Health Science & OccupationsHealth Science & Occupations

Anatomy, Physiology and Disease Anatomy, Physiology and Disease

Chapter 13Chapter 13The The RespiratoryRespiratory System System

“It’s a Gas!”“It’s a Gas!”

IntroductionIntroduction

Respiratory systemRespiratory system purposepurpose to to transport oxygentransport oxygen from environment and get it from environment and get it

into blood stream to be utilized by into blood stream to be utilized by cells.cells. movesmoves 12,000 quarts of air per 12,000 quarts of air per 2424 hrs hrs removes wasteremoves waste gas – or carbon dioxide – from gas – or carbon dioxide – from

body to avoid “body to avoid “hyper-carbiahyper-carbia.”.” closely related to closely related to cardio-vascularcardio-vascular system and they system and they

are sometimes grouped together as the are sometimes grouped together as the

cardiocardio-pulmonary-pulmonary system. system.

System OverviewSystem Overview

Components includeComponents include heart, heart, blood, and network of blood blood, and network of blood vessels.vessels.

ArteriesArteries carry blood carry blood aawayway from heart, branch into from heart, branch into smaller vessels called smaller vessels called arteriolesarterioles, which become , which become capilcapillarieslaries, where nutrients , where nutrients are exchanged; capillaries are exchanged; capillaries become become venulesvenules, that enlarge , that enlarge and become and become veinsveins..

Components of Respiratory SystemComponents of Respiratory System

Two lungsTwo lungs that serve as vital organs that serve as vital organs Upper and lower airwaysUpper and lower airways that conduct, or move, that conduct, or move,

gas through system.gas through system. Terminal airTerminal air sacs called sacs called alveolialveoli surrounded by surrounded by

network of capillaries that allow gas exchange.network of capillaries that allow gas exchange. Thoracic cageThoracic cage that houses, protects, and that houses, protects, and

facilitates function for system.facilitates function for system. MusclesMuscles of breathing of breathing

Respiratory SystemRespiratory System

““Air” contains many gases…Air” contains many gases…

Nitrogen Nitrogen ((78.08%) 78.08%) which is a which is a support gassupport gas that that keeps lungs openkeeps lungs open by adding by adding volumevolume, or filler, to , or filler, to vitally needed oxygenvitally needed oxygen

OxygenOxygen ( (20.95%)20.95%) essentialessential to life to life Carbon DioxideCarbon Dioxide ( (0.03%)0.03%) found in found in very smallvery small

concentrationsconcentrations ArgonArgon (0.93%) (0.93%) Neon & KryptonNeon & Krypton: trace amounts: trace amounts

Ventilation Ventilation vsvs. Respiration. Respiration

VentilationVentilation: is : is bulk movementbulk movement of air down to of air down to terminal air sacs, or terminal air sacs, or alveolialveoli, of lungs., of lungs.

RespirationRespiration: the process of : the process of gas exchangegas exchange, , where where oxygenoxygen is is added added to blood and to blood and carbon carbon dioxidedioxide is is removed. removed.

External RespirationExternal Respiration:: Movement Movement of oxygen from of oxygen from alveoli to bloodalveoli to blood..

Internal RespirationInternal Respiration: Movement of oxygen : Movement of oxygen from from blood to cellsblood to cells..

““Gas Law’s”Gas Law’s”

Boyle’s LawBoyle’s Law ( (PV=k1PV=k1): when ): when temp temp is constant so is pressure is constant so is pressure & volume.& volume.

Charles’ LawCharles’ Law ( (V=k2TV=k2T): when ): when pressurepressure is constant so is is constant so is volume.volume.

The Airways and LungsThe Airways and Lungs Human reserve oxygenHuman reserve oxygen: : 4 4 to to 66 minutes minutes Respiratory systemRespiratory system is series of is series of

branching tubes called branching tubes called bronchibronchi.. As branches get smallerAs branches get smaller they are called they are called

bronchiolesbronchioles & end in & end in alveolialveoli, terminal or , terminal or distal end of respiratory system.distal end of respiratory system.

alveolusalveolus is surrounded by is surrounded by alveolar-alveolar-capillary membranecapillary membrane & provides & provides interfaceinterface between respiratory and cardiovascular between respiratory and cardiovascular systemssystems

alveolar-capillary membranealveolar-capillary membrane

Upper AirwaysUpper Airways

begin at nostrilsbegin at nostrils, or , or naresnares, & end at , & end at vocal cordsvocal cords..

FunctionsFunctions::

1. heat/cool air1. heat/cool air

2. filtering & humidifying 2. filtering & humidifying

3. olfactation (3. olfactation (to smellto smell))

4. phonations (4. phonations (produce soundproduce sound))

5. ventilation: or 5. ventilation: or conductingconducting gas to gas to

lower airways.lower airways.

Upper AirwaysUpper Airways

Pathology Connection: Pathology Connection:

Allergic RhinitisAllergic Rhinitis::

DXDX: when allergens (like pollen) trigger nasal : when allergens (like pollen) trigger nasal mucosa to secrete excessive mucous.mucosa to secrete excessive mucous.

S/SS/S: runny nose, itchy, red or edematous eyes : runny nose, itchy, red or edematous eyes

RxRx: antihistamines: antihistamines

Pathology Connection:Pathology Connection: Nasal polypsNasal polyps::

DXDX: non-cancerous growths within nasal cavity: non-cancerous growths within nasal cavity

S/SS/S: chronic inflamation, dyspnea, nocturnal : chronic inflamation, dyspnea, nocturnal apneaapnea

RxRx: surgically removed if they become large : surgically removed if they become large enough to block nasal passagewayenough to block nasal passageway

Mucociliary EscalatorMucociliary Escalator

Nasal CiliaNasal Cilia beat beat 1,000–1,5001,000–1,500 times/min times/min propelpropel gel layer & its trapped debris gel layer & its trapped debris upward 1 upward 1

inch/mininch/min to be expelled. to be expelled. smokingsmoking paralyzes paralyzes this escalatorthis escalator

Paranasal SinusesParanasal Sinuses air-filled cavitiesair-filled cavities found around nose found around nose prolongprolong and and intensifyintensify sound sound warmwarm & & humidifyhumidify air air Not born with themNot born with them: develop over time resulting : develop over time resulting

in in reformationreformation of face and head. of face and head.

Pharynx Pharynx

hollow muscular structurehollow muscular structure starting behind nasal starting behind nasal cavity, lined with cavity, lined with epithelialepithelial tissue. tissue.

divided into divided into 33 sections sections

- - nasopharynxnasopharynx

- - oropharynxoropharynx

- - laryngopharynxlaryngopharynx

NasopharynxNasopharynx

contains lymphatic tissuecontains lymphatic tissue called called adenoidsadenoids; ; passageways into middle ear called passageways into middle ear called Eustachian Eustachian tubes.tubes.

OropharynxOropharynx centercenter section of pharynx section of pharynx locatedlocated behind oral, or behind oral, or buccalbuccal cavity cavity air, food and liquid, from oral cavity air, food and liquid, from oral cavity

pass throughpass through Contains tonsilsContains tonsils During swallowingDuring swallowing uvulauvula and and soft soft

palatepalate move in posterior and move in posterior and superior position to superior position to protectprotect nasal nasal pharynx from entry of food or liquidpharynx from entry of food or liquid

LaryngopharynxLaryngopharynx

ConnectsConnects to both larynx, part of respiratory to both larynx, part of respiratory system, and esophagus, part of digestive system, and esophagus, part of digestive systemsystem

Both Both food & airfood & air pass through pass through Potenial problemPotenial problem: :

- - airway obstructionairway obstruction

- infection - infection

- trauma- trauma

Larynx (Larynx (voice boxvoice box))

Semi-rigid structureSemi-rigid structure composed of composed of cartilagecartilage provide movement of vocal provide movement of vocal cords to control speech.cords to control speech.

““Adams appleAdams apple” (thyroid cartilage) is ” (thyroid cartilage) is largestlargest of cartilages found in larynx. of cartilages found in larynx.

Cricoid cartilageCricoid cartilage lies below providing lies below providing structurestructure & & support support in exposed area of in exposed area of airway to prevent collapse.airway to prevent collapse.

Food travelsFood travels into esophagus; into esophagus; air travelsair travels into larynx.into larynx.

GlottisGlottis is opening that leads into larynx, is opening that leads into larynx, & eventually lungs& eventually lungs

EpiglottisEpiglottis: closes tightly when we : closes tightly when we swallow to swallow to preventprevent food from entering food from entering lungslungs

Oropharyngeal AirwaysOropharyngeal Airways

Pathology ConnectionPathology Connection Common coldCommon cold

EtiologyEtiology: over : over 200200 different types of viruses different types of viruses

DxDx: : acute inflammationacute inflammation of of upper respiratoryupper respiratory mucous membranesmucous membranes

RxRx: managing symptoms: antipyretics, : managing symptoms: antipyretics, antihistamines.antihistamines.

- can be prevented with good hand-washing- can be prevented with good hand-washing

- not an allergy or influenza- not an allergy or influenza

SinusitisSinusitis

DxDx: Infection & inflammation of sinuses: Infection & inflammation of sinuses

EtiologyEtiology: : chemicalchemical irritation vs irritation vs bacterialbacterial

S/SS/S: pressure, pain, fever & headaches: pressure, pain, fever & headaches

RxRx: antipyretics, anti-inflammatory meds, : antipyretics, anti-inflammatory meds,

antibiotics if bacterial antibiotics if bacterial notnot viral. viral.

TonsillitisTonsillitis

DxDx: Inflammation of tonsils : Inflammation of tonsils

EtiologyEtiology: bacterial: bacterial

S/SS/S: pain, dysphasia, fever, edema: pain, dysphasia, fever, edema

RxRx: antibiotics, antipyretics, possible tonsillectomy.: antibiotics, antipyretics, possible tonsillectomy.

Pharyngitis Pharyngitis

DxDx: sore throat : sore throat

EtiologyEtiology: Bacterial frequently : Bacterial frequently Strep throatStrep throat

S/SS/S: similar to Tonsillitis but with edema to neck : similar to Tonsillitis but with edema to neck

glands.glands.

RxRx: warm salt-H2O gargle antipyretics/anti-: warm salt-H2O gargle antipyretics/anti-

inflammatory meds, antibiotics if severe. inflammatory meds, antibiotics if severe.

LaryngitisLaryngitis

DxDx: viral inflammation of voice box: viral inflammation of voice box

S/SS/S: hoarseness : hoarseness

EtiologyEtiology: excessive use of voice: excessive use of voice

RxRx: complete voice rest, humidification: complete voice rest, humidification

Acute EpiglotitisAcute Epiglotitis DxDx: Dangerous infection causes swelling of : Dangerous infection causes swelling of

epiglottis and airway obstruction.epiglottis and airway obstruction.

EtiologyEtiology: 1. usually : 1. usually Haemophilus influenzae Haemophilus influenzae type Btype B

2. most common in children 2. most common in children 2-6 y/o2-6 y/o

3. incidence lower when Flu shot taken3. incidence lower when Flu shot taken

S/SS/S: fever, sore throat, respiratory distress, drooling,: fever, sore throat, respiratory distress, drooling,

dysphasia, and dysphonia.dysphasia, and dysphonia.

Acute Epiglottis, cont’dAcute Epiglottis, cont’d

RxRx: - onset is : - onset is fastfast, & requires , & requires rapid treatmentrapid treatment

- maintain open airway- maintain open airway

- cool humidified O2- cool humidified O2

- orotracheal intubation or cricothyroidotomy- orotracheal intubation or cricothyroidotomy

- IV antibiotics, anti-inflammatory meds- IV antibiotics, anti-inflammatory meds

- hospitalization - hospitalization

LaryngotracheobronchitisLaryngotracheobronchitis““CroupCroup””

DxDx: infection of laryngeal area: infection of laryngeal area

EtiologyEtiology: viral or bacterial: viral or bacterial

S/S: barking cough like a goose, inspiratory stridorS/S: barking cough like a goose, inspiratory stridor

RxRx: rest, antibiotics & anti-inflammatory meds: rest, antibiotics & anti-inflammatory meds

NoteNote: Sometimes called “: Sometimes called “CroupCroup” or “” or “PertussisPertussis””

The Lower Respiratory TractThe Lower Respiratory Tract

TracheaTrachea Largest pipeLargest pipe in respiratory system in respiratory system Begins bifurcatingBegins bifurcating at center of chest into at center of chest into leftleft and and

rightright mainstem bronchi @ mainstem bronchi @ carinacarina.. Each bronchi branchEach bronchi branch into lobular bronchi that into lobular bronchi that

correspond to correspond to five lobesfive lobes of lungs (3 in right; of lungs (3 in right; 22 in in left)left)

LobesLobes

UpperUpper

Middle Middle

LowerLower

LobesLobes

UpperUpper

LowerLower

Epithelial LayersEpithelial Layers

First containsFirst contains mucociliarymucociliary escalator escalator MiddleMiddle is lamina propria layer which contains is lamina propria layer which contains

smooth musclesmooth muscle, lymph, and , lymph, and nerve tractsnerve tracts Third layerThird layer is protective and supportive is protective and supportive

basement basement cartilaginouscartilaginous layer layer

Epithelial Epithelial LayersLayers

FirstFirst

MiddleMiddle

ThirdThird

Tissue layers in the bronchiTissue layers in the bronchi

BronchiBronchi

Branching continues getting more Branching continues getting more numerous and smallernumerous and smaller

Cartilaginous rings Cartilaginous rings become more irregular become more irregular and eventually fade awayand eventually fade away

BronchiolesBronchioles

Bronchioles average only 1 mm in diameter; Bronchioles average only 1 mm in diameter; have 10-15 generationshave 10-15 generations

There is no cartilage layer. There is no cartilage layer. There is no gas exchange yet. There is no gas exchange yet. Terminal bronchioles (generation 16) have Terminal bronchioles (generation 16) have

average diameter of 0.5 mmaverage diameter of 0.5 mm Next airways beyond terminal bronchioles Next airways beyond terminal bronchioles

are respiratory bronchioles: some gas are respiratory bronchioles: some gas exchange occurs hereexchange occurs here

Alveolar Ducts and SacsAlveolar Ducts and Sacs

Alveolar ducts Alveolar ducts originate from originate from respiratory bronchioles respiratory bronchioles

Terminal air sacs called Terminal air sacs called alveolialveoli Adults have 300–600 million Adults have 300–600 million alveolialveoli = =

80 m80 m22 surface area surface area Surrounded by Surrounded by alveolarcapillaryalveolarcapillary

membranemembrane

Components of Alveolar Components of Alveolar Capillary MembraneCapillary Membrane

11stst component: First layer is liquid surfactant component: First layer is liquid surfactant layer that lines alveoli, lowers surface tension in layer that lines alveoli, lowers surface tension in alveoli and prevents alveolar collapsealveoli and prevents alveolar collapse

22ndnd component: tissue layer that produces component: tissue layer that produces surfactant and allows easy gas molecule surfactant and allows easy gas molecule movementmovement

33rdrd component: interstitial space that contains component: interstitial space that contains interstitial fluidinterstitial fluid

44thth component: capillary endothelium that component: capillary endothelium that contains capillary blood and RBCscontains capillary blood and RBCs

Pathology Connection: Pathology Connection: AtelectasisAtelectasis

Etiology: Etiology: air sacs of lungs are either partially or air sacs of lungs are either partially or totally collapsed due to inability to take deep totally collapsed due to inability to take deep breaths due to injury or surgerybreaths due to injury or surgery

S/S: S/S: decreased breath soundsdecreased breath sounds TX: TX: PREVENTION!! PREVENTION!! Incentive spirometer, Incentive spirometer,

deep breathing, coughing, splinting deep breathing, coughing, splinting incisional site during coughing incisional site during coughing

Pathology Connection: Pathology Connection: PneumoniaPneumonia

Etiology:Etiology:Lung infection that can be caused by Lung infection that can be caused by virus, fungi, or bacteriavirus, fungi, or bacteria

S/S: S/S: inflammation of infected area with inflammation of infected area with accumulation of cell debris and fluid, accumulation of cell debris and fluid, decreased breath sounds and/or rhonci, decreased breath sounds and/or rhonci, possible feverpossible fever

DX: DX: CXR (chest x-ray)CXR (chest x-ray) TX: TX: antibiotics, nebulizer treatments, O2antibiotics, nebulizer treatments, O2

PneumoniaPneumonia

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary Disease (COPD)Disease (COPD)

Group of diseases characterized by difficulty Group of diseases characterized by difficulty evacuating air from lungsevacuating air from lungs

Types: asthma; emphysema; chronic bronchitisTypes: asthma; emphysema; chronic bronchitis Associated with Associated with

• CoughCough• Sputum productionSputum production• DyspneaDyspnea• Airflow obstructionAirflow obstruction• Impaired gas exchangeImpaired gas exchange

AsthmaAsthma Etiology:Etiology: many triggers such as allergens, many triggers such as allergens,

food, exercise, cold air, inhaled irritants, food, exercise, cold air, inhaled irritants, smokingsmoking

S/S:S/S: dyspnea, wheezing, productive dyspnea, wheezing, productive cough, hypoxiacough, hypoxia

DX:DX: history and physical exam, lung function history and physical exam, lung function teststests

TX:TX: bronchodilators, steroids, and anti-asthmatic bronchodilators, steroids, and anti-asthmatic agents; O2 if neededagents; O2 if needed

Triggers for AsthmaTriggers for Asthma

Chronic BronchitisChronic Bronchitis

Etiology:Etiology: cigarette smoking and long term cigarette smoking and long term exposure to air pollutantsexposure to air pollutants

S/S:S/S: dyspnea, wheezing, productive cough, dyspnea, wheezing, productive cough, hypoxiahypoxia

DX:DX: H and P, lung function tests H and P, lung function tests TX:TX: antibiotics if bacterial, bronchodilators, O2 if antibiotics if bacterial, bronchodilators, O2 if

neededneeded

EmphysemaEmphysema

Etiology:Etiology: cause not fully known but cause not fully known but associated with smoking and one genetic associated with smoking and one genetic form from alpha 1-antitrypsin deficiencyform from alpha 1-antitrypsin deficiency

S/S:S/S: dyspnea, tachypnea, wheezing, productive dyspnea, tachypnea, wheezing, productive cough, hypoxiacough, hypoxia

DX:DX: H/P, lung function tests H/P, lung function tests TX:TX: O2, bronchodilators, alpha 1-antitrypsin O2, bronchodilators, alpha 1-antitrypsin

replacementreplacement

Asthma and EmphysemaAsthma and Emphysema