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[6] The Airways:

 The respiratory system starts at the nose and mouth and continues through the airways and the lungs.
Air enters the respiratory system through the nose and mouth and passes down the throat (pharynx)
and through the voice box, or larynx. The entrance to the larynx is covered by a small flap of tissue
(epiglottis) that automatically closes during swallowing, thus preventing food or drink from entering
the airways.
 The windpipe (trachea) is the largest airway. The trachea branches into two smaller airways: the left
and right bronchi, which lead to the two lungs.
 Each lung is divided into sections (lobes): three in the right lung and two in the left lung. The left lung
is a little smaller than the right lung because it shares space in the left side of the chest with the heart.
 The bronchi themselves branch many times into smaller airways, ending in the narrowest airways
(bronchioles), which are as small as one half of a millimeter (or 2/100 of an inch) across. The airways
resemble an upside-down tree, which is why this part of the respiratory system is often called the
bronchial tree. Large airways are held open by semiflexible, fibrous connective tissue called cartilage.
Smaller airways are supported by the lung tissue that surrounds and is attached to them. The walls of
the smaller airways have a thin, circular layer of smooth muscle. The airway muscle can relax or
contract, thus changing airway size.
 Thousands of small air sacs (alveoli) are at the end of each bronchiole. Together, the millions of
alveoli of the lungs form a surface of more than 100 square meters (1111 square feet). Within the
alveolar walls is a dense network of tiny blood vessels called capillaries. The extremely thin barrier
between air and capillaries allows oxygen to move from the alveoli into the blood and allows carbon
dioxide to move from the blood in the capillaries into the air in the alveoli.
 The pleura is a slippery membrane that covers the lungs as well as the inside of the chest wall. It
allows the lungs to move smoothly during breathing and as the person moves. Normally, the two
layers of the pleura have only a small amount of lubricating fluid between them. The two layers glide
smoothly over each other as the lungs change size and shape.
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[6] [10] Blood and Lung Interaction:
Pulmonary circulation

The pulmonary circulation is the portion of the circulatory system which carries deoxygenated blood away from
the right ventricle, to the lungs, and returns oxygenated blood to the left atrium and ventricle of the heart. The
vessels of the pulmonary circulation are the pulmonary arteries and the pulmonary veins. A separate system
known as the bronchial circulation supplies oxygenated blood to the tissue of the larger airways of the lung.

Deoxygenated blood leaves the heart, goes to the lungs, and then re-enters the heart; Deoxygenated blood leaves
through the right ventricle through the pulmonary artery. From the right atrium, the blood is pumped through
the tricuspid valve (or right atrioventricular valve), into the right ventricle. Blood is then pumped from the right
ventricle through the pulmonary valve and into the main pulmonary artery.

The pulmonary arteries carry deoxygenated blood to the lungs, where carbon dioxide is released and oxygen is
picked up during respiration. Arteries are further divided into very fine capillaries which are extremely thin-
walled. The pulmonary vein returns oxygenated blood to the left atrium of the heart.

The oxygenated blood then leaves the lungs through pulmonary veins, which return it to the left part of the
heart, completing the pulmonary cycle. This blood then enters the left atrium, which pumps it through the mitral
valve into the left ventricle. From the left ventricle, the blood passes through the aortic valve to the aorta. The
blood is then distributed to the body through the systemic circulation before returning again to the pulmonary

From the right ventricle, blood is pumped through the semilunar pulmonary valve into the left and right main
pulmonary arteries (one for each lung), which branch into smaller pulmonary arteries that spread throughout the


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[2] Define Total lung volume
Lung volumes are also known as respiratory volumes. It refers to the volume of gas in the lungs at a given
time during the respiratory cycle. Lung capacities are derived from a summation of different lung
volumes. The average total lung capacity of an adult human male is about 6 litres of air.

[6] [10] Measurement of Lung volume:

Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.

How the Test is Performed

Spirometry measures airflow. By measuring how much air you exhale, and how quickly you exhale, spirometry
can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a
mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the
rate of air that you breathe in and out over a period of time. When standing, some numbers might be slightly

Lung volume measurement can be done in two ways:

 The most accurate way is called body plethysmography. You sit in a clear airtight box that looks like a phone
booth. The technologist asks you to breathe in and out of a mouthpiece. Changes in pressure inside the box help
determine the lung volume.

 Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period
of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume.

Lung Volumes:
Lung volumes are also known as respiratory volumes. It refers to the volume of gas in the lungs at a given time
during the respiratory cycle. Lung capacities are derived from a summation of different lung volumes. The
average total lung capacity of an adult human male is about 6 litres of air. Lung volumes measurement is an
integral part of pulmonary function test. These volumes tend to vary, depending on the depth of respiration,
ethnicity, gender, age, body composition[1] and in certain respiratory diseases. A number of the lung volumes
can be measured by Spirometry- Tidal volume, Inspiratory reserve volume, and Expiratory reserve volume.
However, measurement of Residual volume, Functional residual capacity, and Total lung capacity is through
body plethysmography, nitrogen washout and helium dilution technique.

Lung Volumes

 Tidal Volume(TV)

It is the amount of air that can be inhaled or exhaled during one respiratory cycle. This depicts the
functions of the respiratory centres, respiratory muscles and the mechanics of the lung and chest wall.

The normal adult value is 10% of vital capacity (VC), approximately 300-500ml (6‐8 ml/kg); but can
increase up to 50% of VC on exercise

 Inspiratory Reserve Volume(IRV)

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It is the amount of air that can be forcibly inhaled after a normal tidal volume.IRV is usually kept in
reserve, but is used during deep breathing. The normal adult value is 1900-3300ml.

 Expiratory Reserve Volume(ERV)

It is the volume of air that can be exhaled forcibly after exhalation of normal tidal volume. The normal
adult value is 700-1200ml. ERV is reduced with obesity, ascites or after upper abdominal surgery

 Residual Volume(RV)

It is the volume of air remaining in the lungs after maximal exhalation. Normal adult value is averaged at
1200ml(20‐25 ml/kg) .It is indirectly measured from summation of FRC and ERV and cannot be measured
by spirometry.

In obstructive lung diseases with features of incomplete emptying of the lungs and air trapping, RV may
be significantly high. The RV can also be expressed as a percentage of total lung capacity and values in
excess of 140% significantly increase the risks of barotrauma, pneumothorax, infection and reduced
venous return due to high intra thoracic pressures as noticed in patients with high RV who require surgery
and mechanical ventilation thus needs high peri-operative inflation pressures.

Lung capacities

 Inspiratory capacity(IC)

It is the maximum volume of air that can be inhaled following a resting state. It is calculated from the sum
of inspiratory reserve volume and tidal volume. IC = IRV+TV

 Total Lung Capacity(TLC)

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It is the maximum volume of air the lungs can accommodate or sum of all volume compartments or
volume of air in lungs after maximum inspiration. The normal value is about 6,000mL(4‐6 L). TLC is
calculated by summation of the four primary lung volumes (TV, IRV, ERV, RV).

TLC may be increased in patients with obstructive defects such as emphysema and decreased in patients
with restrictive abnormalities including chest wall abnormalities and kyphoscoliosis.

 [2] Vital Capacity(VC)

It is the total amount of air exhaled after maximal inhalation. The value is about 4800mL and it varies
according to age and body size. It is calculated by summing tidal volume, inspiratory reserve volume, and
expiratory reserve volume. VC = TV+IRV+ERV.

VC indicates ability to breathe deeply and cough, reflecting inspiratory and expiratory muscle strength.VC
should be 3 times greater than TV for effective cough. VC is sometimes reduced in obstructive disorders
and always in restrictive disorders

 Function Residual Capacity(FRC)

It is the amount of air remaining in the lungs at the end of a normal exhalation. It is calculated by adding
together residual and expiratory reserve volumes. The normal value is about 1800 – 2200 mL. FRC =

FRC does not rely on effort and highlights the resting position when inner and outer elastic recoils are
balanced. FRC is reduced in restrictive disorders. The ratio of FRC to TLC is an index of hyperinflation.
In COPD, FRC is upto 80% of TLC.


[6] [10] Pressure airflow volume relationship of lungs:

Airflow and lung volume measurements can be used to differentiate obstructive from restrictive pulmonary
disorders, to characterize severity, and to measure responses to therapy. Measurements are typically reported
as absolute flows and volumes and as percentages of predicted values using data derived from large
populations of people presumed to have normal lung function. Variables used to predict normal values
include age, sex, ethnicity, and height.

Quantitative measures of inspiratory and expiratory flow are obtained by forced spirometry. Nose clips are
used to occlude the nares.

In expiratory flow assessments, patients inhale as deeply as possible, seal their lips around a mouthpiece, and
exhale as forcefully and completely as possible into an apparatus that records the exhaled volume (forced
vital capacity [FVC]) and the volume exhaled in the first second (the forced expiratory volume in 1 sec
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In inspiratory flow and volume assessments, patients exhale as completely as possible, then forcibly inhale.

These maneuvers provide several measures:.

 FVC: Maximal amount of air that the patient can forcibly exhale after taking a maximal inhalation

 FEV1: Volume exhaled in the first second

 Peak expiratory flow (PEF): Maximal speed of airflow as the patient exhales

 FEV1 is the most reproducible flow parameter and is especially useful in diagnosing and monitoring
patients with obstructive pulmonary disorders (eg, asthma, COPD).
 FEV1 and FVC help differentiate obstructive and restrictive lung disorders. A normal FEV1 makes
irreversible obstructive lung disease unlikely whereas a normal FVC makes restrictive disease
 The forced expiratory flow averaged over the time during which 25 to 75% of the FVC is exhaled may
be a more sensitive marker of mild, small airway airflow limitation than the FEV 1, but the
reproducibility of this variable is poor.
 The peak expiratory flow (PEF) is the peak flow occurring during exhalation. This variable is used
primarily for home monitoring of patients with asthma and for determining diurnal variations in

Lung volume
Lung volumes are measured by determining functional residual capacity (FRC) and with spirometry. FRC is
the amount of air remaining in the lungs after normal exhalation. The total lung capacity (TLC) is the volume
of gas that is contained in the lungs at the end of maximal inspiration.

Normal lung volumes

ERV = expiratory reserve volume; FRC = functional residual capacity; IC = inspiratory capacity; IRV =
inspiratory reserve volume; RV = residual volume; TLC = total lung capacity; VC = vital capacity; VT=
tidal volume.

FRC = RV + ERV; IC = VT + IRV; VC = VT+ IRV + ERV.

FRC is measured using gas dilution techniques or a plethysmograph (which is more accurate in patients who
have airflow limitation and trapped gas).

Gas dilution techniques include

 Nitrogen washout

 Helium equilibration

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 With nitrogen washout, the patient exhales to FRC and then breathes from a spirometer containing
100% oxygen. The test ends when the exhaled nitrogen concentration is zero. The collected volume of
exhaled nitrogen is equal to 81% of the initial FRC.
 With helium equilibration, the patient exhales to FRC and then is connected to a closed system
containing known volumes of helium and oxygen. Helium concentration is measured until it is the
same on inhalation and exhalation, indicating it has equilibrated with the volume of gas in the lung,
which can then be estimated from the change in helium concentration that has occurred.
 Both of these techniques may underestimate FRC because they measure only the lung volume that
communicates with the airways. In patients with severe airflow limitation, a considerable volume of
trapped gas may communicate very poorly or not at all.
 Body plethysmography uses Boyle’s law to measure the compressible gas volume within the thorax
and is more accurate than gas dilution techniques. While sitting in an airtight box, the pat ient tries to
inhale against a closed mouthpiece from FRC. As the chest wall expands, the pressure in the closed
box rises. Knowing the pre-inspiratory box volume and the pressure in the box before and after the
inspiratory effort allows for calculation of the change in box volume, which must equal the change in
lung volume.
Boyle's law:

where P is pressure and V is volume

Flow-volume loop
In contrast to the spirogram, which displays airflow (in L) over time (in sec), the flow-volume loop (see
Figure: Flow-volume loops) displays airflow (in L/sec) as it relates to lung volume (in L) during maximal
inspiration from complete exhalation (residual volume [RV]) and during maximum expiration from complete
inhalation (TLC). The principal advantage of the flow-volume loop is that it can show whether airflow is
appropriate for a particular lung volume.

Flow-volume loops

(A) Normal. Inspiratory limb of loop is symmetric and convex. Expiratory limb is linear. Airflow at the
midpoint of inspiratory capacity and airflow at the midpoint of expiratory capacity are often measured and
compared. Maximal inspiratory airflow at 50% of forced vital capacity (MIF 50% FVC) is greater than
maximal expiratory airflow at 50% FVC (MEF 50% FVC) because dynamic compression of the airways
occurs during exhalation.

(B) Obstructive disorder (eg, emphysema, asthma). Although all airflow is diminished, expiratory
prolongation predominates, and MEF < MIF. Peak expiratory flow is sometimes used to estimate degree of
airway obstruction but depends on patient effort.

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(C) Restrictive disorder (eg, interstitial lung disease, kyphoscoliosis). The loop is narrowed because of
diminished lung volumes. Airflow is greater than normal at comparable lung volumes because the
increased elastic recoil of lungs holds the airways open.

(D) Fixed obstruction of the upper airway (eg, tracheal stenosis, goiter). The top and bottom of the loops
are flattened so that the configuration approaches that of a rectangle. Fixed obstruction limits flow equally
during inspiration and expiration, and MEF = MIF.

(E) Variable extrathoracic obstruction (eg, unilateral vocal cord paralysis, vocal cord dysfunction). When
a single vocal cord is paralyzed, it moves passively with pressure gradients across the glottis. During
forced inspiration, it is drawn inward, resulting in a plateau of decreased inspiratory f low. During forced
expiration, it is passively blown aside, and expiratory flow is unimpaired. Therefore, MIF 50% FVC <
MEF 50% FVC.

(F) Variable intrathoracic obstruction (eg, tracheomalacia). During a forced inspiration, negative pleural
pressure holds the floppy trachea open. With forced expiration, loss of structural support results in
tracheal narrowing and a plateau of diminished flow. Airflow is maintained briefly before airway
compression occurs.


[6] [10] Physics of alveoli

(1) Alveoli of lungs

The oxygen exchange in the lungs takes place across the membranes of small balloon-like structures called
alveoli attached to the branches of the bronchial passages. These alveo li inflate and deflate with inhalation
and exhalation. The behavior of the alveoli is largely dictated by LaPlace's law and surface tension. It
takes some effort to breathe in because these tiny balloons must be inflated, but the elastic recoil of the
tiny balloons assists us in the process of exhalation. If the elastic recoil of the alveoli is compromised, as
in the case of emphysema, then it is difficult to exhale forcibly.

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(2) Inflating the alveoli

Inflating the alveoli in the process of respiration requires an excess pressure inside the alveoli relative to
their surroundings. This is actually accomplished by making the pressure in the thoracic cavity negative
with respect to atmospheric pressure.

The amount of net pressure required for inflation is dictated by the surface tension and radii of the tiny
balloon-like alveoli. During inhalation the radii of the alveoli increase from about 0.05 mm to 0.1 mm .

The remarkable property of the surfactant which coats the alveoli is that it reduces the surfac e tension by a
factor of about 15 so that the 1 mmHg pressure differential is sufficient to inflate the alveoli. Other factors
affecting the remarkable efficiency of oxygen transport across the lung membranes is characterized in
Fick's Law which states The net diffusion rate of a gas across a fluid membrane is proportional to the
difference in partial pressure, proportional to the area of the membrane and inversely proportional to the
thickness of the membrane.

(3) Surfactant role in respiration

One of the remarkable phenomena in the process of respiration is the role of the fluid coating the walls of
the alveoli of the lungs. This fluid, called a surfactant, lowers the surface tension of the balloon-like
alveoli by about a factor of 15 compared to the normal mucous tissue fluid in which they are immersed.
There appears to be a nearly constant amount of this surfactant per alveolus, so that when the alveoli are
deflated it is more concentrated on the surface. Since the surface-tension-lowering effect of the surfactant
depends on this concentration, it diminishes the required pressure for inflation of the alveoli at their most
critical phase. For a given surface tension, the pressure to inflate a smaller bubble is greater. It is the
surfactant which makes possible the inflation of the alveoli with only about 1 mmHg of pressure excess
over their surroundings. The baby's first breath depends upon this surfactant and is made more difficult in
premature infants by the incomplete formation of the surfactant.

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(4) Alveoli and Exhalation

The alveoli of the lungs act much like balloons in that there is some effort involved to inflate them, but
when the inflating pressure is released, the recoil of the elastic walls provides the pressure necessary to
deflate them. The lungs are suspended in the thoracic cavity which is normally at a slight negative
pressure. When the diaphragm is lowered, that pressure becomes more negative and the lungs expand into
the cavity. Air from the atmosphere moves into the resulting partial vacuum and inf lates the alveoli. One
is aware of the effort, but it is not extreme as in the case of the baby's first breath . Once the alveoli are
fully inflated, exhalation can be accomplished by merely relaxing the diaphragm, since the wall tension in
all the tiny alveoli will act to force the air out of them. By forcing the diaphragm upward, we can exhale
forcefully by adding the diaphragm effort to the recoil of the elastic alveoli. In diseases like emphysema,
the elasticity of the alveoli is lost and exhalation becomes a laborious process.


[6] [10] The breathing mechanism

The Lungs and Breathing

 The lungs are enveloped in parietal and visceral pleura and the space between the lungs an d
thoracic wall is called the pleural space. This is usually filled with pleural fluid which forms a
pleural seal that holds the outer surface of the lungs against the inner surface of the thoracic wall.
This ensures that when the thoracic cavity expands or reduces, the lungs move with it due to the
surface tension of the pleural fluid forming the pleural seal.
 Therefore, the contraction and relaxation of certain muscles during breathing causes movement of
the lungs, changing the volume of air within the lungs.
 Boyle’s law states that, when temperature is constant, the volume of gas is inversely proportional
to pressure. Therefore, when the lungs expand increasing the volume of air within them, pressure
declines. When the pressure of the air outside the lungs is greater than the air inside, air will rush
into the lungs, and vice versa.

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Mechanism of Breathing
Breathing is simply defined as the physical process in which oxygen is taken into the body and carbon dioxide
is forced out from the body. Breathing is brought about by two sets of muscles-

i.Internal intercoastal muscles

ii. External intercoastal muscles
Besides these muscles, diaphragm and abdominal muscles help in breathing.

The process of breathing involves two phases:

1. Inspiration/ Inhalation
2. Expiration/ Exhalation

1. Inspiration

It is the inhalation of air into lung and is brought about by chest expanding.
It takes place when the volume of thoracic cavity increases and the air pressure decreases.
Enlargement of thoracic cavity involves the following events which occurs simultaneously:

 During inspiration, the external intercostal muscles contract and the internal one relax.
 Due to contraction of external intercostal muscles, the ribs are pulled upward and outward.
 The muscle of diaphragm contract which lowers the diaphragm.
 As a result the size of thoracic cavity increases as well as the lungs expand simultaneously.
 As the lungs expand, the air pressure inside the lungs decreases.
 In order to balance the air pressure, air rushes from atmosphere into the lungs through air passage.

The process of inspiration is active, as it needs energy for muscle contraction. At rest, it lasts about 2 sec.

2. Expiration

It is the forcing of air out from lungs and is brought about by chest contracting.
It takes place when the size of thoracic cavity is reduced and the air pressure is increased.
The process involves in expiration are as follows:

 The internal intercostal muscle contract.

 Due to contraction of internal intercostal muscles, ribs are pulled back to their normal position.
 The muscle of diaphragm relaxes and comes to its original dome-shaped.
 As a result, the size of thoracic cavity decreases and the size of lungs also decreases.
 Due to which the air pressure increases in lungs.
 In order to equalize the air pressure, air is expelled out from the lungs to the atmosphere through respiratory

Expiration is passive process as it does not require the expenditure of energy.

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Forced Breathing
Forced breathing requires active inspiratory and expiratory effort with the help of accessory muscles.

Forced inhalation

This is similar to normal inspiration (diaphragm and external intercostals) but requires effort from the
inspiratory accessory muscles such as scalenes, sternocleidomastoid, pectoralis major and minor, serratus
anterior and latissimus dorsi.

Forced expiration

Unlike normal expiration, this is an active process. It involves contraction of the abdominal muscles which
forces the diaphragm upwards reducing the volume of the thoracic cavity. It also requires contraction of
the internal intercostal muscles and innermost intercostal muscles which pull the ribs downwards. Both these
actions contribute to a decreased thoracic volume and pressure is inversely proportional to volume. Therefore
pressure within the lungs increases forcing the air out quicker than in normal expiration.


[2] What are the major components for cardiovascular system?

(a) Heart

(b) Arteries

(c) Veins

(d) Capillaries

(e) Blood


[6] Major components of cardiovascular system:

Cardiovascular system is the transport system of the body, through which the nutrients are conveyed to places
where these are utilized, and the metabolites (waste products) are conveyed to appropriate places from where
these are expelled. The conveying medium is a liquid tissue, the blood, which flows in tubular channels called
blood vessels. The circulation is maintained by the central pumping organ called the heart.

Components of Cardiovascular system:

Cardiovascular system is a closed system of tubes made up of the following parts based on their structural and
topographical characteristics.

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(1) Heart

It is a four-chambered muscular organ which pumps blood to various parts of the body. Each half of the heart
has a receiving chamber called atrium, and a pumping chamber called ventricle.

Chambers of the Heart

The heart is a muscular organ about the size of a fist, located just behind and slightly left of the
breastbone. The heart pumps blood through the network of arteries and veins called the cardiovascular

The heart has four chambers:

 The right atrium receives blood from the veins and pumps it to the right ventricle.
 The right ventricle receives blood from the right atrium and pumps it to the lungs, where it is
loaded with oxygen.
 The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle.
 The left ventricle (the strongest chamber) pumps oxygen-rich blood to the rest of the body. The left
ventricle’s vigorous contractions create our blood pressure.
 The coronary arteries run along the surface of the heart and provide oxygen-rich blood to the heart
muscle. A web of nerve tissue also runs through the heart, conducting the complex signals that
govern contraction and relaxation. Surrounding the heart is a sac called the pericardium.

(2) Arteries:

The arteries are the blood vessels that deliver oxygen-rich blood from the heart to the tissues of the body. Each
artery is a muscular tube lined by smooth tissue and has three layers:

 The intima, the inner layer lined by a smooth tissue called endothelium
 The media, a layer of muscle that lets arteries handle the high pressures from the heart
 The adventitia, connective tissue anchoring arteries to nearby tissues

The largest artery is the aorta, the main high-pressure pipeline connected to the heart's left ventricle. The aorta
branches into a network of smaller arteries that extend throughout the body. The arteries' smaller branches are

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called arterioles and capillaries. The pulmonary arteries carry oxygen-poor blood from the heart to the lungs
under low pressure, making these arteries unique.
(3) Veins:

A vein is an elastic blood vessel that transports blood from various regions of the body to the heart. Veins
are components of the cardiovascular system, which circulates blood to provide nutrients to t he cells of the
body. Unlike the high pressure arterial system, the venous system is a low pressure system that relies on
muscle contractions to return blood to the heart.

Types of Veins

Veins can be categorized into four main types: pulmonary, systemic, superficial, and deep veins.

 Pulmonary veins carry oxygenated blood from the lungs to the left atrium of the heart.
 Systemic veins return oxygen-depleted blood from the rest of the body to the right atrium of the
 Superficial veins are located close to the surface of the skin and are not located near a
corresponding artery.
 Deep veins are located deep within muscle tissue and are typically located near a corresponding
artery with the same name (for example coronary arteries and veins).

These are draining channels which carry blood from different parts of the body back to the heart.

 Like rivers, the veins arc formed by tributaries.

 The small veins (venules) join together to form, larger veins, which in turn unite to form great veins
called venae cavae.

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(4) Capillaries:

 Capillaries are very tiny blood vessels — so small that a single red blood cell can barely fit through

 They help to connect your arteries and veins in addition to facilitating the exchange of certain elements
between your blood and tissues.

 This is why tissues that are very active, such as your muscles, liver, and kidneys, have an abundance of
capillaries. Less metabolically active tissues, such as certain types of connective tissue, don’t have as

These are networks of microscopic vessels which connect arterioles with the venules. These come in intimate
contact with the tissues for a free exchange of nutrients and metabolites across their walls between the blood
and the tissue fluid. The metabolites are partly drained by the capillaries and partly by lymphatics. Capillaries
are replaced by sinusoids in certain organs, like liver and spleen.

(4) Blood:

Blood is a special type of tissue of human body. The character which differentiates it from rest of the tissues of
human body is that it is in fluid form. It is composed of Blood Cells and Plasma. Plasma is the watery portion of
blood and makes about 55% of the blood volume. Blood circulates through our body and delivers essential
substances like oxygen and nutrients to the body’s cells. It also transports metabolic waste products away from
those same cells. There is no substitute for blood. It cannot be made or manufactured. Generous blood donors
are the only source of blood for patients in need of a blood transfusion. The blood cells make about 45% of the
blood volume and are of three types:

 Red Blood Cells

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Red blood cells represent 40%-45% of your blood volume. They are generated from your bone marrow
at a rate of four to five billion per hour. They have a lifecycle of about 120 days in the body.

 White Blood Cells

Although white blood cells (leukocytes) only account for about 1% of your blood, they are very
important. White blood cells are essential for good health and protection against illness and disease.
Like red blood cells, they are constantly being generated from your bone marrow. They flow through the
bloodstream and attack foreign bodies, like viruses and bacteria. They can even leave the bloodstream to
extend the fight into tissue.

 Platelets

Platelets are an amazing part of your blood. Platelets are the smallest of our blood cells and literally look
like small plates in their non-active form. Platelets control bleeding. Wherever a wound occurs, the
blood vessel will send out a signal. Platelets receive that signal and travel to the area and transform into
their “active” formation, growing long tentacles to make contact with the vessel and form clusters to
plug the wound until it heals.


[2] Define Bernolli’s principles

In fluid dynamics, Bernoulli's principle states that an increase in the speed of a fluid occurs simultaneously with
a decrease in pressure or a decrease in the fluid's potential energy.The principle is named after Daniel Bernoulli


[2] What are all the real time applications using Bernoli’s principles

In echocardiography, the Bernoulli’s principle can be applied when interpreting blood flow, which can describe
a decrease in localized pressure produced by high flow rate near blockages as mentioned above with an
illustration. For clinical medicine, the simplified equation allows for an easy estimation of pressure gradients
from velocity.

Another use of Bernoulli's equation is with the venturi mask. The venturi mask is a medical oxygen mask that
delivers a concentration of oxygen to patients on controlled oxygen therapy. There is a tube from the mask that
is connected to a nozzle which connects to a supply of pure oxygen(usually from the hospital wall). The tube,
that is directly connected to the mask has a small window which allows room air(oxygen poor) to flow into the
mask. The venturi mask can control the amount of oxygen poor air( the air that we normally breathe) that flows
in, along with pure oxygen delivered from its connected nozzle. As oxygen flows into the tube, it creates a
decrease in pressure due to oxygen passing through a narrow opening of the tube. This drop in pressure allows
air to flow into the mask, mixing with the pure oxygen from the nozzle, which is the consequence of Bernoulli's


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[6] [10] o2 and co2 exchange in the capillary system:

The primary function of the respiratory system is to take in oxygen and eliminate carbon dioxide. Inhaled
oxygen enters the lungs and reaches the alveoli. The layers of cells lining the alveoli and the surrounding
capillaries are each only one cell thick and are in very close contact with each other. This barrier between air
and blood averages about 1 micron (1/10,000 of a centimeter, or 0.000039 inch) in thickness. Oxygen passes
quickly through this air-blood barrier into the blood in the capillaries. Similarly, carbon dioxide passes from
the blood into the alveoli and is then exhaled.
Oxygenated blood travels from the lungs through the pulmonary veins and into the left side of the heart,
which pumps the blood to the rest of the body (see Function of the Heart). Oxygen-deficient, carbon dioxide-
rich blood returns to the right side of the heart through two large veins, the superior vena cava and the inferior
vena cava. Then the blood is pumped through the pulmonary artery to the lungs, where it picks up oxygen and
releases carbon dioxide.
To support the absorption of oxygen and release of carbon dioxide, about 5 to 8 liters (about 1.3 to 2.1
gallons) of air per minute are brought in and out of the lungs, and about three tenths of a liter (about three
tenths of a quart) of oxygen is transferred from the alveoli to the blood each minute, even when the person is
at rest. At the same time, a similar volume of carbon dioxide moves from the blood to the alveoli and is
exhaled. During exercise, it is possible to breathe in and out more than 100 liters (about 26 gallons) of air per
minute and extract 3 liters (a little less than 1 gallon) of oxygen from this air per minute. The rate at which
oxygen is used by the body is one measure of the rate of energy expended by the body. Breathing in and out
is accomplished by respiratory muscles.
Three processes are essential for the transfer of oxygen from the outside air to the blood flowing through the
lungs: ventilation, diffusion, and perfusion.

 Ventilation is the process by which air moves in and out of the lungs.

 Diffusion is the spontaneous movement of gases, without the use of any energy or effort by the body,
between the gas in the alveoli and the blood in the capillaries in the lungs.

 Perfusion is the process by which the cardiovascular system pumps blood throughout the lungs.

The body's circulation is an essential link between the atmosphere, which contains oxygen, and the cells of
the body, which consume oxygen. For example, the delivery of oxygen to the muscle cells throughout the
body depends not only on the lungs but also on the ability of the blood to carry oxygen and on the ability of
the circulation to transport blood to muscle. In addition, a small fraction of the blood pumped from the heart
enters the bronchial arteries and nourishes the airways.

Gas exchange between alveolar spaces and capillaries:

The function of the respiratory system is to move two gases: oxygen and carbon dioxide. Gas exchange takes
place in the millions of alveoli in the lungs and the capillaries that envelop them. As shown below, inhaled
oxygen moves from the alveoli to the blood in the capillaries, and carbon dioxide moves from the blood in the
capillaries to the air in the alveoli.

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[2] What are the different types of flow

(1) Compressible Flow

(2) Laminar Flow
(3)Turbulent flow
(4) Viscous Flow
(5) Steady Flow
(6) Unsteady Flow

[2] [6] Physical activity of heart:

 The right atrium receives blood into the heart. In diagrams like the one below, this is the one on the top
left of the image. This blood is deoxygenated as it has supplied it’s oxygen to where it is needed by our
tissues and organs. It enters the right atrium of the heart via two large veins, the superior and inferior
vena cava.
 From the right atrium, the blood travels down into the right ventricle through the tricuspid valve. Valves
in the heart prevent blood from flowing backwards.
 From the right ventricle, the blood is pumped upwards to the lungs through the pulmonary arteries,
passing through the pulmonary valve.
 In the lungs, our blood picks up oxygen, which we call oxygenated blood. The contraction of the right
ventricle is not strong enough to send the oxygenated blood all around the body after the lungs, so the
oxygenated blood needs to return to the heart for another pump.
 Entering the heart through the pulmonary veins, oxygenated blood comes into the left atrium.
Continuing down through the mitral valve, it passes to the left ventricle.

18 | K r i p a ’ s n o t e s . .
 From the diagram above, you can see that the muscle of the left ventricle (pictured in pink) is thicker
than that of the right ventricle. This is because of the additional force needed to pump blood around the
whole body rather than just the lungs.

 From the left ventricle, blood passes through the aortic valve, and exits the heart via the aorta. The aorta
is a very important blood vessel, accommodating high pressure blood from the heart. The aorta has
elastic properties, allowing it to expand as higher pressure blood passes through, then contract passively.

 From the aorta, the blood travels through smaller arteries and capillaries to reach all parts of our body.
Returning through veins, the now deoxygenated blood returns to the vena cava, and the journey begins


Transmural pressure:

 Transmural pressure is the difference in pressure between two sides of a wall or equivalent separator.
For lungs, it is Transpulmonary pressure

 Transpulmonary pressure is the difference between the alveolar pressure and the intrapleural pressure in
the pleural cavity. During human ventilation, air flows because of pressure gradients.

Ptp = Palv – Pip. Where Ptp is transpulmonary pressure, Palv is alveolar pressure, and Pip is intrapleural

19 | K r i p a ’ s n o t e s . .

 Since atmospheric pressure is relatively constant, pressure in the lungs must be higher or lower than
atmospheric pressure for air to flow between the atmosphere and the alveoli.
 If 'transpulmonary pressure' = 0 (alveolar pressure = intrapleural pressure), such as when the lungs are
removed from the chest cavity or air enters the intrapleural space (a pneumothorax), the lungs collapse
as a result of their inherent elastic recoil.
 Under physiological conditions the transpulmonary pressure is always positive; intrapleural pressure is
always negative and relatively large, while alveolar pressure moves from slightly negative to slightly
positive as a person breathes.
 For a given lung volume, the transpulmonary pressure is equal and opposite to the elastic recoil pressure
of the lung.
 The transpulmonary pressure vs Volume curve of inhalation (usually plotted as Volume in function of
Pressure) is different from that of exhalation, the difference being described as hysteresis. Lung volume
at any given pressure during inhalation is less than the lung volume at any given pressure during


Transpulmonary pressure can be measured by placing pressure transducers. The alveolar pressure is estimated
by measuring the pressure in the airways while holding one's breath.[2] The intrapleural pressure is estimated
by measuring the pressure inside a balloon placed in the esophagus.[2]

Measurement of transpulmonary pressure assists in spirometry in availing for calculation of static lung

Bernoulli’s principle applied to cardio vascular system

Because flowing blood has mass and velocity it has kinetic energy (KE). This KE is proportionate to the
mean velocity squared (V2; from KE = ½ mV2). Furthermore, as the blood flows inside a vessel, pressure
is exerted laterally against the walls of the vessel; this pressure represents the potential or pressure energy
(PE). The total energy (E) of the blood flowing within the vessel, therefore, is the sum of the kinetic and
potential energies (assuming no gravitational effects) as shown below.

E = KE + PE (where KE ∝ V2) Therefore, E ∝ V2 + PE

There are two important concepts that follow from this relationship.

 Blood flow is driven by the difference in total energy between two points. Although pressure is
normally considered as the driving force for blood flow, in reality it is the total energy that drives
flow between two points (e.g., longitudinally along a blood vessel or across a heart valve).
 Throughout most of the cardiovascular system, KE is relatively low, so for practical purposes, it is
stated that the pressure energy (PE) difference drives flow. When KE is high, however, adding KE
to the PE significantly increases the total energy, E. To illustrate this, consider the flow across the
aortic valve during cardiac ejection.

20 | K r i p a ’ s n o t e s . .
 Late during ejection, the intraventricular pressure (PE) falls slightly below the aortic pressure
(PE), nevertheless, flow continues to be ejected into the aorta. The reason for this is that the KE of
the blood as it moves across the valve at a very high velocity ensures that the total energy (E) in
the blood crossing the valve is higher than the total energy of the blood more distal in the aorta.

 Kinetic energy and pressure energy can be interconverted so that total energy remains
unchanged. This is the basis of Bernoulli's Principle. This principle can be illustrated by a blood
vessel that is suddenly narrowed then returned to its normal diameter. In the narrowed region
(stenosis), the velocity increases as the diameter decreases.
 Quantitatively, V ∝ 1/D2 because flow (F) is the product of mean velocity (V) and vessel cross-
sectional area (A) (F = V ∙ A), and A is directly related to diameter (D) (or radius, r) squared
(from A = π ∙ r2). If the diameter is reduced by one-half in the region of the stenosis, the velocity
increases 4-fold.
 Because KE ∝ V2, the KE increases 16-fold. Assuming that the total energy is conserved within
the stenosis (E actually decreases because of resistance), then the 16-fold increase in KE must
result in a proportionate decrease in PE.
 Once past the narrowed segment, KE will revert back to its pre-stenosis value because the post-
stenosis diameter is the same as the pre-stenosis diameter and flow is conserved. Because of the
resistance of the stenosis, and the likelihood of turbulence, the post-stenosis PE and E will both


[2] [6] Blood flow laminar or turbulent

Generally in the body, blood flow is laminar. However, under conditions of high flow, particularly in the
ascending aorta, laminar flow can be disrupted and become turbulent. When this occurs, blood does not flow
linearly and smoothly in adjacent layers, but instead the flow can be described as being chaotic. Turbulent flow
also occurs in large arteries at branch points, in diseased and narrowed (stenotic or partially obstructed)
arteries (see figure below), and across stenotic heart valves.

21 | K r i p a ’ s n o t e s . .
Turbulence increases the energy required to drive blood flow because turbulence increases the loss of energy in
the form of friction, which generates heat. When plotting a pressure-flow relationship (see figure to right),
turbulence increases the perfusion pressure required to drive a given flow. Alternatively, at a given perfusion
pressure, turbulence leads to a decrease in flow.

Turbulence does not begin to occur until the velocity of flow becomes high enough that the flow lamina break
apart. Therefore, as blood flow velocity increases in a blood vessel or across a heart valve, there is not a gradual
increase in turbulence. Instead, turbulence occurs when a critical Reynolds number (Re) is exceeded. Reynolds
number is a way to predict under ideal conditions when turbulence will occur. The equation for Reynolds
number is:

Where V = mean velocity, D = vessel diameter, ρ = blood density, and η = blood viscosity

As can be seen in this equation, Re increases as velocity increases, and decreases as viscosity increases.
Therefore, high velocities and low blood viscosity (as occurs with anemia due to reduced hematocrit) are
more likely to cause turbulence. An increase in diameter without a change in velocity also increases Re
and the likelihood of turbulence; however, the velocity in vessels ordinarily decreases disproportionately
as diameter increases. The reason for this is that flow (F) equals the product of mean velocity (V) times
cross-sectional area (A), and area is proportionate to radius squared; therefore, the velocity at constant
flow is inversely related to radius (or diameter) squared. For example, if radius (or diameter) is doubled,
the velocity decreases to one-fourth its normal value, and Re decreases by one-half.

Under ideal conditions (e.g., long, straight, smooth blood vessels), the critical Re is relatively high.
However, in branching vessels, or in vessels with atherosclerotic plaques protruding into the lumen, the
critical Re is much lower so that there can be turbulence even at normal physiological flow velocities.

Turbulence generates sound waves (e.g., ejection murmurs, carotid bruits) that can be heard with a
stethoscope. Because higher velocities enhance turbulence, murmurs intensify as flow increases. Elevated
cardiac outputs, even across anatomically normal aortic valves, can cause physiological murmurs because
of turbulence. This sometimes occurs in pregnant women who have elevated cardiac output and who may
22 | K r i p a ’ s n o t e s . .
also have anemia, which decreases blood viscosity. Both factors increase the Reynolds number, which
increases the likelihood of turbulence.


[2] Define laminar flow

In fluid dynamics, laminar flow is characterized by fluid particles following smooth paths in layers, with each
layer moving smoothly past the adjacent layers with little or no mixing. In laminar flow, the motion of the
particles of the fluid is very orderly with particles close to a solid surface moving in straight lines parallel to that


[2] [6] [10] Brief principle about spirometer

 Spirometry (spy-ROM-uh-tree) is a common office test used to assess how well your lungs work by
measuring how much air you inhale, how much you exhale and how quickly you exhale.

 Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other
conditions that affect breathing. Spirometry may also be used periodically to monitor your lung
condition and check whether a treatment for a chronic lung condition is helping you breathe better.

Why it's done

Your doctor may suggest a spirometry test if he or she suspects your signs or symptoms may be caused by a
chronic lung condition such as:

 Asthma


 Chronic bronchitis

 Emphysema

 Pulmonary fibrosis

How to Prepare for the Spirometry Test

You don’t need to do anything to prepare for spirometry, though there are a few things to keep in mind:

 Don’t eat a big meal right before the test.

 Ask your doctor if there are medications you should not take the day of the test.

23 | K r i p a ’ s n o t e s . .
 Wear comfortable clothes.

The test itself takes about 15 minutes. It’s done in your doctor’s office, and afterward, you can go about your
day as normal.

How Spirometry Works

 You’ll sit in a chair and have a clip placed on your nose to keep your nostrils closed. Then, you’ll take a
deep breath and exhale as quickly and hard as you can into a tube.
 You’ll need to wrap your lips tightly around the tube so all your air goes into it. Usually, the test is given
three times to make sure the results are the same every time.
 The tube connects to a machine called a spirometer. It records how much air you breathe out from your
lungs and the speed at which you exhale.
 All this information helps the doctor figure out what’s causing your breathing problems.

Spirometry Test Risks

Spirometry is a painless test. Most people have no problems with it. Depending on your health, the deep
breathing might make you feel a little tired or lightheaded.
If you have heart disease or have had surgery recently, check with your doctor to make sure spirometry won’t
be a problem for you.

Spirometry Test Results

You might hear your doctor or a technician refer to two key measurements in spirometry. They are:

 Forced vital capacity (FVC). This measures the amount of air you can breathe in and out.
 Forced expiratory volume (FEV-1). This measures how much air you can exhale from your lungs in 1


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