www.drsarma.in 1 guest lecture to biomed dept. prathyusha engineering college by dr. r.v.s.n....
TRANSCRIPT
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Guest Lecture to Biomed Dept.
Prathyusha Engineering College
by
Dr. R.V.S.N. Sarma., M.D., M.Sc., (Canada)
Consultant Physician & Chest Specialist
Mobile: 93805 21221 or 98940 60593
Visit our website: www.drsarma.in
RESPIRATORY PHYSIOLOGY
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Lecture map
Physiology of respiration Definitions and structures Mechanics of breathing Measurements of pulmonary function Cellular Respiration, Pulmonary disorders Blood gases - Diffusion Neural control of respiration Hemoglobin (and disorders) Transport of C02
Acid/base balance
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Anatomy of Respiratory Tree
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Longitudinal Section
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The Thorax and its contents
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What is Respiration ?
Goals: What is the respiratory system? What is respiration? What are the structural features? What are their functions?
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Ventilation: Action of breathing with muscles and lungs
Gas exchange: Between air and capillaries in the lungs. Between systemic capillaries and tissues of
the body 02 utilization:
Cellular respiration in mitochondria
Respiration
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The Vocal Chords (Voice Box)
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Functions of the Respiratory System
Gas Exchange O2, CO2
Acid-base balance CO2 +H2O←→ H2CO3 ←→ H+ + HCO3-
Phonation Pulmonary defense Pulmonary metabolism and handling of
bioactive materials
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Inspiratory Movements
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Thoracic Cavity Diaphragm:
Sheets of striated muscle divides anterior body cavity into 2 parts.
Above diaphragm: thoracic cavity: Contains heart, large blood vessels, trachea,
esophagus, thymus, and lungs.
Below diaphragm: abdominopelvic cavity: Contains liver, pancreas, GI tract, spleen, and
genitourinary tract.
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Mechanics of breathing
Gas: the more volume, the less pressure (Boyle’s)
Inspiration:
lung volume increases ->
decrease in intrapulmonary pressure,
to just below atmospheric pressure ->
air goes in!
Expiration: viceversa
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Intrapleural space:
“Space” between visceral & parietal pleurae.
Visceral and parietal pleurae (membranes) are flush against each other.
Lungs normally remain in contact with the chest wall.
Lungs expand and contract along with the thoracic cavity.
Mechanics of breathing
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Pleural Layers – Cross Section
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Mechanics of breathing
Compliance:
This the ability of the lungs to stretch during
inspiration
lungs can stretch when under tension.
Elasticity:
It is the ability of the lungs to recoil to their
original collapsed shape during expiration
Elastin in the lungs helps recoil
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Inspiration
Inspiration – Active process
Diaphragm contracts -> increased thoracic volume vertically.
Intercostals contract, expanding rib cage -> increased thoracic volume laterally.
More volume -> lowered pressure -> air in.
Negative pressure breathing
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Expiration
Expiration – Passive Due to recoil of elastic lungs. Less volume -> pressure within alveoli is just
above atmospheric pressure -> air leaves lungs.
Note: Residual volume of air is always left behind, so alveoli do not collapse.
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Mechanics of breathing
During Quiet breath: +/- 3 mmHg intrapulmonary pressure.
During Forced breath: Extra muscles, including abdominals +/- 20-30 mm Hg intrapulmonary pressure
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Dynamics of Respiration
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The Pressures
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X-Ray of Chest
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Respiration
It is the process by which the body takes in oxygen and utilizes and removes CO2 from the tissues into the expired air
It comprises of Ventilation by the lungs
inspiration and expiration Gas exchange across alveolar membrane
Diffusion in the alveoli, Fick’s law Transport of gases by blood (haemoglobin) Uptake of O2 and release of CO2 by tissues
Diffusion at the cellular level
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Conducting Zone
Conducting zone: Includes all the
structures that air passes through before reaching the respiratory zone.
Mouth, nose, pharynx, glottis, larynx, trachea, bronchi.
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Conducting Zone Conducting zone Warms and humidifies until inspired air
becomes: 37 degrees Saturated with water vapor
Filters and cleans: Mucus secreted to trap particles Mucus/particles moved by cilia to be
expectorated.
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Conducting Airways
Includes: From Trachea --> Terminal bronchioles
Trachea --> right and left main stem bronchi.Right main stem vulnerable to foreign particlesMain stem bronchi -->lobar bronchi.Dichotomous branching: ~16 generations of airwaysConvection Flow
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Conducting Zone
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Respiratory Zone
Respiratory zone
Region of gas exchange between air and blood- Respiratory bronchioles- Alveolar ducts, Alveolar Sacs and- Alveoli
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Respiratory Zone
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Respiratory Zone
Air duct
Air Sac
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Respiratory Zone
Alveoli Air sacs Honeycomb-like clusters ~ 300 million.
Large surface area (60–80 m2). Each alveolus: only 1 thin cell layer. Total air barrier is 2 cells across (2 m)
(alveolar cell and capillary endothelial cell).
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Respiratory Zone
Alveolar cells
Alveolar type I: structural cells.
Alveolar type II: secrete surfactant.
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Branching of Airways
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Branching of Airways
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Branching of Airways
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Branching of Airways
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Respiratory Zone
Respiratory Zone : Respiratory bronchioles,
Alveoli (300 million), Alveolar ducts, Alveolar sacs
Gas Exchange : respiratory membrane
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Respiratory Zone
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Ventilation
Mechanical process that moves air in and out of the lungs.
Diffusion of… O2: air to blood.
C02: blood to air.
Rapid: large surface area small diffusion
distance.
Insert 16.1
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Bronchial Section - microscopic
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Higher magnification of Bronchus
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Terminal Bronchioles - bifurcation
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Alveoli under microscope
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Alveoli - higher magnification
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EM of the alveoli
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Alveoli
8 million alveolar ducts
300 million alveoli (diameter 70-300 m)
Total alveolar surface area ~ 70 m2
Alveolar membrane thickness < 1 m.
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Netter FH, CIBA Collection ofMedical Illustrations 2nd ed. 1980vol.7, p. 29.
Cross Section of Alveolus
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Secretion of Surfactant by Alveoli
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Section of Bronchus - schematic
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The large surface area of alveoli
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Bronchoscopy
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Blood Vessels of the Lung
Pulmonary Artery:
Deoxygenated (venous) cardiac output.
Pulmonary capillaries
extremely dense
underground parking garage
Pulmonary Veins:
Oxygenated (arterial) cardiac output.
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Alveolar capillary interface
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Alveolar capillary interface - schematic
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Alveolar capillary interface
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Surface tension
Surfactant
produced by alveolar type II cells.
Interspersed among water molecules.
Lowers surface tension.
RDS, respiratory distress syndrome, in preemies.
First breath: big effort to inflate lungs!
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Surface tension
Insert fig. 16.12
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Pulmonary Function
Spirometry
Breathe into a closed system, with air, water, moveable bell
Insert fig. 16.16
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Lung Volumes
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Lung Volumes
Tidal volume (TV): in/out with quiet breath (500 ml)
Total minute volume: tidal x breaths/min 500 x 12 = 6 L/min Exercise: even 200 L/min!
Anatomical dead space: Conducting zone Dilutes tidal volume, by a constant amount. Deeper breaths -> more fresh air to alveoli.
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Lung Volumes
Inspiratory reserve volume (IRV): extra (beyond TV) in with forced inspiration.
Expiratory reserve volume (ERV): extra (beyond TV) out with forced expiration.
Residual volume: always left in lungs, even with forced expiration. Not measured with spirometer
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Lung Capacities
Vital capacity (VC): the most you can actually ever expire, with forced inspiration and expiration.
VC= IRV + TV + ERV
Total lung capacity: VC plus residual volume
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Pulmonary disorders
Restrictive disorder: Vital capacity is reduced. Less air in lungs.
Obstructive disorder: Rate of expiration is reduced. Lungs are “fine,” but bronchi are
obstructed.
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Disorders
Air/ Fluid in the pleural space Pneumothorax Hydrothorax Pyothorax Hydropneumothorax
Restrictive disorder: Black lung from coal mines. Pulmonary fibrosis: Tuberculosis too much connective tissue.
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Pneumothorax – collapse lung
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Obstructive Sleep Apnea
Normal
OSA
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Pulmonary Disorders
COPD (chronic obstructive pulmonary disease):
Smoking is the main cause for COPD Asthma Emphysema Chronic bronchitis
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Disorders
Asthma: Obstructive Inflammation, mucus secretion, bronchial
constriction. Provoked by: allergic, exercise, cold and
dry air Anti-inflammatories, including inhaled
epenephrine (specific for non-heart adrenergic receptors), anti-leukotrienes, anti-histamines.
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Disorders
Emphysema: Alveolar tissue is destroyed. Chronic progressive condition
Cigarette smoking stimulates macrophages and WBC to secrete enzymes which digest proteins.
Or: genetic inability to stop trypsin (which digests proteins).
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Blood Gases
Barometers use mercury (Hg) as convenience to measure total atmospheric pressure.
Sea level: 760 mm Hg (torr)
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Blood Gases
Total pressure of a gas mixture is = to the sum of the independent, partial pressures of each gas (Dalton’s Law).
In sea level atmosphere: PSTP = 760 mm Hg = PN2 + P02 + PC02 + PH20
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Blood Gases
Partial pressures: % of that gas x total pressure.
In atmosphere: 02 is 21%, so (.21 x 760) = 159 mm Hg = P02
Note: atmospheric P02 decreases on a mountain, increases as one dives into the ocean.
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Blood Gases
But inside you, the air is saturated with water vapor. PH20 = 47 mm Hg at 37 degrees
So, inside you, there is less P02: P02 = 105 mm Hg in alveoli. In constrast, alveolar air is enriched in
CO2, as compared to inspired air. PCO2 = 40 mm Hg in alveoli.
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Blood Gases
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Blood Gases
Gas and fluid in contact: Gas dissolved in a fluid depends directly on
its partial pressure in the gas mixture. With a set solubility, non changing temp. (Henry’s law)
So…
P02 in alveolar air ~ = P02 in blood.
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Blood Gases
O2 electrodes can measure dissolved O2 in a
fluid. (also CO2 electrodes)
Good index of lung function. Arterial P02 is only slightly below alveolar P02
Arterial P02 = 100 mm Hg Alveolar P02 = 105 mm Hg P02 in the systemic veins is about 40 mm Hg.
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Lung Perfusion and Ventilation
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Ventilation – Perfusion Matching
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System Overview
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Circulation Overview
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Ventilation and Perfusion
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Perfusion
Geometry of vascular tree R = ŋ/r4
Passive factors affecting PVR PA pressure LA pressure effect of lung volume on PVR
Local factors regulating Q and matching V/Q HPV pH/pCO2
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Capillary Sheet
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Capillary Recruitment
Normal
Dilatation
Recruitment
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Tissue Respiration
Oxygen release and CO2 pick up at the tissue level.
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Cellular Respiration
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Blood gases
Most O2 is in hemoglobin 0.3 ml dissolved in plasma + 19.7 ml in hemoglobin 20 ml O2 in 100 ml blood! But: O2 in hemoglobin-> dissolved ->
tissues. Breathing pure O2 increases only the
dissolved portion. - insignificant effect on total O2
- increased O2 delivery to tissues
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Pulmonary Circulation
Left ventricle pumps to entire body, Right ventricle only to lungs. Both ventricles pump 5.5 L/min! Pulmonary circulation: various adaptations.- Low pressure, low resistance.- Prevents pulmonary edema.
- Pulmonary arteries dilate if P02 is low (opposite of systemic)
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Neural control
Respiratory centers
In hindbrain - medulla oblongata - pons
Automatic breathing
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Neural control
I neurons = inspiration E neurons = expiration I neurons -> spinal motor neurons ->
respiratory muscles. E neurons inhibit I neurons.
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Neural control
Also voluntary breathing controlled by the
cerebral cortex.
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Chemoreceptors
Oxygen: large “reservoir” attached to hemoglobin.
So chemoreceptors are more sensitive to changes in PC02
(as sensed through changes
in pH). Ventilation is adjusted to maintain arterial
PC02 of 40 mm Hg. Chemoreceptors are located throughout the
body (in brain and arteries).
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Chemoreceptors (CTZ)
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Each hemoglobin has 4 polypeptide chains (2 alpha, 2 beta) and 4 hemes (colored pigments).
In the center of each heme group is 1 atom of iron that can combine with 1 molecule 02.
(so there are four 02 molecules per hemoglobin molecule.)
280 million hemoglobin molecules per RBC!
Hemoglobin
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Hemoglobin
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Hemoglobin
Oxyhemoglobin: Ferrous iron (Fe2+) plus 02.
Deoxyhemoglobin: Still ferrous iron (reduced). No 02.
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Hemoglobin
Carboxyhemoglobin: Carbon monoxide (CO) binds to heme
instead of 02 Smokers
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Hemoglobin Loading: Load 02 into the RBC.
Deoxyhemoglobin plus 02 -> Oxyhemoglobin.
Unloading: Unload 02 into the tissues.
Oxyhemoglobin -> deoxyhemoglobin plus 02.
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Hemoglobin
Loading/unloading depends on: P02 Affinity between hemoglobin and 02
pH temperature
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Hemoglobin
Dissociation curve: % oxyhemoglobin saturation at different values of P02.
Describes effect of P02 on loading/unloading. Sigmoidal At low P02 small changes produce large
differences in % saturation and unloading. Exercise: P02 drops, much more unloading from
veins. At high P02 slow to change.
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Oxyhemoglobin Dissociation Curve
Insert fig.16.34
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Hemoglobin
Affinity between hemoglobin and 02:
pH falls -> less affinity -> more unloading (and vice versa if pH increases)
temp rises -> less affinity -> more unloading
exercise, fever
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Hemoglobin
Arteries: 97% saturated (i.e. oxyhemoglobin) Veins: 75% saturated. Arteries: 20 ml 02 /100 ml blood. Veins: ~ 5 ml less Only 22% was unloaded! Reservoir of oxygen in case:
don’t breathe for ~5 min exercise (can unload up to 80%!)
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Hemoglobin
Fetal hemoglobin (F): Gamma chains (instead of beta) More affinity than adult (A) hemoglobin
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Hemoglobin
Anemia: Hemoglobin below normal.
Polycythemia Hemoglobin above normal. Altitude adjustment.
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Disorders
Sickle-cell anemia: fragile, inflexible RBC inherited change: one base pair in DNA -> one
aa in beta chains hemoglobin S protects vs. malaria; african-americans
Thalassemia: defects in hemoglobin type of anemia
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RBC
RBC no nucleus no mitochondria
Cannot use the 02 they carry!!! Respire glucose, anaerobically.
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C02 transported in the blood:
- most as bicarbonate ion (HC03-)
- dissolved C02
- C02 attached to hemoglobin
(Carbaminohemoglobin)
C02 Transport
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C02 Transport
• Carbonic anhydrase in RBC promotes
useful changes in blood PC02
H20 + C02 -> H2C03 -> HC03-
high PC02
CA
H20 + C02 <- H2C03 <-
HC03- low PC02
CA
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C02 Transport
Chloride shift: Chloride ions help maintain electroneutrality. HC03
- from RBC diffuses out into plasma.
RBC becomes more +. Cl- attracted in (Cl- shift).
H+ released buffered by combining with deoxyhemoglobin.
Reverse in pulmonary capillaries
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Acid-Base Balance
Normal blood pH: 7.40 (7.35- 7.45)
Alkalosis: pH up Acidosis: pH down
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Acid-Base Balance
H20 + C02
Hypoventilation: PC02 rises, pH falls (acidosis).
Hyperventilation: PC02 falls, pH rises (alkalosis).
H2C03 H+ + HC03-
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Acid-Base Balance
Ventilation is normally adjusted to keep
pace with metabolic rate, so homeostasis
of blood pH is maintained.
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Acid-Base Balance
Hyperventilation -> PC02 down -> pH of CSF
up -> vasoconstriction -> dizziness.
If hyperventilating, should you breath into paper bag? Yes! It increases PC02!
Metabolic acidosis can trigger hyperventilation.
Diarrhea -> acidosis.
Vomit -> alkalosis.
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Other Functions of the Respiratory System
BEHAVIORAL- talking, laughing, singing, reading
DEFENSE- humidification, particle expulsion
(coughing, sneezing), particle trapping (clots),
immunoglobulins from tonsils and adenoids, a-1
antitrypsin, lysozyme, interferon, complement system
SECRETIONS- mucus (goblet cells, mucus
glands)
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Other Functions: cont
METABOLIC- forms angiotensin II, prostacyclin,
bradykinin, serotonin and histamine
ACID - BASE BALANCE- changes in ventilation
e.g., acute acidosis of exercise
MISCELLANAEOUS- lose heat and water, liquid
reservoir for blood,force generation for lifting,
vomiting, defaecation and childbirth
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Best of Luck to all of you !!!
CD of my lectures is made available
Contact us for any clarifications or needs
Dr R.V.S.N.Sarma., M.D., M.Sc.,(Canada)
Web site: www.drsarma.in
E-mail: [email protected]
Mobile: 93605 21221 or 98949 60593
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