), the heart
chambers fill with blood in preparation of subsequent ejection. Each
ventricle ejects approximately 70 mL of blood per beat and has an output
of approximately 5 L per minute.
HEART CHAMBERS

The four chambers of the heart constitute the right and left side
pumping systems. The right side of the heart, made up of the right atrium
and right ventricle, distributes venous blood (deoxygenated blood) to the
lungs via the pulmonary artery (pulmonary circulation) for oxygenation.
The right atrium receives blood returning from the superior vena cava,
inferior vena cava and coronary sinus.
The left side of the heart, composed of the left atrium and ventricle,
distributes oxygenated blood to the remainder of the body via the aorta
(systemic circulation). The left atrium receives oxygenated blood from the
pulmonary circulation via the pulmonary veins.

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HEART VALVES
The four valves in the heart permit blood to flow in only one
direction. The valves which are composed of thin leaflets of fibrous tissue,
open and close in response to the movement of blood and pressure
changes within the chambers.

Atrioventricular valves separate the atria from the ventricles; there

are 2 atrioventricular valves which are the tricuspid and bicuspid valves.
Tricuspid valve is composed of three cusps or leaflets, separates the right
atrium from the right ventricle. The mitral or bicuspid valve, lies between
the left atrium and left ventricle.
Semilunar valves are composed of three half-moon-like leaflets.
The valve between the right ventricle and the pulmonary artery is called
the pulmonic valve; while the valve between the left ventricle and the aorta
is called the aortic valve.

53

ARTERIES AND ARTERIOLES

Arteries are thick-walled structures that carry blood from the heart
to the tissues. The aorta, which has a diameter of approximately 25mm (I
inch), gives rise to numerous branches which divide into smaller arteries
that are about 4 mm in diameter. The walls of the arteries and arterioles
are composed of three layers: the intima, an inner endothelial cell layer,
the media, a middle layer of smooth elastic tissue; and the adventitia, an
outer layer of connective tissue.
Arteries distribute oxygenated blood from the left side of the heart
to the tissues, whereas the veins carry deoxygenated blood from the
tissues to the right side of the heart.

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CAPILLARIES

Capillaries are composed of a single layer of endothelial cells. This

thin-walled structure permits rapid and efficient transport of nutrients to the
cells and removal of metabolic wastes. Capillary vessels, located within
the tissues, connect the arterial and venous systems and are the site of
exchange of nutrients and metabolic wastes between the circulatory
system and the tissues.
VEINS AND VENULES
Capillaries join to form larger vessels called venules, which join to
form veins. The venous system is therefore structurally analogous to the
arterial system; venous correspond to arterioles. The walls of the veins, in
contrast to those of the arteries are thinner and considerably less
muscular.

55

LYMPHATIC VESSELS

Lymphatic vessels are a complex network of thin-walled vessels

similar to the blood capillaries. This network collects lymphatic fluid from
tissues and organs and transports the fluid to the venous circulation. The
lymphatic system complements the function of the circulatory system.
Lymphatic vessels transport lymph and tissue fluids from the interstitial
space to systemic veins.
BLOOD
The cellular component of blood consists of three primary cell
types: RBCs, WBCs and platelets. Circulating through the vascular
system and serving as a link between body organs, the blood carries
oxygen absorbed from the lungs and nutrients absorbed from the
gastrointestinal tract to the body cells for cellular metabolism. Blood also
carries waste products produced by cellular metabolism to the lungs, skin,
liver and kidneys, where they are transformed and eliminated from the
body. Blood also carries hormones, antibodies and other substances to
their sites of action or use.
56

57

Anatomy of Respiratory System

The Respiratory System is crucial to every human being. Without it, we

would cease to live outside of the womb.
Respiration is the act of breathing:

inhaling (inspiration) - taking in oxygen

exhaling (expiration) - giving off carbon dioxide

58

The respiratory system is made up of the organs involved in breathing and

consists of the:

nose

pharynx

larynx

trachea

bronchi

lungs

The upper respiratory tract includes the:

nose

nasal cavity

ethmoidal air cells

frontal sinuses

maxillary sinus

larynx

trachea

The lower respiratory tract includes the:

59

lungs

bronchi

alveoli

The lungs take in oxygen, which all cells throughout the body need to
live and carry out their normal functions. The lungs also get rid of carbon
dioxide, a waste product of the body's cells.
The lungs are a pair of cone-shaped organs made up of spongy,
pinkish-gray tissue. They take up most of the space in the chest, or the
thorax (the part of the body between the base of the neck and diaphragm).
The lungs are inside in a membrane called the pleura.
The lungs are separated from each other by the mediastinum, an area
that contains the following:

heart and its large vessels

trachea (windpipe)

esophagus

thymus

lymph nodes

The right lung has three sections, called lobes. The left lung has two
lobes. When you breathe, the air:
60

enters the body through the nose or the mouth

travels down the throat through the larynx (voice box) and trachea
(windpipe)

goes into the lungs through tubes called main-stem bronchi

o

one main-stem bronchus leads to the right lung and one to

the left lung

in the lungs, the main-stem bronchi divide into smaller

bronchi

and then into even smaller tubes called bronchioles

bronchioles end in tiny air sacs called alveoli

Physiology of Respiratory System

Functions
The function of the respiratory system is to give us a surface area for
exchanging gases between the air and our circulating blood. It moves that
air to and from the surfaces of the lungs while it protects the lungs from
dehydration, temperature changes and unwelcome pathogens. It also
plays a part in making sounds such as talking, singing, other nonverbal
sounds and works with the central nervous system for the ability to smell.
The four processes of respiration:
61

1. BREATHING or ventilation
2. EXTERNAL RESPIRATION, which is the exchange of gases
(oxygen and carbon dioxide) between inhaled air and the blood.
3. INTERNAL RESPIRATION, which is the exchange of gases
between the blood and tissue fluids.
4. CELLULAR RESPIRATION
The main processes, the respiratory system serves for:

REGULATION OF BLOOD pH, which occurs in coordination with

the kidneys, and as a

DEFENSE AGAINST MICROBES

Control of body temperature due to loss of evaporate during

expiration

Breathing and Lung Mechanics

Ventilation is the exchange of air between the external environment and
the alveoli. Air moves by bulk flow from an area of high pressure to low
pressure. All pressures in the respiratory system are relative to
atmospheric pressure (760mmHg at sea level). Air will move in or out of
the lungs depending on the pressure in the alveoli. The body changes the
pressure in the alveoli by changing the volume of the lungs. As volume
increases pressure decreases and as volume decreases pressure

62

increases. There are two phases of ventilation; inspiration and expiration.

During each phase the body changes the lung dimensions to produce a
flow of air either in or out of the lungs.
The body is able to stay at the dimensions of the lungs because of the
relationship of the lungs to the thoracic wall. Each lung is completely
enclosed in a sac called the pleural sac. Two structures contribute to the
formation of this sac. The parietal pleura is attached to the thoracic wall
where as the visceral pleura is attached to the lung itself. In-between
these two membranes is a thin layer of intrapleural fluid. The intrapleural
fluid completely surrounds the lungs and lubricates the two surfaces so
that they can slide across each other. Changing the pressure of this fluid
also allows the lungs and the thoracic wall to move together during normal
breathing. Much the way two glass slides with water in-between them are
difficult to pull apart, such is the relationship of the lungs to the thoracic
wall.
The rhythm of ventilation is also controlled by the "Respiratory Center"
which is located largely in the medulla oblongata of the brain stem. This is
part of the autonomic system and as such is not controlled voluntarily (one
can increase or decrease breathing rate voluntarily, but that involves a
different part of the brain). While resting, the respiratory center sends out
action potentials that travel along the phrenic nerves into the diaphragm
and the external intercostal muscles of the rib cage, causing inhalation.

63

Relaxed exhalation occurs between impulses when the muscles relax.

Normal adults have a breathing rate of 12-20 respirations per minute.
The Pathway of Air
When one breathes air in at sea level, the inhalation is composed of
different gases. These gases and their quantities are Oxygen which
makes up 21%, Nitrogen which is 78%, Carbon Dioxide with 0.04% and
others with significantly smaller portions.

Diagram of the Pharynx.

In the process of breathing, air enters into the nasal cavity through the
nostrils and is filtered by coarse hairs (vibrissae) and mucous that are
found there. The vibrissae filter macroparticles, which are particles of large
size. Dust, pollen, smoke, and fine particles are trapped in the mucous
that lines the nasal cavities (hollow spaces within the bones of the skull
that warm, moisten, and filter the air). There are three bony projections

64

inside the nasal cavity. The superior, middle, and inferior nasal
conchae. Air passes between these conchae via the nasal meatuses.
Air then travels past the nasopharynx, oropharynx, and laryngopharynx,
which are the three portions that make up the pharynx. The pharynx is a
funnel-shaped tube that connects our nasal and oral cavities to the larynx.
The tonsils which are part of the lymphatic system, form a ring at the
connection of the oral cavity and the pharynx. Here, they protect against
foreign invasion of antigens. Therefore the respiratory tract aids the
immune system through this protection. Then the air travels through the
larynx. The larynx closes at the epiglottis to prevent the passage of food
or drink as a protection to our trachea and lungs. The larynx is also our
voicebox; it contains vocal cords, in which it produces sound. Sound is
produced from the vibration of the vocal cords when air passes through
them.
The trachea, which is also known as our windpipe, has ciliated cells and
mucous secreting cells lining it, and is held open by C-shaped cartilage
rings. One of its functions is similar to the larynx and nasal cavity, by way
of protection from dust and other particles. The dust will adhere to the
sticky mucous and the cilia helps propel it back up the trachea, to where it
is either swallowed or coughed up. The mucociliary escalator extends
from the top of the trachea all the way down to the bronchioles, which we

65

will discuss later. Through the trachea, the air is now able to pass into the
bronchi.
Inspiration
Inspiration is initiated by contraction of the diaphragm and in some
cases the intercostals muscles when they receive nervous impulses.
During normal quiet breathing, the phrenic nerves stimulate the
diaphragm to contract and move downward into the abdomen. This
downward movement of the diaphragm enlarges the thorax. When
necessary, the intercostal muscles also increase the thorax by contacting
and drawing the ribs upward and outward.
As the diaphragm contracts inferiorly and thoracic muscles pull the chest
wall outwardly, the volume of the thoracic cavity increases. The lungs are
held to the thoracic wall by negative pressure in the pleural cavity, a very
thin space filled with a few milliliters of lubricating pleural fluid. The
negative pressure in the pleural cavity is enough to hold the lungs open in
spite of the inherent elasticity of the tissue. Hence, as the thoracic cavity
increases in volume the lungs are pulled from all sides to expand, causing
a drop in the pressure (a partial vacuum) within the lung itself (but note
that this negative pressure is still not as great as the negative pressure
within the pleural cavity--otherwise the lungs would pull away from the
chest wall). Assuming the airway is open, air from the external
environment then follows its pressure gradient down and expands the
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alveoli of the lungs, where gas exchange with the blood takes place. As
long as pressure within the alveoli is lower than atmospheric pressure air
will continue to move inwardly, but as soon as the pressure is stabilized air
movement stops.
Expiration
During quiet breathing, expiration is normally a passive process and does
not require muscles to work (rather it is the result of the muscles relaxing).
When the lungs are stretched and expanded, stretch receptors within the
alveoli send inhibitory nerve impulses to the medulla oblongata, causing it
to stop sending signals to the rib cage and diaphragm to contract. The
muscles of respiration and the lungs themselves are elastic, so when the
diaphragm and intercostal muscles relax there is an elastic recoil, which
creates a positive pressure (pressure in the lungs becomes greater than
atmospheric pressure), and air moves out of the lungs by flowing down its
pressure gradient.
Although the respiratory system is primarily under involuntary control, and
regulated by the medulla oblongata, we have some voluntary control over
it also. This is due to the higher brain function of the cerebral cortex.
When under physical or emotional stress, more frequent and deep
breathing is needed, and both inspiration and expiration will work as active
processes. Additional muscles in the rib cage forcefully contract and push

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air quickly out of the lungs. In addition to deeper breathing, when coughing
or sneezing we exhale forcibly. Our abdominal muscles will contract
suddenly (when there is an urge to cough or sneeze), raising the
abdominal pressure. The rapid increase in pressure pushes the relaxed
diaphragm up against the pleural cavity. This causes air to be forced out of
the lungs.
Another function of the respiratory system is to sing and to speak. By
exerting conscious control over our breathing and regulating flow of air
across the vocal cords we are able to create and modify sounds.
Lung Compliance
Lung Compliance is the magnitude of the change in lung volume
produced by a change in pulmonary pressure. Compliance can be
considered the opposite of stiffness. A low lung compliance would mean
that the lungs would need a greater than average change in intrapleural
pressure to change the volume of the lungs. A high lung compliance would
indicate that little pressure difference in intrapleural pressure is needed to
change the volume of the lungs. More energy is required to breathe
normally in a person with low lung compliance. Persons with low lung
compliance due to disease therefore tend to take shallow breaths and
breathe more frequently.

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Determination of Lung Compliance Two major things determine lung

compliance. The first is the elasticity of the lung tissue. Any thickening of
lung tissues due to disease will decrease lung compliance. The second is
surface tensions at air water interfaces in the alveoli. The surface of the
alveoli cells is moist. The attractive force, between the water cells on the
alveoli, is called surface tension. Thus, energy is required not only to
expand the tissues of the lung but also to overcome the surface tension of
the water that lines the alveoli.
To overcome the forces of surface tension, certain alveoli cells (Type II
pneumocytes) secrete a protein and lipid complex called ""Surfactant,
which acts like a detergent by disrupting the hydrogen bonding of water
that lines the alveoli, hence decreasing surface tension.
Control of respiration
Central control
Peripheral control
CO2 is converted to HCO3; most CO2 produced at the tissue cells is carried
to lungs in the form of HCO3

CO2 & H2O form carbonic acid (H2CO3)

changes to HCO3 & H+ ions

result is H+ ions are buffered by plasma proteins

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Respiratory System: Upper and Lower Respiratory Tracts

For the sake of convenience, we will divide the respiratory system in to the
upper and lower respiratory tracts:
Upper Respiratory Tract
The upper respiratory tract consists of the nose and the pharynx. Its
primary function is to receive the air from the external environment and
filter, warm, and humidify it before it reaches the delicate lungs where gas
exchange will occur.
Air enters through the nostrils of the nose and is partially filtered by the
nose hairs, then flows into the nasal cavity. The nasal cavity is lined with
epithelial tissue, containing blood vessels, which help warm the air; and
secrete mucous, which further filters the air. The endothelial lining of the
nasal cavity also contains tiny hairlike projections, called cilia. The cilia
serve to transport dust and other foreign particles, trapped in mucous, to
the back of the nasal cavity and to the pharynx. There the mucus is either
coughed out, or swallowed and digested by powerful stomach acids. After
passing through the nasal cavity, the air flows down the pharynx to the
larynx.
Lower Respiratory Tract

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The lower respiratory tract starts with the larynx, and includes the trachea,
the two bronchi that branch from the trachea, and the lungs themselves.
This is where gas exchange actually takes place.
1. Larynx
The larynx (plural larynges), colloquially known as the voice box, is an
organ in our neck involved in protection of the trachea and sound
production. The larynx houses the vocal cords, and is situated just below
where the tract of the pharynx splits into the trachea and the esophagus.
The larynx contains two important structures: the epiglottis and the vocal
cords.
The epiglottis is a flap of cartilage located at the opening to the larynx.
During swallowing, the larynx (at the epiglottis and at the glottis) closes to
prevent swallowed material from entering the lungs; the larynx is also
pulled upwards to assist this process. Stimulation of the larynx by ingested
matter produces a strong cough reflex to protect the lungs. Note: choking
occurs when the epiglottis fails to cover the trachea, and food becomes
lodged in our windpipe.
The vocal cords consist of two folds of connective tissue that stretch and
vibrate when air passes through them, causing vocalization. The length
the vocal cords are stretched determines what pitch the sound will have.
The strength of expiration from the lungs also contributes to the loudness

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of the sound. Our ability to have some voluntary control over the
respiratory system enables us to sing and to speak. In order for the larynx
to function and produce sound, we need air. That is why we can't talk
when we're swallowing.
1. Trachea
2. Bronchi
3. Lungs

Homeostasis and Gas Exchange

Gas exchange
Homeostasis is maintained by the respiratory system in two ways: gas
exchange and regulation of blood pH. Gas exchange is performed by the
lungs by eliminating carbon dioxide, a waste product given off by cellular
respiration. As carbon dioxide exits the body, oxygen needed for cellular
respiration enters the body through the lungs. ATP, produced by cellular
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respiration, provides the energy for the body to perform many functions,
including nerve conduction and muscle contraction. Lack of oxygen affects
brain function, sense of judgment, and a host of other problems.
Gas Exchange
Gas exchange in the lungs and in the alveoli is between the alveolar air
and the blood in the pulmonary capillaries. This exchange is a result of
increased concentration of oxygen, and a decrease of C02. This process
of exchange is done through diffusion.
External Respiration
External respiration is the exchange of gas between the air in the alveoli
and the blood within the pulmonary capillaries. A normal rate of respiration
is 12-25 breaths per minute. In external respiration, gases diffuse in either
direction across the walls of the alveoli. Oxygen diffuses from the air into
the blood and carbon dioxide diffuses out of the blood into the air. Most of
the carbon dioxide is carried to the lungs in plasma as bicarbonate ions
(HCO3-). When blood enters the pulmonary capillaries, the bicarbonate
ions and hydrogen ions are converted to carbonic acid (H2CO3) and then
back into carbon dioxide (CO2) and water. This chemical reaction also
uses up hydrogen ions. The removal of these ions gives the blood a more
neutral pH, allowing hemoglobin to bind up more oxygen. De-oxygenated
blood "blue blood" coming from the pulmonary arteries, generaly has an

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oxygen partial pressure (pp) of 40 mmHg and CO pp of 45 mmHg.

Oxygenated blood leaving the lungs via the pulmonary veins has a O2 pp
of 100 mmHg and CO pp of 40 mmHg. It should be noted that alveolar O2
pp is 105 mmHg, and not 100 mmHg. The reason why pulmonary venous
return blood has a lower than expected O2 pp can be explained by
"Ventilation Perfusion Mismatch".
Internal Respiration
Internal respiration is the exchanging of gases at the cellular level.
The Passage Way from the Trachea to the Bronchioles
There is a point at the inferior portion of the trachea where it branches into
two directions that form the right and left primary bronchus. This point is
called the Carina which is the keel-like cartilage plate at the division point.
We are now at the Bronchial Tree. It is named so because it has a series
of respiratory tubes that branch off into smaller and smaller tubes as they
run throughout the lungs.
Right and Left Lungs

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Diagram of the lungs

The Right Primary Bronchus is the first portion we come to, it then
branches off into the Lobar (secondary) Bronchi, Segmental (tertiary)
Bronchi, then to the Bronchioles which have little cartilage and are lined
by simple cuboidal epithelium (See fig. 1). The bronchi are lined by
pseudostratified columnar epithelium. Objects will likely lodge here at the
junction of the Carina and the Right Primary Bronchus because of the
vertical structure. Items have a tendency to fall in it, where as the Left
Primary Bronchus has more of a curve to it which would make it hard to
have things lodge there.
The Left Primary Bronchus has the same setup as the right with the
lobar, segmental bronchi and the bronchioles.
The lungs are attached to the heart and trachea through structures that
are called the roots of the lungs. The roots of the lungs are the bronchi,

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pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves.

These structures enter and leave at the hilus of the lung which is "the
depression in the medial surface of a lung that forms the opening through
which the bronchus, blood vessels, and nerves pass" (medlineplus.gov).
There are a number of terminal bronchioles connected to respiratory
bronchioles which then advance into the alveolar ducts that then
become alveolar sacs. Each bronchiole terminates in an elongated space
enclosed by many air sacs called alveoli which are surrounded by blood
capillaries. Present there as well, are Alveolar Macrophages, they ingest
any microbes that reach the alveoli. The Pulmonary Alveoli are
microscopic, which means they can only be seen through a microscope,
membranous air sacs within the lungs. They are units of respiration and
the site of gas exchange between the respiratory and circulatory systems.
Cellular Respiration
First the oxygen must diffuse from the alveolus into the capillaries. It is
able to do this because the capillaries are permeable to oxygen. After it is
in the capillary, about 5% will be dissolved in the blood plasma. The other
oxygen will bind to red blood cells. The red blood cells contain hemoglobin
that carries oxygen. Blood with hemoglobin is able to transport 26 times
more oxygen than plasma without hemoglobin. Our bodies would have to
work much harder pumping more blood to supply our cells with oxygen

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without the help of hemoglobin. Once it diffuses by osmosis it combines

with the hemoglobin to form oxyhemoglobin.
Now the blood carrying oxygen is pumped through the heart to the rest of
the body. Oxygen will travel in the blood into arteries, arterioles, and
eventually capillaries where it will be very close to body cells. Now with
different conditions in temperature and pH (warmer and more acidic than
in the lungs), and with pressure being exerted on the cells, the hemoglobin
will give up the oxygen where it will diffuse to the cells to be used for
cellular respiration, also called aerobic respiration. Cellular respiration is
the process of moving energy from one chemical form (glucose) into
another (ATP), since all cells use ATP for all metabolic reactions.
It is in the mitochondria of the cells where oxygen is actually consumed
and carbon dioxide produced. Oxygen is produced as it combines with
hydrogen ions to form water at the end of the electron transport chain (see
chapter on cells). As cells take apart the carbon molecules from glucose,
these get released as carbon dioxide. Each body cell releases carbon
dioxide into nearby capillaries by diffusion, because the level of carbon
dioxide is higher in the body cells than in the blood. In the capillaries,
some of the carbon dioxide is dissolved in plasma and some is taken by
the hemoglobin, but most enters the red blood cells where it binds with
water to form carbonic acid. It travels to the capillaries surrounding the

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lung where a water molecule leaves, causing it to turn back into carbon
dioxide. It then enters the lungs where it is exhaled into the atmosphere.
Lung Capacity

The normal volume moved in or out of the lungs during quiet breathing is
called tidal volume. When we are in a relaxed state, only a small amount
of air is brought in and out, about 500 mL. You can increase both the
amount you inhale, and the amount you exhale, by breathing deeply.
Breathing in very deeply is Inspiratory Reserve Volume and can
increase lung volume by 2900 mL, which is quite a bit more than the tidal
volume of 500 mL. We can also increase expiration by contracting our
thoracic and abdominal muscles. This is called expiratory reserve
volume and is about 1400 ml of air. Vital capacity is the total of tidal,
inspiratory reserve and expiratory reserve volumes; it is called vital
capacity because it is vital for life, and the more air you can move, the
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better off you are. There are a number of illnesses that we will discuss
later in the chapter that decrease vital capacity. Vital Capacity can vary a
little depending on how much we can increase inspiration by expanding
our chest and lungs. Some air that we breathe never even reaches the
lungs! Instead it fills our nasal cavities, trachea, bronchi, and bronchioles.
These passages aren't used in gas exchange so they are considered to be
dead air space. To make sure that the inhaled air gets to the lungs, we
need to breathe slowly and deeply. Even when we exhale deeply some air
is still in the lungs,(about 1000 ml) and is called residual volume. This air
isn't useful for gas exchange. There are certain types of diseases of the
lung where residual volume builds up because the person cannot fully
empty the lungs. This means that the vital capacity is also reduced
because their lungs are filled with useless air.

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