Rspiratory System

Chapter 23
The Respiratory
System
Respiratory System Anatomy

Structurally, the respiratory system is divided into upper and lower divisions or tracts. The upper respiratory tract consists of the nose, pharynx and associated structures. The lower respiratory tract
Upper respiratory tract
consists of the larynx,

trachea, bronchi and lungs.
Lower respiratory tract
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Functionally, the respiratory system is divided into the conducting zone and the respiratory zone.
The conducting zone is involved with bringing air to

the site of external respiration and consists of the nose, pharynx, larynx, trachea, bronchi,
bronchioles and terminal bronchioles.

The respiratory zone is the main site of gas exchange
and consists of the respiratory bronchioles, alveolar
ducts, alveolar sacs, and alveoli.


Air passing through the respiratory
tract traverses the: Nasal cavity
Pharynx
Larynx Trachea Primary (1o) bronchi Secondary (2o) bronchi Tertiary (3o) bronchi Bronchioles Alveoli (150 million/lung)

The external nose is visible on the face. The internal nose is a large cavity beyond the nasal
vestibule.
The internal nasal

cavity is divided by a nasal septum into right and
left nares.

Three nasal conchae (or turbinates) protrude from each
lateral wall into the breathing passages. Tucked under each nasal concha is an opening, or meatus, for a duct that drains secretions of the sinuses and tears into the nose.
Receptors in the
olfactory epithelium pierce the bone of the cribriform plate.

The pharynx is a hollow tube that starts posterior to the internal nares and descends to the opening of the larynx in the neck. It is formed by a complex arrangement of skeletal muscles that assist in deglutition.
It functions as:
o o o
a passageway for air and food a resonating chamber a housing for the tonsils

The pharynx has 3 anatomical regions: The nasopharynx; oropharynx; and laryngopharynx In this graphic, slitting the muscles of the posterior pharynx shows the back of the tongue
in the laryngopharynx.
The nasopharynx is separated from the oropharynx by the hard and soft palate.

The nasopharynx lies behind the internal nares. It contains the pharyngeal tonsils (adenoids) and the openings of the
Eustachian tubes
(auditory tubes) which come off of it and travels to the middle
ear cavity.

The oropharynx lies behind the mouth and participates in both respiratory and digestive functions. The main palatine tonsils (those usually taken in a
tonsillectomy) and small lingual tonsil are housed

here. The laryngopharynx lies inferiorly and opens into the larynx (voice box) and the esophagus. It participates in both respiratory and digestive
functions.

The larynx, composed of 9 pieces of cartilage, forms a short passageway connecting the laryngopharynx with the trachea (the windpipe).
The thyroid cartilage (the large

Adams apple) and the one below it (the cricoid cartilage) are landmarks for making an emergency airway (called a
cricothyrotomy).
Anterior view of the larynx


The epiglottis is a flap of elastic cartilage covered with a mucus membrane, attached to the root of the tongue. The epiglottis guards the entrance of the glottis, the
opening between the vocal folds.

o
For breathing, it is held anteriorly, then pulled backward to close off the glottic opening during
swallowing.

The rima glottidis (glottic opening) is formed by a pair of mucous membrane vocal folds (the true vocal cords). The vocal folds are situated high in the larynx just
below where the larynx and the esophagus split off

from the pharynx.

Cilia in the upper respiratory tract move mucous and
trapped particles down toward the pharynx. Cilia in the lower respiratory tract move them up toward the larynx.

As air passes from the laryngopharynx into the larynx, it leaves the upper respiratory tract and enters the lower respiratory tract.
Air passing through the respiratory tract Nasal cavity Pharynx Larynx Trachea Primary bronchi Secondary bronchi Lower respiratory tract Upper respiratory tract
Tertiary bronchi
Bronchioles Alveoli (150 million/lung)

The trachea is a semi-rigid pipe made of semi-circular cartilaginous rings, and located anterior to the esophagus. It is about 12 cm long and extends from the inferior
portion of the larynx into the mediastinum where it

divides into right and left primary (1o, mainstem) bronchi. It is composed of 4 layers: a mucous secreting epithelium called the mucosa, and three layers of CT (submucosa,
hyaline cartilage, and adventitia).


The tracheal cartilage rings are incomplete posteriorly, facing the esophagus. Esophageal masses can press into this soft part of the
trachea and make it difficult

to breath, or even totally obstruct the airway.

The right and left primary (1o or mainstem) bronchi emerge from the inferior trachea to go to the lungs, situated in the right and left pleural cavities.
The carina is an internal

ridge located at the junction of the two mainstem bronchi a very sensitive area for triggering the
cough reflex.

The 1o bronchi divide to form 2o and 3o bronchi which respectively supply the lobes and segments of each lung. 3o bronchi divide into
bronchioles which in
turn branch through about 22 more divisions (generations).
o
The smallest are the
terminal bronchioles.

The bronchi and bronchioles go through structural changes as they branch and become smaller. The mucous membrane changes and then disappears. The cartilaginous rings become more sparse, and
eventually disappear altogether.

As cartilage decreases, smooth muscle (under the control of the Autonomic Nervous System) increases.
o
Sympathetic stimulation causes airway dilation, while parasympathetic stimulation causes airway
constriction.

All the branches from the trachea to the terminal bronchioles are conducting airways they do not
participate in gas
exchange.

The cup-shaped outpouchings which participate in gas
exchange are called alveoli.

The first alveoli dont appear until the respiratory bronchioles where they are rudimentary and mostly nonfunctioning.

Respiratory bronchioles give way to alveolar ducts, and the epithelium (simple cuboidal) changes to simple squamous, which comprises the alveolar ducts, alveolar
sacs, and alveoli.

Taken together, these structures form the functional unit of the lung, which is the pulmonary lobule. Wrapped in elastic
C.T., each pulmonary

lobule contains a lymphatic vessel, an arteriole, a venule and a terminal
bronchiole.
The pulmonary lobule

As part of the pulmonary lobule, alveoli are delicate structures composed chiefly of type I alveolar cells, which allow for exchange of gases with the pulmonary capillaries. Alveoli make up a large surface area (750 ft2).
Type II cells secrete a

substance called surfactant that prevents collapse of the alveoli during exhalation.

Alveoli macrophages (also called dust cells) scavenge the alveolar surface to engulf and remove microscopic debris that has made it past the mucociliary blanket
that traps most foreign particles higher in

the respiratory tract. The alveoli (in close proximity to the capillaries) form the alveolar-capillary membrane
(AC membrane).
Blood Supply to the Lungs

The lungs receive blood via two sets of arteries
Pulmonary arteries carry deoxygenated blood from
the right heart to the lungs for oxygenation Bronchial arteries branch from the aorta and deliver oxygenated blood to the lungs primarily perfusing the muscular walls of the bronchi and bronchioles
Ventilation-Perfusion Coupling
Ventilation-perfusion coupling is the coupling of perfusion (blood flow) to each area of he lungs to match the extent of ventilation (airflow) to alveoli in that area
In the lungs, vasoconstriction in response to hypoxia

diverts pulmonary blood from poorly ventilated areas of the lungs to well-ventilated regions In all other body tissues, hypoxia causes dilation of blood vessels to increase blood flow

As organs, the lungs are divided into lobes by fissures. The right lung is divided by the oblique fissure and the horizontal fissure into 3 lobes .
The left lung is divided into

2 lobes by the oblique fissure. Each lobe receives it own 2o bronchus that branches into 3o segmental bronchi (which
continue to further divide).


The apex of the lung is superior, and extends slightly above the clavicles. The base of the lungs rests on the diaphragm.
The cardiac notch

in the left lung (the indentation for the heart) makes the left lung 10 % smaller
than the right lung.


The lungs are separated from each other by the heart and other structures in the mediastinum. Each lung is enclosed by a double-layered pleural
membrane.
The parietal pleura line the walls of the thoracic cavity. The visceral pleura adhere tightly to the surface of
the lungs themselves.


On each side of the thorax, a pleural cavity is formed. The integrity of this space (really potential space) between the parietal and visceral pleural layers is crucial to the mechanism of breathing.
o
Pleural fluid reduces friction and produces a surface
tension so the layers can slide across one another.

The pleura, adherent to the chest wall and to the lung, produces a mechanical coupling for the two layers to move together.
Understanding Gases
To understand how this mechanical coupling between the lungs, the pleural cavities and the chest wall results in breathing, we first need to discuss some physics of
gases called the

gas laws.
Understanding Gases
The respiratory system depends on the medium of the earths atmosphere to extract the oxygen necessary for life. The atmosphere is composed of these gases:
Nitrogen (N2)
Oxygen (O2) Carbon Dioxide (CO2) Water Vapor
78%
21% 0.04% variable, but on average around 1%
Understanding Gases
The gases of the atmosphere have a mass and a weight (5 x 1018 kg, most within 11 km of the surface). Consequently, the atmosphere exerts a significant force on every object on the planet (recall that pressure is measured as force applied per unit area,
P = F/A.)
We are accustomed to the tremendous force pressing down on every square inch of our body.
Understanding Gases
A barometer is an instrument that measures atmospheric pressure. Baro = pressure or weight Meter = measure
Air pressure varies greatly

depending on the altitude and the temperature.
Understanding Gases
There are many different units used to measure atmospheric pressure. At sea level, the air pressure is: 14.7 lb/in2 = 1 atmosphere
760 mmHg = 1 atmosphere

76 cmHg = 1 atmosphere 29.9 inHg = 1 atmosphere At high altitudes, the atmospheric pressure is less; descending to sea level, atmospheric pressure is greater.
Understanding Gases
Gases obey laws of physics called the gas laws. These laws apply equally to the gases of the atmosphere, the gases in our lungs, the gases dissolved in the blood, and the gases diffusing into and out of the cells of our body.
To understand the mechanics of ventilation and

respiration, we need to have a basic understanding of 3 of the 5 common gas laws.
Understanding Gases
Boyles law applies to containers with flexible walls like our thoracic cage. It says that volume and pressure are inversely related.
o
If there is a decrease in volume there will be an

increase in pressure. V 1/P
Understanding Gases
Daltons law applies to a mixture of gases. It says that the pressure of each gas is directly proportional to the percentage of that gas in the total mixture: PTotal = P1 + P2 + P3 Since O2 = 21% of atmosphere, the partial pressure
exerted by the contribution of just O2 (written pO2

or PAO2) = 0.21 x 760 mmHg = 159.6 mmHg at sea level.
Gas Exchange
Gas Exchange
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Understanding Gases
Henrys law deals with gases and solutions.
It says that increasing the partial pressure of a gas

over (in contact with) a solution will result in more of the gas dissolving into the solution. The patient in this picture is getting more O2 in contact with his
blood - consequently,
more oxygen goes into his blood.
Medicimage/Phototake Copyright John Wiley & Sons, Inc. All rights reserved.
Understanding Gases
Gas will always move from a region of high pressure to a region of low pressure. Applying Boyle's law: If the volume inside the thoracic cavity , the pressure .
Ventilation and Respiration

Pulmonary ventilation is the movement of air between
the atmosphere and the alveoli, and consists of inhalation

and exhalation. Ventilation, or breathing, is made possible by changes in the intrathoracic volume.

In contrast to ventilation, respiration is the exchange of gases. External respiration (pulmonary) is gas exchange between the
alveoli and the blood.

Internal respiration (tissue) is gas exchange between the systemic capillaries and the tissues of the body.

External respiration in the lungs is possible because of the implications of Boyles law: The volume of the thoracic cavity can be increased or decreased by the
action of the diaphragm, and other muscles of the chest

wall. By changing the volume of the thoracic cavity (and the lungs remember the mechanical coupling of the chest wall, pleura, and lungs), the pressure in the lungs
will also change.


Changes in air pressure result in movement of the air. Contraction of the diaphragm and external intercostal (rib) muscles increases the size of the thorax. This
decreases the intrapleural pressure so air can flow in

from the atmosphere (inspiration). Relaxation of the diaphragm, with/without contraction of the internal intercostals, decreases the size of the thorax, increases the air pressure, and
results in exhalation.

Certain thoracic muscles participate in inhalation; others aid exhalation. The diaphragm is the primary muscle of respiration all
the others are

accessory.

The recruitment of accessory muscles greatly depends on
whether the respiratory movements are quiet (normal), or forced (labored).

(Interactions Animation)
In the following animation, the mechanical coupling mechanism can be understood by relating the concepts of the gas laws to the unique anatomical features of the airways, pleural cavities, and muscles of respiration.
Pulmonary Ventilation

Airflow and Work of Breathing

Differences in air pressure drive airflow, but 3 other factors also affect the ease with which we ventilate:
1. The surface tension of alveolar fluid causes the alveoli
to assume the smallest possible diameter and accounts

for 2/3 of lung elastic recoil. Normally the alveoli would close with each expiration and make our Work of Breathing insupportable.
o
Surfactant prevents the complete collapse of alveoli
at exhalation, facilitating reasonable levels of work.


2. High lung compliance means the lungs and chest wall
expand easily. Compliance is decreased by a
broken rib, or by diseases such

as pneumonia or emphysema.
Measuring Ventilation
Ventilation can be measured using spirometry. Tidal Volume (VT) is the volume of air inspired (or expired) during normal quiet breathing (500 ml). Inspiratory Reserve Volume (IRV) is the volume inspired during a very deep inhalation (3100 ml
height and gender dependent).

Expiratory Reserve Volume (ERV) is the volume expired during a forced exhalation (1200 ml).
Spirometry continued Vital Capacity (VC) is all the air that can be exhaled after maximum inspiration.
o
It is the sum of the inspiratory reserve + tidal

volume + expiratory reserve (4800 ml).
Residual Volume (RV) is the air still present in the lungs after a force exhalation (1200 ml).
o
The RV is a reserve for mixing of gases but is not
available to move in or out of the lungs.

Old and new spirometers used to measure ventilation.

A graph of spirometer volumes and capacities

Only about 70% of the tidal volume reaches the respiratory zone the other 30% remains in the conducting zone (called the anatomic dead space). If a single VT breath = 500 ml, only 350 ml will
exchange gases at the alveoli.

o
In this example, with a respiratory rate of 12, the minute ventilation = 12 x 500 = 6000 ml.
The alveolar ventilation (volume of air/min that actually reaches the alveoli) = 12 x 350 = 4200ml.
Exchange of O2 and CO2

Using the gas laws and understanding the principals of ventilation and respiration, we can calculate the
amount of oxygen and

carbon dioxide exchanged between the lungs and the blood.

Daltons Law states that each gas in a mixture of gases exerts its own pressure as if no other gases were present. The pressure of a specific gas is the partial pressure Pp.
Total pressure is the sum of all the partial pressures.

Atmospheric pressure (760 mmHg) = PN2 + PO2 + PH2O + PCO2 + Pother gases
o
Since O2 is 21% of the atmosphere, the PO2 is 760 x 0.21 = 159.6 mmHg.

Each gas diffuses across a permeable membrane (like the AC membrane) from the side where its partial pressure is greater to the side where its partial pressure is less.
The greater the difference, the faster the rate of

diffusion. Since there is a higher PO2 on the lung side of the AC membrane, O2 moves from the alveoli into the blood. Since there is a higher PCO2 on the blood side of the
AC membrane, CO2 moves into the lungs.


PN2 PO2 PH2O PCO2 Pother gases = 0.786 = 0.209 = 0.004 = 0.0004 = 0.0006 x 760 mmHg x 760 mmHg x 760 mmHg x 760 mmHg x 760 mmHg Total = 597.4 mmHg = 158.8 mmHg = 3.0 mmHg = 0.3 mmHg = 0.5 mmHg = 760.0 mmHg
Partial pressures of gases in inhaled air for sea level


Henrys law states that the quantity of a gas that will dissolve in a liquid is proportional to the partial pressures of the gas and its solubility.
A higher partial pressure of a

gas (like O2) over a liquid (like blood) means more of the gas will stay in solution. Because CO2 is 24 times more soluble in blood (and
soda pop!) than in O2, it more readily dissolves.


Even though the air we breathe is mostly N2, very little dissolves in blood due to its low solubility. Decompression sickness (the bends) is a result of the
comparatively insoluble N2 being forced to dissolve

into the blood and tissues because of the very high pressures associated with diving.
o
By ascending too rapidly, the N2 rushes out of the tissues and the blood so forcefully as to cause vessels
to pop and cells to die.

Transport of O2 and CO2

In the blood, some O2 is dissolved in the plasma as a gas (about 1.5%, not enough to stay alive not by a long shot!). Most O2 (about 98.5%) is carried attached to Hb.
Oxygenated Hb is called oxyhemoglobin.

CO2 is transported in the blood in three different forms:
1. 7% is dissolved in the plasma, as a gas. 2. 70% is converted into carbonic acid through the
action of an enzyme called carbonic anhydrase.

o
CO2 + H2O sites as oxygen).
H2CO3
H+ + HCO3-
3. 23% is attached to Hb (but not at the same binding

The O2 transported in the blood (PO2 = 100 mmHg) is needed in the tissues to continually make ATP (PO2 = 40 mmHg at the capillaries). CO2 constantly diffuses from the tissues
(PCO2 = 45 mmHg) to
be transported in the blood (PCO2 = 40 mmHg)
Internal Respiration occurs at systemic capillaries

The amount of Hb saturated with O2 is called the SaO2.
Each Hb molecule can carry 1, 2, 3, or 4 molecules of O2. Blood leaving the lungs has Hb that is fully saturated (carrying 4 molecules of O2 oxyhemoglobin).
o
The SaO2 is close to 95-98% .
When it returns, it still has 3 of the 4 O2 binding sites occupied.

o
SaO2 = 75%

The relationship between the amount of O2 dissolved in the plasma and the saturation of Hb is called the oxygenhemoglobin saturation curve. The higher the PO2
dissolved in the plasma,

the higher the SaO2.

Measuring SaO2 has
become as commonplace
in clinical practice as taking a blood pressure. Pulse oximeters which used to cost $5,000
can now be purchased

at your local
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pharmacy.

Although PO2 is the most important determinant of SaO2, several other factors influence the affinity with which
Hb binds O2 .
Acidity (pH), PCO2 and blood temperature shift the entire O2 Hb saturation curve either to the left (higher affinity for O2), or
to the right (lower affinity

for O2).

As blood flows from the lungs toward the tissues, the increasing acidity (pH decreases) shifts the O2Hb saturation curve to the right, enhancing unloading of O2 (which is just what we want to happen). This is called the Bohr effect. At the lungs, oxygenated blood has a reduced capacity
to carry CO2 ,and it is unloaded as we exhale (also just

what we want to happen). This is called the Haldane effect.
Fetal and Maternal Hemoglobin

Fetal hemoglobin (Hb-F) has a higher affinity for oxygen
(it is shifted to the left) than adult hemoglobin A, so it binds O2 more strongly. The fetus is thus able to attract oxygen
across the placenta

and support life, without lungs.
Control of Respiration
The medulla rhythmicity area, located in the brainstem, has centers that control basic respiratory patterns for both inspiration and expiration. The inspiratory center stimulates the diaphragm
via the phrenic nerve, and

the external intercostal muscle via intercostal nerves.
o
Inspiration normally lasts about 2 sec.

Exhalation is mostly a passive process, caused by the
elastic recoil of the lungs. Usually, the expiratory center is inactive during quiet breathing (nerve impulses cease for about 3 sec). During forced exhalation,
however, impulses from this

center stimulate the internal intercostal and abdominal muscles to contract.
Other sites in the pons help the medullary centers manage the transition between inhalation and exhalation. The pneumotaxic center limits inspiration to prevent hyperexpansion.
The apneustic
center coordinates the transition between inhalation and exhalation.
Other brain areas also play a role in respiration:
Our cortex has voluntary control of breathing. Stretch receptors sensing over-inflation arrests breathing temporarily (Herring Breuer reflex). Emotions (limbic system) affect respiration. The hypothalamus, sensing a fever, increases breathing, as does moderate pain (severe pain causes
apnea.)
(Interactions Animation)
Regulation of Ventilation

Response to Pollutants
Initial Response Mucous layer thickens. Goblet cells over-secrete
mucous.
Basal cells proliferate.
Normal columnar epithelium in the respiratory tract
Advanced Response to Irritation Mucous layer and goblet cells disappear. Basal cells become malignant & invade deeper tissue.
Diseases and Disorders

Asthma is a disease of hyper-reactive airways (the major abnormality is constriction of smooth muscle in the bronchioles, and inflammation.) It presents as attacks of
wheezing, coughing, and excess mucus production.

It typically occurs in response to allergens; less often to emotion. Bronchodilators and antiinflammatory corticosteroids
are mainstays of treatment.

Pulse Picture Library/CMP mages /Phototake Copyright John Wiley & Sons, Inc. All rights reserved.

Chronic bronchitis and emphysema are caused by chronic irritation and inflammation leading to lung destruction. Patients may cough up
green-yellow sputum due to

infection and increased mucous secretion (productive cough). They are almost exclusively diseases of cigarette smoking.

Pneumonia is an acute infection of the lowest parts of the respiratory tract. The small bronchioles and alveoli become filled with
an inflammatory fluid exudate.

o
It is typically caused by infectious agents such as bacteria, viruses, or fungi.

Normal Lungs Pneumonia Patient
Du Cane Medical Imaging, Ltd./Photo Researchers, Inc
End of Chapter 23
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Chapter 23

Respiratory System Anatomy

consists of the larynx,

Lower respiratory tract

Copyright John Wiley & Sons, Inc. All rights reserved.

Respiratory System Anatomy

The conducting zone is involved with bringing air to

bronchioles and terminal bronchioles.

and consists of the respiratory bronchioles, alveolar

ducts, alveolar sacs, and alveoli.

Respiratory System Anatomy

Respiratory System Anatomy

The internal nasal

Respiratory System Anatomy

Respiratory System Anatomy

Respiratory System Anatomy

Respiratory System Anatomy

Respiratory System Anatomy

tonsillectomy) and small lingual tonsil are housed

Respiratory System Anatomy

Copyright John Wiley & Sons, Inc. All rights reserved.

Respiratory System Anatomy

The thyroid cartilage (the large

Anterior view of the larynx

Respiratory System Anatomy

opening between the vocal folds.

Respiratory System Anatomy

below where the larynx and the esophagus split off

Copyright John Wiley & Sons, Inc. All rights reserved.

Respiratory System Anatomy

Copyright John Wiley & Sons, Inc. All rights reserved.

Respiratory System Anatomy

Respiratory System Anatomy

portion of the larynx into the mediastinum where it

hyaline cartilage, and adventitia).

Respiratory System Anatomy

trachea and make it difficult

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Respiratory System Anatomy

The carina is an internal

Respiratory System Anatomy

The smallest are the

Respiratory System Anatomy

eventually disappear altogether.

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Respiratory System Anatomy

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Respiratory System Anatomy

exchange are called alveoli.

Respiratory System Anatomy

sacs, and alveoli.

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Respiratory System Anatomy

C.T., each pulmonary

Respiratory System Anatomy

Type II cells secrete a

Respiratory System Anatomy

that traps most foreign particles higher in

Blood Supply to the Lungs

Copyright John Wiley & Sons, Inc. All rights reserved.

In the lungs, vasoconstriction in response to hypoxia

Copyright John Wiley & Sons, Inc. All rights reserved.

Respiratory System Anatomy