FISIOLOGI SISTEM PERNAPASAN

Introduction
• Cells continually use O2 &
release CO2
• Respiratory system
designed for gas
exchange
• Cardiovascular system
transports gases in blood
• Failure of either system
– rapid cell death from O2
starvation
 BASIC FUNCTION
VENTILATION

GAS EXCHANGE

GAS TRANSPORT

REGULATION OF RESPIRATION
 Functions
• Provides for gas exchange (O2 and CO2)
• Helps regulate blood pH
• Contains receptors for sense of smell
• Filters inspired air
• Produces vocal sounds (phonation)
• Excretes small amounts of water and heat
• Modified respiratory movements
– Expressing emotions (laughing, sighing, and sobbing)
– Expel foreign matter from the lower air passages
(sneezing and coughing)
 ORGANIZATION
Structurally
• Upper respiratory system (nose, pharynx, and
associated structures)
• Lower respiratory system (larynx, trachea, bronchi,
and lungs)
Functionally
• Conducting zone (filter, warm, and moisten air and conduct
it into the lungs)
– nose, pharynx, larynx, trachea, bronchi, bronchioles,
and terminal bronchioles
• Respiratory zone (main sites of gas exchange)
– respiratory bronchioles, alveolar ducts, alveolar sacs,
and alveoli
 VENTILATION

• inflow and outflow of air between

atmosphere and lung alveoli
 Mechanics of Pulmonary Ventilation
Inspiration Muscles
• Diaphragm
• External intercostal muscles
• Accessory muscles (sternocleidomastoid,
scalene muscles)
Expiration muscle
• Active expiration
• Internal intercostal muscles
• Abdominal muscles
 Hukum Boyle

• Ukuran container tertutup , tekanan di dalam ↑

• Area utk pergerakan molekul-moleku lebih kecil,
tekanan ↑
 Dimensi Rongga Dada

• Pemasukan udara memerlukan aktivitas otot & perubahan

ukuran dada
• Kontraksi diaphragma : ↑ dimensi vertical dada
 Inspirasi Tenang

• Diaphragm naik 1 cm & iga-iga terangkat

• Tekanan Intrathoracic , 2-3 liters udara masuk
 Expirasi tenang

• Proses Passive tanpa aktivitas otot

• Elastic recoil & surface tension alveoli menarik ke dalam
• Tekanan Alveolar ↑ & udara keluar
 Pernapasan Paksa
• Expirasi paksa
– Otot abdominal
mendorong
diaphragma naik
– internal intercostals
menekan iga
• Inspirasi paksa
– sternocleidomastoid,
scalenus & pectoralis
minor mengangkat
dada
Pressure Changes during Inspiration and
Expiration
 Respiratory cycle

• Tekanan Alveolar  & udara masuk

• Tekanan Alveolar ↑ & udara keluar
 Faktor yang mempengaruhi Ventilasi
Pulmonal
• Alveolar Surface Tension
• Compliance paru
• Airway resistance
 Alveolar Surface Tension
• Surface tension : a force exerted by a thin layer of
alveolar fluid that coats the luminal surface of
alveoli
– Causes alveoli to assume smallest possible diameter
– accounts for two-thirds of lung elastic recoil
• During breathing, surface tension must be
overcome to expand the lungs during each
inhalation
• Surfactant (a mixture of phospholipids and
lipoproteins) present in alveolar fluid -> reduces its
surface tension
– deficiency of surfactant causes respiratory distress
syndrome
 Compliance paru
• How much effort is required to stretch the lungs and
chest wall
• High compliance : lungs and chest wall expand easily
• Low compliance : lungs and chest wall resist
expansion
• Elasticity and surface tension
– Elastic fibers in lung tissue are easily stretched
– surfactant in alveolar fluid reduces surface tension
• Decreased compliance
– scar lung tissue (tuberculosis)
– lung tissue to become filled with fluid (pulmonary
edema)
– produce a deficiency in surfactant
– impede lung expansion (paralysis of intercostal
muscles)
– destruction of elastic fibers in alveolar walls
(emphysema)
 Airway resistance
• Walls of the airways (bronchioles) offer some
resistance to normal flow of air
• Lungs expand -> bronchioles enlarge ->
decreased airway resistance
• Exhalation -> diameter of bronchioles decreases -
> increased airway resistance
• Any condition that narrows or obstructs the
airways increases resistance (asthma or chronic
obstructive pulmonary disease (COPD))
• Sympathetic division of autonomic nervous
system -> relaxation of smooth muscle in the
walls of the airways -> bronchodilation ->
decreased resistance.
• Parasympathetic nerve fibers in lung
parenchyma -> cause mild to moderate
constriction of the bronchioles.
– Antikolinergic drugs block the effects of
acetylcholine -> relax the respiratory passages
enough to relieve obstruction
 Lung Volumes and Capacities
• Spirometer / Respirometer. : apparatus
commonly used to measure volume of air
exchanged during breathing and respiratory
rate
• Spirogram : recording
• Upward deflection -> Inhalation
• Downward deflection -> exhalation
Spirometer
Spirometer
 Volume Paru-paru
• Tidal volume : volume udara yg masuk pada
setiap inspirasi (500 mL)
• Inspiratory reserve volume (IRV) : tambahan
udara yg masuk pada inspirasi maksimal (3000
mL)
• Expiratory reserve volume(ERV) : tambahan
udara yg dikeluarkan scr aktif (1200 mL)
• Residual volume (RV) : volume sisa dalam
paru (1200 mL)
 Kapasitas paru-paru
• Inspiratory capacity : IRV + TV = 3500 mL
• Functional residual capacity (FRC) : ERV + RV
= 2400 mL
• Vital capacity (VC) : IRV + TV + ERV = 4800 ml
• Total lung capacity : VC + RV = 6000 ml
• FEV1 (forced expiratory volume in 1 second) :
volume udara yg dapat diekspirasi dalam
waktu satu detik pertama
• FVC (forced vital capacity) : pengukuran
kapasitas vital yang didapat dengan
melakukan aktifitas pernapasan dengan
kekuatan maksimal
 Respiratory minute volume/minute
ventilation
• Amount of air moved each minute
= respiratory rate x tidal volume
= 12x500 mL = 6L/min
• Minimal respiratory rate 2 to 4 breaths per
minute -> MV = 1,5-2 L
• Maximal respiratory rate 40 to 50 breaths per
minute -> minute respiratory volume 200
L/min, or more than 30 times normal
 Dead space
• Anatomical dead space (volume rongga mati)
= 150 mL
• Alveolar dead space/physiologic dead space :
alveoli that nonfunctional or only partially
functional
 Ventilasi Alveolar
• Jumlah udara yg mencapai alveoli tiap menit =
RR x (TV – volume rongga mati)
• Ventilasi alveolar = 12 x (500-150)
= 12 x 350
= 4200 mL
• Major factors determining the concentrations
of oxygen and carbon dioxide in the alveoli.
 Functions of the Respiratory
Passageways
• Inhaled air around conchae and meatuses
warmed by blood in capillaries
• Mucus secreted by goblet cells moistens air
and traps dust particles
• Drainage from nasolacrimal ducts and
secretions from paranasal sinuses also helps
moisten air
• Cilia move mucus and trapped dust particles
toward pharynx to be swallowed or spit out