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itself
- PARIETAL PLEURA: attached inside the chest
LUNGS wall/ thoracic cavity
Functions: NOSE
1. Gas exchange - Very important because it is where air enters
- Transport of gas from the atmosphere towards - Although we can breathe through our mouth, it is
the lungs, to the blood, to the different tissues. better if we breathe through our nose because:
- Elimination of CO2 - it humidifies the air
2. Host defense - entraps of clear particles more than 10m in size
- It secretes several inflammatory mediators, (protective function: it acts as protective barrier)
immunoglobulins. - sense of smell (olfactory sense)
3. Metabolic organ - 50% of the total resistance of the airway
- It secretes several hormones - Host defense
- Ex. Dopamine, Serotonin, Angiotensin - Secretes several inflammatory mediators,
immunoglobulins.
Volume: 4 Liters
Surface Area: 85 m2 PARANASAL SINUSES
Demonstrates functional unity - Frontal, Sphenoid, Ethmoid, Maxillary
Weight (Adults): approximately 1 kg - It lightens the skull
- For voice resonance
- In SINUSITIS, changes in voice may be evident.
LARYNX
LEFT LUNG
- Divided into 2 LOBES (upper, lower)
- Divided by OBLIQUE FISSURE
- It has the LINGULA (part of the lungs where the 1
heart lies)
LOWER AIRWAY
- Undergoes dichotomous branching (divides
into twos)
- This tubular structure is composed of cartilage
and muscle
- Bronchi and bronchioles differ in:
- Size
- Cartilage
- Epithelium
- Blood supply
2. BRONCHIAL CIRCULATION
- It is where gas exchange occurs. - 2 Bronchial Arteries
- Polygonal in shape. - Supplies the bronchi, bronchioles, blood vessels,
- Type 1 and Type 2 cells. nerves, lymph nodes and visceral pleura.
- TYPE1 CELLS - 1/3 of the blood returns to the atrium
- 96-98% of the surface area - Rest of the blood to the left atrium via the
- Thin cytoplasm pulmonary veins.
- Basement membrane fused with the capillary
endothelium INNERVATION
- When we breathe, our breathing is AUTOMATIC
TYPE2 CELLS and UNDER CNS CONTROL
Small and cuboidal - Autonomic Nervous system
Although they are more numerous that Type1 -
cells, they only cover around 2-4% of surface Parasympathetic stimulation:
area because they are small and cuboidal. BRONCHOCONSTRICTION
- Accessory Muscles:
A. STERNOCLEIDOMASTOID 1. PERICILIARY FLUID
B. SCALENE MUSCLES Secreted by the pseudostratified columnar
epithelium
2. MUCUS GLANDS
2. At EXPIRATION - Secreted by mucus and serous cells
- In ordinary quiet respiration, EXPIRATION is
purely PASSIVE. It is accomplished when the Functions:
muscles of inspiration relax. - To remove particles and particulate in the lungs
- In forced expiration: (protective function)
a. Rectus abdominis, oblique and transverse
muscles PULMONARY SURFACTANT
b. Internal intercostals Secreted by Type2 pneumocytes
80% phospholipids: Dipalmitoyl Phosphatidyl
Choline (DPPC); ex.Lecithin
8% proteins
8% Neutral Lipids (cholesterol)
SP-A
hydrophilic collectin,
Type II epithelial cells and clara cells
Required in the formation of tubular myelin
SP-B
Hydrophobic protein
Protein clipped from Type II cell
Optimize rapid absorption and spreading
of phospholipids
LAPLACE LAW
P= 2T P= pressure
r T= tension
r= radius
- The SMALLER the RADIUS (sphere), the
HIGHERER the TENSION is.
- It has a tendency to collapse towards the
X-ray picture: normal vs. collapsed lungs
LARGER sphere (radius).
white out lung
MECHANICS OF BREATHING
- How the lungs and the chest wall act together in
order for the air to enter the lungs.
BOYLES LAW
- At constant temperature, the volume of gas is
inversely proportional to pressure.
- Decreasing volume increases collisions and
increases pressure
K =PV
- It is true with the ALVEOLI. If there is a high P1V1 = P2V2
surface tension in one of the alveoli, it has a
tendency to collapse to the other alveoli.
- If all the alveoli have high surface tension, then
the lungs will collapse.
- Pulmonary surfactant reduces/decreases surface
tension; it makes the alveoli stable
- Accessory Muscles:
A. STERNOCLEIDOMASTOID
B. SCALENE MUSCLES
C. Pectoralis major, minor
D. Serratus anterior
E. Muscles that fix the shoulder girdle: levator
scapula, trapezius, rhomboids
TRANSMURAL PRESSURE
- Pressure changes across the lung and chest wall
- TRANSPULMONARY PRESSURE =
ALVEOLAR PRESSURE PLEURAL
PRESSURE
- Once the diaphragm contracts, VOLUME of the COMPLIANCE: Static Lung Mechanics
CHEST WALL INCREASES. - Measure of distensibility of matter and specifies
- INTRAPLEURAL PRESSURE will DECREASE the ease with which matter can be stretched or
- Subatmospheric (negative) distorted.
- Or in other words, it measures the expandibility
- INTRA-ALVEOLAR PRESSURE will DECREASE of the lungs and thoracic wall
- Ex. stretching a rubber band
- Once the glottis opens, the air now from the - The ease of stretching the rubber band is
atmosphere will rush in towards the lungs. COMPLIANCE.
- As you decrease the pleural and alveolar - ability to return to its original state is 7
pressure, there is now flow of air inside the airway ELASTICITY
and lungs.
C = V V= change in volume
P P= change in pressure
REYNOLDS NUMBER
B. AIRWAY RESISTANCE
RESISTANCE
- Point of HIGHEST RESISTANCE is at the
segmental bronchi or the MEDIUM-SIZED
AIRWAYS.
- The smaller tubes (bronchioles) work in parallel,
so the resistance is decreased.
viscosity, length = resistance - Ex. 3 + 3 + 3 = 9 (SERIES)
radius = resistance 1/3 + 1/3 + 1/3 = 1 (PARALLEL)
- That is why smaller airways have smaller 9
- Resistance is the inverse of flow. resistance than medium-sized airways.
- The higher the viscosity and the longer the tube, - During normal quiet breathing, the point of
the greater the resistance. highest resistance is at the medium sized airways.
- The smaller the radius, the higher the resistance.
WORK OF BREATHING
Work = pressure x change in volume
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Diffusion
Respiratory zone
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Example
Apex, V=2, Q=1, V/Q = 2
Base, V=1, Q=2, V/Q = 0.5
Hypoventilation
Decreased or insufficient volume of air that Ideal gas law
enters the alveoli
Effects
Poor oxygenation of blood
CO retention Those variables:
Respiratory acidosis
n = quantity of gas
Causes R = constant
CNS infection/injury T = temperature
Immerse in very cold water P = pressure in mmHg
Decreased temperature hypoventilation V = volume (liters)
because of pooroxygenation Combination of Boyles and Charles Law
Anesthetize
Vapor Pressure of Water
Daltons Law
A=Area
Surface area of lungs/alveoli = 80m
Increase area, increase diffusion of gas
T = thickness (respiratory membrane) is inversely
proportional to diffusion
Fibrosis
Uptake of O
Interstitial space thicken affects diffusion
Low O = hypoxemic RBC, when they go the the lungs (0.75 of a
second), during the firstthird (0.25 of a second) the
(P1-P2) is pressure difference/pressure blood is already saturated with O
gradient; the greater thedifference, the greater the
diffusion Indication: during exercise, blood flow to the
lungs will decrease to around 0.25 of a second. If
D is the diffusion coefficient, square root of MW; normal lungs, before 0.25, blood is already
which is directlyproportional to solubility coefficient saturated with O
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Pressures between the pulmonary and This is true only for the systemic circulation
systemic circulation: In pulmonary circulation this is not true due to thin-
walled property and lack of smooth muscles
Systemic pressure is at least ten times higher than
Recruitment and Distension
the pulmonary pressure
If you increase the pressure through recruitment,
Because the pulmonary blood vessels
the resistance decreases and some of the
have thinner walls with more smooth
pulmonary vessels will open up
muscles unlike in systemic circulation
where the vessels are thicker and more
Just like your small airways, these capillaries work
muscular
in parallel and somehow function as one big tube
As you recruit more vessels, resistance further
Systemic circulation also has arterioles which
decreases
contain a large amount of smooth muscles
In distension, when the pressure increases,
When you're running or exercising, you need more
instead of opening up the other vessels, they
blood in the lower extremities such as the legs and
dilate the existing vessels, increasing the caliber
these arterioles regulate blood flow to these parts
and resistance also decreases
Pulmonary circulation is the only vascular
These two mechanisms (recruitment and
bed which receives the entire cardiac distension) work hand-in-hand
output so the pressure must be low
enough to allow easier transport of blood During inspiration, there is no plugging of the
from the ventricles or else the right part of
vessels so resistance is still high. But once you
the heart will have a difficult time in inhale, extra-alveolar vessels will pull the walls of
pushing blood towards the pulmonary
the blood vessels through traction
circulation
If you increase the lung volume, you decrease the
Pulmonary vessels
resistance
Surrounded by gas
Contained inside the alveoli Even if the capillaries are thin-walled, they are still
Gas affects the blood vessels (alveolar elastic. There will come a time where the
pressure affects pulmonary vessels) maximum elasticity is reached and the resistance
again decreases.
2 types of pulmonary vessels exist:
Measurement of blood flow
Alveolar vessels, which are located at the Fick's principle governs blood flow:
septum, and once the alveolar pressure increases, Oxygen consumption per minute is equal to the
it will compress the alveolar vessels. So amount of oxygen taken up by the blood in the 18
effectively, they are affected by the pressures lungs per minute
surrounding them. Distribution of blood flow
Organs with greater areas have greater blood flow
The base of a structure has greater blood flow
Amines:
Serotonin almost completely removed
Norepinephrine up to 30% removed
Histamine and Dopamine unaffected
Arachidonic acid metabolites: Transport of CO2 in the blood
Prostaglandins E2 and F almost completely
removed Same as oxygen, can be dissolved in the plasma
Prostaglandin A2 unaffected Carbaminohemoglobin CO2 bound to Hgb
Prostacyclin (PGI2) unaffected Cabonic anhydrase converts CO2 and water to
Leukotrienes almost completely removed carbonic acid
Majority of carbon dioxide is transported as
Filtration action for the blood bicarbonate
As blood flows to these capillary networks, it is Chloride shift (Hamburger shift) movement of Cl-
somehow filtered ion from the plasma towards the inside via
diffusion
Transport of oxygen in the blood
2 forms of O2 in the blood
Combined in the plasma (dissolved state) : 1-3 L
Combined with Hgb as HbO2
Concentration of Hgb: 14-15 g/100mL of blood
1 Hgb molecule: 4 O2 molecules
1 gram of Hgb: 1.34 mL of O2
Combined or Dissolved
Henry's Law
The amount of dissolved gas is proportional to the
partial pressure
0.003 mL O2 / 100 mL of blood or 0.003 vol%
100 mmHg of O2 : 0.3 mL / 100 mL of blood
Oxyhemoglobin 20
HgbA (adults) optimal form of Hgb
HgbF (fetal hemoglobin, high affinity for oxygen so
fetuses cannot utilize oxygen because it is tightly
bound to hemoglobin)
Central controller
Medullary respiratory center
Dorsal inspiratory area
Rhythm of ventilation
Inhibited by impulses from pneumotaxic center
Vagal and glossopharyngeal nerves
Ventral expiratory area
Normally inactive
Apneustic center
Tissues: Bohr effect Lower pons
Lungs: Haldane effect If transacted inspiratory gasps or Apneustic
Significance: Most of the CO2 are taken by the Seen in severe brain injury
RBC Pneumotaxic center
Upper pons
Inhibits respiration
CO2 Dissociation Curve: Regulates respiratory volume
CO2 may be carried as dissolved, bicarbonate, fine tuning
and carmabinohemoglobin forms CO2 dissociation
curve is steeper and more linear than O2 Sensory receptors
dissociation curve CO2 curve is right-shifted by Central chemoreceptors
increases in SO2 Ventral surface of the medulla near the 9th and
10th CN
Regulation of Respiration Changes in H ion in CSF
Governed by the:
Condition of CSF
Local blood flow
Local metabolism
Peripheral chemoreceptors
Carotid bodies
Aortic bodies
Responds to:
Decrease PaO2 & pH
Increase in PaCO2 (less important than
central receptors)
Hering-Breuer Reflex
Components:
Sensory receptors stretch and deflation
Sensory afferent neurons vagus nerve
Respiratory center (DRG)
Efferent neurons phrenic and intercostal nerves
Effectors inspiratory muscles
Inspiration
Stimulates inflation receptors
Inhibitory impulses through vagus nerves
Inhibition of respiratory center cuts impulses to
respiratory muscles
Expiration stimulates deflation receptors Effects of Exercise
Excitatory impulses through the vagus Increase demand for O2
Excitation of the respiratory center Increase CO2 production
Increase respiratory rate
Contraction of inspiratory muscles Motor cortex sends impulses to respiratory center
Body movements stimulates proprioceptors
Double Vagotomy Increased body temperature stimulates respiratory
center
Abolishes Hering-Breuer reflex Increased CO2 stimulates respiratory center
Results to slower and deeper breathing
Still rhythmic due to the activity of pneumotaxic Increase diffusing capacity of O2
center
Inhibits respiration and allows expiration Increases 3 times
Opening of dormant capillaries increases area of
Mechanisms of rhythmicity after double diffusing membrane
vagotomy: Dilatation of pulmonary capillaries
Opening up of previously collapsed alveoli
Active Dorsal Respiratory Group (DRG) Blood is fully saturated with O2 despite rapid flow
Stimulates inspiratory muscles and pneumotaxic
center
Pneumotaxic center stimulates expiratory center
Inhibits inspiratory center
Cuts off impulses to inspiratory muscles and
pneumotaxic center
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Pneumotaxic center ceases to stimulate the
expiratory center
No inhibition of inspiratory center
High-altitude
Oxygen toxicity
Pulmonary edema
Decreased vital capacity secondary to atelectasis
Premature babies retrolental fibroplasia
Absorption Atelectasis
Decompression Sickness
Caused by the formation of N2 bubbles during
ascent from a deep dive
May result in pain bends and neurological
disturbances
Can be prevented by a slow, staged ascent
Incidence is reduced by breathing a helium-
oxygen mixture
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