FISIOLOGI RESPIRASIClick to edit Master subtitle style

Dr. Bernhard Arianto Purba, M.Kes., AIFO

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Textbooks

Guyton, A.C & Hall, J.E. 2006. Textbook of Medical Physiology. The 11th edition. Philadelphia: Elsevier-Saunders: 471-551. Marieb, E.N., and Hoehn, K. 2007. Human Anatomy and Physiology. The 7th edition. USA: Benjamin Cummings, Pearson Educaton, Inc. Brooks, G.A. & Fahey, T.D. 1985. Exercise Physiology. Human Bioenergetics and Sts Aplications. New York : Mac Millan Publishing Company. Foss, M.L. & Keteyian, S.J. 1998. Foxs Physiological Basis for Exercise and Sport. 4th ed. New York : W.B. Saunders Company. Astrand, P.O. and Rodahl, K. 1986. Textbook of Work Pysiology, Physiological Bases of Exercise. New York : McGraw Hill. Ganong, M. Wiliiam. 2003. Review of Medical Physiology. The 21st edition. USA: McGrawHill Companies. Banerjee, Ashis. 2005. Clinical Physiology. Cambridge: Cambridge University Press.

The Student ObjectiveAfter attending the discussion of respiratory physiology, students will be able to explain the normal function of respiratory system, rightly

THE SUBTOPICS1. 2. 3. 4. 5. 6. 7. 8.

Structure of the Respiratory System The Pulmonary Ventilation Lung Volume and Capacity The O2 CO2 Exchange The Transport of O2 and CO2 The Control of Respiration Exercise and The Respiratory System Aging and Respiratory System

Structures of The Respiratory System

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Upper Respiratory System Nose Pharynx Associated structures Lower Respiratory System Larynx Trachea Bronchi Lung

Organs of the Respiratory System

Anatomy OverviewNasal cavity Pharynx

Larynx Trachea

The respiratory tract includes: Nose (nasal cavity) Pharynx (nasopharynx, oropharynx, laryngopharynx) Larynx Trachea Bronchi (primary, secondary (lobar), tertiary (segmental) Bronchioles Terminal bronchioles Respiratory bronchioles Alveolar ducts Alveoli

Bronchi Bronchioles Respiratory bronchioles

Right Lung

Left Lung

Alveolar duct

Alveoli

Histology

Respiratory Epithelium = Pseudostratified Ciliated Columnar (PSCC)

Conducting Zone

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All the structures through which air passes before reaching the respiratory zone. Warms and humidifies inspired air. Filters and cleans: Mucus secreted trap particles in the inspired air. Mucus moved by cilia to be expectorated.

Respiratory bronchioles n Alveolar ducts n Alveolar sacs n Respiration (=exchange of gases)n

Nose (nasal cavity)Air normally enters through external nares through nasal vestibule into nasal cavity. Functions of nasal cavity include: warming, moistening & filtering air; olfaction

PharynxAir passes from nasal cavity into nasopharynx, past oropharynx & through laryngopharynx to larynx Nasopharynx lined with PSCC epithelium, but oro & laryngopharynx lined with stratified squamous epithelium

LarynxAir passageway made of 9 pieces of cartilage (1) Thyroid cartilage, (1) Epiglottis, (1) Cricoid cartilage, (2) Arytenoid, (2) Corniculate, (2) Cuneiform A.K.A your voicebox because it contains the vocal cords

Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Thyroid cartilage protects anterior & lateral walls of airway Epiglottis leaf-shaped cartilage that protects opening (glottis) of airway when swallowing Cricoid cartilage complete ring of cartilage; protects posterior wall of airway; attaches to trachea

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Arytenoid, corniculate & cuneiform cartilages attach to upper (false) vocal folds & lower (true) vocal cords

TracheaTough but flexible windpipe, anterior to esophagus

attached to cricoid cartilage (at about C6 vertebral level) & ends within mediastinum by branching into left & right primary bronchi (at T5 vertebral level)

End of trachea known as Carina

Carina

Bronchial Tree

TracheaLined with respiratory epithelium

C-shaped pieces of hyaline cartilage protecting airway while allowing for swallowing

Trachealis muscle (smooth muscle) runs across posterior wall of trachea connecting ends of tracheal cartilage

BronchiCarin aTrachea splits into a left & right primary bronchus which enters into the hilus of each lung

Within the lung, the primary bronchi branch into secondary (lobar) bronchi (3 in right lung/2 in left lung)

Secondary bronchi then branch into 10 tertiary (segmental) bronchi

Tertiary bronchi then continue to branch into smaller & smaller bronchi & then into very narrow bronchioles

This branching patterns creates the bronchial tree

Changes In AirwayAs you go further down into the bronchial tree of each lung, changes in the airway occur: increased number of airways (1 primary; 2 or 3 secondary; 10 tertiary bronchi; 6000 terminal bronchioles; millions of alveolar ducts) decreased diameter of each airway decreased amount of cartilage in the airways (no cartilage at all by terminal bronchioles) increased amount of smooth muscle (relative to diameter) lining epithelium changes from PSCC simple squamous epithelium (in alveoli)12/23/12

Lungs

Located within the thoracic cavity, surrounded by the double-layered pleural membrane parietal pleura lines cavity wall visceral pleura covers the lungs

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Lungs- Anatomical FeaturesApex extends 1 above clavicle Hilus at medial surface; where primary bronchus, pulmonary artery & veins enter/exit lung Superior lobeRight lung Left lung

Superior lobe Horizontal fissure Middle lobe Oblique fissure Inferior lobe

Oblique fissure

Cardiac notch Inferior lobe

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Base rests on diaphragm

Airways within LungsEach lung has a primary bronchus entering at the hilus

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Each lobe of a lung has a secondary (a.k.a. lobar) bronchus

Lobes are functionally divided into bronchopulmonary segments & each segment has a tertiary (segmental) bronchus

Segments are functionally divided into many lobules & each lobule receives a terminal bronchiole

Relationship of Airways & Pulmonary VesselsAs airways branch within lungs, they are accompanied by branches of the pulmonary artery (carrying de-oxygenated blood into the lungs), & branches of the pulmonary veins (carrying oxygenated blood out of the lungs)

As the alveolar ducts expand to form alveoli, pulmonary arterioles will branch to form a network of pulmonary capillaries, surrounding the alveoli

AlveoliAlveoli are expanded chambers of epithelial tissue that are the exchange surfaces of the lungs

There are about 150 million alveoli in each lung

Multiple alveoli usually share a common alveolar duct, creating alveolar sacs

Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings

AlveoliThere are three types of cells found within alveoli: Alveolar Squamous epithelial (aka type I) cells primary cells making up the wall of the alveoli

Septal (aka type II) cells sectrete surfactant to reduce surface tension which prevents alveoli from sticking together & allows for easier gas exchange

Alveolar macrophages (aka dust cells) phagocytic cells that remove dust, debris & pathogens

Alveolar surfactantn

Surfactant is a complex mixture of phospholipids (dipalmitoylphosphatidyl choline), proteins (surfactant apoproteins), & ions (Ca2+) Type II cells secrete surfactant (lipoproteins) decrease surface tension allowing for easier alveoli inflation Surfactants start to be secreted by the 7th month of pregnancy risk of lung disease in premature babies

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Gas exchange (external respiration) occurs across the Respiratory membrane the fused membranes of the alveolar epithelium & the pulmonary capillary endothelium

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Gas Exchange

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Alveolus

Alveoli Gas exchange across thin epithelium ofmillions of alveoliu

total surface area in humans ~100 m2

AP Biology

Brainstorming

AP Biology

GOALS OF RESPIRATION1. To provide oxygen to the tissues 2. To remove carbon dioxide

MAJOR FUNCTIONAL EVENTS OF RESPIRATION1. Pulmonary Ventilation inflow and outflow of air between the atmosphere and lung alveoli12/23/12

2. Diffusion of oxygen and carbon dioxide between the alveoli and the blood3. Transport of oxygen and carbon dioxide in the blood and body fluids to and from the cells. 4. Regulation of Ventilation

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Mechanics of Pulmonary Ventilation of air in and out of respiratory tract Is the physical movementProvides alveolar ventilation

1.

Downward and upward movement of the diaphragm lengthen or shorten the chest cavity Elevation and depression of the ribs increase or decrease the anteroposterior diameter of the chest cavity

2.

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The Muscles of Breathing Inspiratory muscles

Diaphragm (75%) External Intercostalis Sternocleidomastodeus Scalenus Seratus (anterior) Internal Intercostalis Abdominal Muscles

Expiratory muscles

Boyles Lawo

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Defines the relationship between gas pressure and volume: P = 1/V In a contained gas:n

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external pressure forces molecules closer together movement of gas molecules exerts pressure on container

Gas Pressure and Volume

Figure 23 13

Boyles Lawo

Changes in intrapulmonary pressure occur as a result of changes in lung volume.n

Pressure of gas is inversely proportional to its volume.

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Increase in lung volume decreases intrapulmonary pressure.n

Air goes in.

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Decrease in lung volume, raises intrapulmonary pressure above atmosphere.n

Air goes out.

PULMONAL VENTILATION(BREATHING) 1. Inspiration 2. Expiration * The movement of air into and out of the lung depends on pressure change (Boyles law)

Air flows from area of higher pressure to area of lower pressure

Boyles law

Inspiration and Expiration Mechanism

INSPIRATION Active Boyle law

EXPIRATION Passive

Muscle relaxation Elastic recoil Labor

Active

BREATHING PATTERN Eupnea = Normal quiet breathing Apnea = A temporary cessation of breathing Dyspnea = A painful or labored breathing + tachypnea Costal breathing = Shallow (chest) breathing Diaphragmatic breathing = Deep (abdominal) breathing

Transpulmonar y pressure

S u m m a r y

Other factors affecting ventilationTwo other important factors play role in ventilation: -Resistance within the airway -Lung compliance

Resistance in respiratory passagewaysAirway resistance peaks in the medium-sized bronchi and then declines sharply as the total cross-sectional area of the airway increases rapidly

Astma

AIRWAY RESISTANCE The narrower the airway diameter the higher the resistance The broader the airway diameter the lower the resistance MODIFIED RESPIRATORY MOVEMENT Laughing, Sighing, Sobbing Sneezing, Coughing Talking, Singing

WORK OF BREATHING (work of inspiration) 1. Compliance work or Elastic work that required to expand the lungs against the lung and chest elastic forces

2. Tissue resistance work required to overcome the viscosity of the lung and chest wall structures 3. Airway resistance work required to overcome airway resistance to movement of air into the lungs

COMPLIANCE

The extent to which the lungs expand for each unit increase in transpulmonary pressure Both lungs 200 ml of air per cm of water transpulmonary pressure Thorax and lungs together 110 ml per cm of water transpulmonary pressure

Compliance and Tissue resistance work increased by diseases that cause fibrosis of the lungs as in tuberculosis

Airway resistance work increased by diseases that obstruct the airways as in asthma 3 to 5% of the total energy expended by the body is required to energize the pulmonary ventilatory process

LUNG COMPLIANCE The ease of lung + thoracic wall to expand The higher the compliance the easer to expand The higher the surface tension the lower the compliance The lesser the elasticity the lower the compliance The Compliance decrease in: Scar lung Pulmonary edema Surfactant deficiency Muscle paralysis , emphysema

SURFACTANT- Surface active agent, when it spreads over the surface of a fluid, it reduces the surface tension - Secreted by type II alveolar epithelial cells - Complex mixture of phospholipids, proteins and ions - dipalmitoylphosphatidylcholine - surfactant apoproteins - calcium ions

SURFACTANT1. 2. 3.

Lowers surface tension Stabilizes the size of the alveoli Prevents the accumulation of fluid

ALVEOLAR SURFACE TENSION Alveolar fluid surrounds air in alveoli exerts tension (surface tension) Lowered by Surfactant Great surface tension tend to collapse the lung

Surface tension

Ice Hydrogen bonds are stable

Hydrog en bond

Liquid water Hydrogen bonds break and reform

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N+ a C l

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Surface Tension of Different watery fluids:n n

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72 dynes/cm pure water 50 dynes/cm normal fluids lining the alveoli but without surfactant 5 to 30 dynes/cm fluids lining the alveoli with surfactant included.

Stabilize the sizes of the alveoli - inversely affected by radius of the alveolus - begin to be secreted between the 6th and 7th month of gestation-

Collapse Pressure of Occluded Alveoli Caused by Surface Tensionn

Law of Laplace states that pressure in alveolus is directly proportional to ST; and inversely to radius of alveolin

Thus, pressure in smaller alveoli would be greater than in larger alveoli, if ST were the same in both

Respiratory Distress Syndrome of the Newborn caused by little or no surfactant. The lungs of babies have extreme collapse tendencies, 30 mmHg or more

Ventilation: Surface Tension and Surfactant

The smaller bubble will collapse without surfactant!

Surfactant reduces surface tension

Surfactant reduces surface tension

LUNG VOLUMES1.

2.

Tidal Volume (Vt) is the volume of air inspired or expired with each normal breath - 500 ml Inspiratory Reserve Volume (IRV) the extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force 3000ml

3. Expiratory Reserve Volume (ERV) is the maximum extra volume of air that can be expired by forceful expiration after the end of the normal tidal expiration - 1100 ml 4. Residual Volume (RV) the volume of air remaining in the lungs after the most forceful expiration 1200ml

Pulmonary function tests

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Can help distinguish between obstructive pulmonary disease and restrictive pulmonary diseaseObstructive disease: obstruction in bronchi-bronchioles severely restricts the speed and amount of air movement Damage to lung tissue prevents full lung expansion and recoil

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CAPACITIESInspiratory Capacity (IC) IC = Vt + IRV = 3, 500 ml 2. Functional Residual Capacity (FRC) = 2,300 ml FRC = ERV + RV 3. Vital Capacity (VC) VC = IRV + Vt + ERV = IC + ERV 4. Total Lung Capacity (TLC) = 5, 800ml TLC = Vt + IRV + ERV + RV = IC + FRC = VC + RV1.

Respiratory Volumes

HELIUM DILUTION METHOD

determination Functional Residual capacity, Residual volume, Total Lung Capacity

FRC = Initial conc. Of Helium in spirometerFinal conc. Of Helium FRC = CiHe __ - 1 CfHe RV = FRC REV TLC = FRC + IC ViSpir

FACTORS AFFECTING LUNG VOLUMES AND VITAL CAPACITY1. 2. 3. 4.

Body build or physique Position of the body Strength of respiratory muscles Pulmonary compliance

Minute Respiratory Volumeis the total amount of new moved into the respiratory passages each minute = Tidal volume x Respiratory rate/minute = 500 x 12

Alveolar VentilationTotal volume of new air entering the the alveoli and adjacent gas exchange areas each minute V A= Freq . (VT VD )

Alveolar Ventilation alveolar ventilation rate major factor affecting concentrations of oxygen and carbon dioxide in the alveoli volume of air that reaches alveoli tidal volume minus physiologic dead space then multiplied by breathing rate

minute ventilation tidal volume multiplied by breathing rate amount of air that is moved into the respiratory passageways

Respiratory Dead Space space in the conducting zone of the airways occupied by gas that does not exchange with the blood in the pulmonary vesselsVital Capacity the largest volume of air that can be expired after a maximal inspiratory effort. It is frequently measured clinically as an index of pulmonary function. It gives useful information about the strength of the respiratory muscles and other pulmonary functions. Maximal Voluntary Ventilation (MVV) or Maximal breathing Capacity largest volume of gas that can be moved into and out of the lungs in 1 minute by voluntary effort 125 170 L/min.

ANATOMIC DEAD SPACE space of therespiratory system besides the alveoli and other gas exchange areas Dead space air = 150 ml PHYSIOLOGIC DEAD SPACE alveolar dead space and anatomic dead space In normal person the Anatomic and Physiologic dead spaces are nearly equal In person with partially functional or nonfunctional alveoli the Physiologic dead space is much as 10 x the volume of Anatomic dead space

Anatomical dead spacen

Anatomical dead space: space within the conductive airway, about 150 ml. What will happen to a person who has a tidal volume of 150 ml due to lung disease? What can be done to help the person?

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Dead space importancel l

As dead space increases, effective TV decreases (or as TV decreases) May increase work of breathing by incorporating accessory muscles to breathe normally

Alveolar Ventilation

FUNCTIONS:1.

Cough Reflex Vagus Nerve a. Irritation b. Inspiration 2.5 liters of air are rapidly inspired. Epiglottis closes and the vocal cords shut tightly to entrap the air within the lungs. c. Compression abdominal muscles contract forcefully. Pushing against the diaphragm. Pressure rises to 100 mmHg or more. d. Expulsion air under high pressure in the lungs explude outward

2. Sneeze Reflex Trigeminal Nerve Uvula is depressed so large amounts of air pass directly through the nose helping to clear the nasal passages of foreign matter,

3. Vocalizationa.

b.

Phonation larynx is adapted to act as vibrator (vibrating element is the vocal cord) Vocalization and resonance organs of articulation are the lips, tongue, and soft palate

Smoking

Smoking

Chronic bronchitis, emphysema, and cancer Over 2000 chemicals in tobacco smoke.n

What gives the lung at the top its dark color?

Nonrespiratory Air Movements

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