RESPIRATORY SYSTEM

1. RESPIRATORY SYSTEM

2. RESPIRATION VARIOUS MEANINGS OF RESPIRATION BREATHING INHALATION, EXHALATION GAS EXCHANGE AIR ? BLOOD, BLOOD ? AIR ESPECIALLY O2, CO2 HARVEST ENERGY FROM FOOD CELLULAR RESPIRATION

3. ROLE OF O2 AND CO2 MANY PROCESSES REQUIRE ENERGY CELLULAR RESPIRATION HARVESTS ENERGY FROM FOOD AEROBIC CELLULAR RESPIRATION REQUIRES OXYGEN AEROBIC CELLULAR RESPIRATION PRODUCES CARBON DIOXIDE AS A WASTE PRODUCT

4. RESPIRATORY FUNCTIONS PRIMARY SUPPLY BODY WITH OXYGEN DISPOSE OF CARBON DIOXIDE SECONDARY SOUND PRODUCTION ACID-BASE BALANCE OLFACTORY RECEPTION

5. RESPIRATORY ORGANS NOSE PHARYNX LARYNX TRACHEA BRONCHI LUNGS

8. RESPIRATORY ORGANS NOSE, NASAL CAVITY SHAPED BY BONE, CARTILAGE, DENSE CONNECTIVE TISUE DETECTS ODORS MODIFIES VOICE RESONATING CHAMBER WARMS, CLEANSES, HUMIDIFIES AIR

9. RESPIRATORY ORGANS NOSE: CLEANSE, WARM, & HUMIDIFY GUARD HAIRS �VIBRISSAE� PREVENT INHALATION OF LARGE PARTICLES

10. RESPIRATORY ORGANS NOSE: CLEANSE, WARM, & HUMIDIFY CONCHAE (3) FOLDS OF TISSUE MUCOUS MEMBRANES SUPPORTED BY BONES (TURBINATE) NARROW AIR PASSAGE BENEATH TURBULENCE AIR CONTACTS MUCOUS MEMBRANES WARM, CLEANSE, HUMIDIFY

11. RESPIRATORY ORGANS NOSE: CLEANSE, WARM, & HUMIDIFY RESPIRATORY MUCOSA LINE MUCH OF NASAL CAVITY GOBLET CELLS SECRETE MUCUS MUCUS TRAPS INHALED PARTICLES CILIA MOVE MUCUS ?? STOMACH COLD-SENSITIVE ? RUNNY NOSE LYSOZYME DESTROYS BACTERIA

13. RESPIRATORY ORGANS NOSE: CLEANSE, WARM, & HUMIDIFY RESPIRATORY MUCOSA LYMPHOCYTES IN LAMINAR PROPRIA PROTECTION LARGE BLOOD VESSELS IN LAMINAR PROPRIA WARM AIR ERECTILE TISSUE ALTERNATES AIR FLOW BETWEEN NOSTRILS RECOVERY FROM DRYING

14. RESPIRATORY ORGANS PHARYNX MUSCULAR FUNNEL CHOANAE ? LARYNX THREE REGIONS NASOPHARYNX OROPHARYNX LARYNGOPHARYNX (INACCURATE DRAWING IN BOOK)

15. RESPIRATORY ORGANS LARYNX �VOICEBOX� KEEP FOOD & DRINK FROM AIRWAY GLOTTIS SUPERIOR OPENING EPIGLOTTIS TISSUE FLAP GUARDING GLOTTIS PULL TOGETHER DURING SWALLOWING

16. RESPIRATORY ORGANS LARYNX FRAMEWORK OF CARTILAGE MUSCULAR WALLS INTRINSIC MUSCLES OPERATE VOCAL CHORDS SOUND PRODUCED WHEN AIR PASSES BETWEEN VOCAL CORDS EXTRINSIC MUSCLES ELEVATE LARYNX DURING SWALLOWING

17. RESPIRATORY ORGANS TRACHEA �WINDPIPE� RIGID TUBE ANTERIOR TO ESOPHAGUS SUPPORTED BY C-SHAPED RINGS OF HYALINE CARTILAGE PREVENT COLLAPSE LINED BY CILIATED CELLS MUCUS + DEBRIS ? PHARYNX ? STOMACH BRANCHES INTO PRIMARY BRONCHI ENTER LUNGS

18. RESPIRATORY ORGANS LUNGS RIGHT SUPERIOR LOBE MIDDLE LOBE INFERIOR LOBE LEFT SLIGHTLY SMALLER THAN RIGHT SUPERIOR LOBE INFERIOR LOBE

19. RESPIRATORY ORGANS BRONCHIAL TREE TRACHEA (1) PRIMARY BRONCHI (2) SECONDARY BRONCHI (1 PER LOBE) TERTIARY BRONCHI (8 L & 10 R) BRONCHIOLES (MANY) TERMINAL BRONCHIOLES (x 50 - 80) RESPIRATORY BRONCHIOLES (x 2+) ALVEOLAR DUCTS (x 2 � 10) ALVEOLAR SACS

21. RESPIRATORY ORGANS CONDUCTING DIVISION NOSTRILS ? TERMINAL BRONCHIOLES AIRFLOW CILIATED RESPIRATORY DIVISION RESP BRONCHIOLES ?ALVEOLAR SACS GAS EXCHANGE NOT CILIATED ALVEOLI BUD FROM THESE STRUCTURES

22. RESPIRATORY ORGANS ALVEOLUS / ALVEOLI ~150 MILLION TOTAL 70 SQUARE METER SURFACE AREA (FLOOR OF AVG HOUSE ~140 M2) HIGH SURFACE AREA FACILITATES GAS EXCHANGE

23. RESPIRATORY ORGANS ALVEOLUS / ALVEOLI HOLLOW POUCH 0.2 � 0.5 MM DIAMETER 95% TYPE I ALVEOLAR CELLS THIN CELLS ALLOW RAPID GAS DIFFUSION ~5% TYPE II ALVEOLAR CELLS SECRETE PULMONARY SURFACTANT LUMEN OF ALVEOLI CONTAINS WANDERING ALVEOLAR MACROPHAGES PREDOMINANT CELL TYPE IN LUNGS PHAGOCYTIZE DEBRIS, BACTERIA

24. RESPIRATORY ORGANS ALVEOLAR CAPILLARIES EACH ALVEOLUS SURROUNDED BY BASKET OF BLOOD CAPILLARIES PART OF PULMONARY CIRCULATION AIR MUST DIFFUSE THROUGH �RESPIRATORY MEMBRANE� TYPE I ALVEOLAR CELL ENDOTHELIAL CELL OF CAPILLARY FUSED BASEMENT MEMBRANES TOTAL THICKNESS ~ 0.5 MICROMETERS

27. RESPIRATORY ORGANS ALVEOLAR CAPILLARIES LOW BLOOD PRESSURE IN PULMONARY CIRCULATION 10 mmHg BLOOD PRESSURE 25 mmHg ONCOTIC PRESSURE OSMOTIC UPTAKE EXCEEDS FILTRATION KEEPS ALVEOLI FREE OF FLUID LUNGS ALSO HAVE EXTENSIVE LYMPHATIC DRAINAGE

28. RESPIRATORY ORGANS PLEURAE VISCERAL PLEURA COVERS OUTER SURFACE OF LUNG PARIETAL PLEURA VISCERAL PLEURA FOLDS OUTWARD FORMS PARIETAL PLEURA AND PLEURAL CAVITY PLEURAL FLUID

29. RESPIRATORY ORGANS PLEURAE PLEURAL FLUID VERY SMALL VOLUME CONTAINED WITHIN PLEURAL CAVITY REDUCES FRICTION CREATES PRESSURE GRADIENT ASSISTS WITH INFLATION OF LUNGS COMPARTMENTALIZES REDUCES SPREAD OF INFECTION

30. VENTILATION RESPIRATORY RATE = INSPIRATION + EXPIRATION RESTING ADULT 10 � 15 TIMES PER MINUTE ~500 ML INSPIRED, ~500 ML EXPIRED LARGER AMOUNTS DURING EXERTION

31. VENTILATION AIR MOVEMENT: PRESSURE & FLOW GOVERNED BY SAME PRINCIPLES AS BLOOD FLOW DRIVEN BY ATMOSPHERIC PRESSURE VARIES, ESPECIALLY WITH ALTITUDE

32. VENTILATION AIR MOVEMENT: PRESSURE & FLOW UNIVERSAL GAS LAW: PV = nRT P = PRESSURE V = VOLUME n = AMOUNT OF GAS (MOLES) R = A CONSTANT T = TEMPERATURE PRESSURE AND VOLUME ARE INVERSELY PROPORTIONAL

34. VENTILATION AIR MOVEMENT: PRESSURE & FLOW UNIVERSAL GAS LAW INPIRATION: LUNG VOLUME INCREASES, PRESSURE WITHIN LUNGS DECREASES INTRAPULMONARY PRESSURE PRESSURE DIFFERENCE CAUSES AIR TO FLOW INTO LUNGS DIFFERENCE BETWEEN INTRAPULMONARY PRESSURE AND ATMOSPHERIC PRESSURE

35. VENTILATION AIR MOVEMENT: PRESSURE & FLOW UNIVERSAL GAS LAW EXPIRATION: LUNG VOLUME DECREASES, PRESSURE WITHIN LUNGS INCREASES INTRAPULMONARY PRESSURE PRESSURE DIFFERENCE CAUSES AIR TO FLOW FROM LUNGS DIFFERENCE BETWEEN INTRAPULMONARY PRESSURE AND ATMOSPHERIC PRESSURE

36. VENTILATION INSPIRATION REQUIRES RHYTHMIC CHANGE IN THORACIC CAVITY PRESSURE REQUIRES ENERGY (ATP) ACHIEVED MAINLY BY DIAPHRAGM STIMULATION DROPS DIAPHRAGM, ENLARGING THORACIC CAVITY INTERCOSTAL MUSCLES ALSO INVOLVED MUSCLES ELEVATE RIBS, ENLARGING THORACIC CAVITY

37. VENTILATION INSPIRATION DIAPHRAGM DROPS, RIB CAGE EXPANDS PARIETAL PLEURA CLINGS TO RIBS AND DIAPHRAGM INTRAPLEURAL PRESSURE DROPS 4mmHg ? -6 mmHg DURING INSPIRATION VISCERAL PLEURA CLINGS TO PARIETAL PLEURA SOME PRESSURE CHANGE TRANSFERRED TO LUNGS AIR FLOWS INTO LUNGS, LUNGS EXPAND

38. VENTILATION EXPIRATION PASSIVE, REQUIRES NO ENERGY LUNGS & THORACIC CAGE RETURN TO FORMER DIMENSIONS WHEN TENSION RELEASED VOLUME DECREASE ? PRESSURE INCREASE AIR FLOWS FROM LUNGS MORE COMPLETE EXPIRATION POSSIBLE REQUIRES MUSCLE CONTRACTION

40. VENTILATION RESISTANCE TO AIRFLOW F = DP / R AIRFLOW = PRESSURE / RESISTANCE

41. VENTILATION RESISTANCE TO AIRFLOW RESISTANCE IS AFFECTED BY PULMONARY COMPLIANCE EASE WITH WHICH LUNGS EXPAND REDUCED BY LUNG DISEASES DIAMETER OF BRONCHIOLES SMALL AND NUMEROUS BRONCHOCONSTRICTION BRONCHODILATON

42. VENTILATION ALVEOLAR SURFACE TENSION ALVEOLI RELATIVELY DRY THIN FILM OF WATER REQUIRED FOR GAS EXCHANGE INTERMOLECULAR ATTRACTION CREATES SURFACE TENSION AS DIAMETER DECREASES, SURFACE TENSION INCREASES ALVEOLI WOULD COLLAPSE WITHOUT SURFACTANT SURFACTANT REDUCES SURFACE TENSION

43. VENTILATION ALVEOLAR VENTILATION ONLY AIR REACHING ALVEOLI IS AVAILABLE FOR GAS EXCHANGE SOME AIR REMAINS IN CONDUCTING DIVISION

44. VENTILATION NONRESPIRATORY AIR MOVEMENTS THORACIC PUMP PROMOTES VENOUS RETURN PROMOTES LYMPHATIC RETURN SPEAKING, LAUGHING, ETC. COUGHING & SNEEZING TRIGGERED BY IRRITANTS VIOLENT EXPULSION

45. GAS EXCHANGE COMPOSTION OF AIR MANY GASES NITROGEN (N2) OXYGEN (O2) WATER (H20) CARBON DIOXIDE (CO2)

46. GAS EXCHANGE DIFFUSION OF GASES GASES DIFFUSE DOWN THEIR CONCENTRATION GRADIENTS BETWEEN AIR AND WATER AMOUNT OF GAS DIFFUSING BASED UPON SOLUBILITY IN WATER CONCENTRATION (PARTIAL PRESSURE)

47. ALVEOLAR GAS EXCHANGE ALVEOLAR GAS EXCHANGE OXYGEN: LUNGS ? BLOOD CARBON DIOXIDE: BLOOD ? LUNGS

48. ALVEOLAR GAS EXCHANGE ALVEOLAR GAS EXCHANGE AFFECTED BY CONCENTRATION GRADIENTS OF GASES O2 ? BLOOD, CO2 ? LUNGS (LIMITING FACTOR FOR O2 IS RBC AVAILABILITY) SOLUBILITY OF GASES CO2 VERY SOLUBLE, RAPID DIFFUSION MEMBRANE THICKNESS THIN CELLS NEGLIGIBLE BARRIER MEMBRANE SURFACE AREA VENTILATION � PERFUSION COUPLING GAS EXCHANGE REQUIRES LARGE BLOOD SUPPLY

49. GAS EXCHANGE OXYGEN TRANSPORT O2 BINDS TO HEMOGLOBIN 4 O2 MOLECULES PER HEMOGLOBIN DEOXYHEMOGLOBIN (HHb) OXYHEMOGLOBIN (HbO2) CO ALSO BINDS TO HEMOGLOBIN COMPETES WITH O2 BINDS MUCH MORE TIGHTLY (200X)

50. GAS EXCHANGE CARBON DIOXIDE TRANSPORT TRANSPORTED IN THREE FORMS DISSOLVED GAS CARBONIC ACID CARBAMINO COMPOUNDS

51. GAS EXCHANGE CARBON DIOXIDE TRANSPORT ~90% OF THE CO2 GENERATED REACTS WITH WATER CO2 + H2O ? H2CO3 ? H+ + HCO3- ~5% OF THE CO2 GENERATED REACTS WITH AMINO GROUPS OF PLASMA PROTEINS AND GLOBIN OF HEMOGLOBIN ~5% OF THE CO2 GENERATED REMAINS CO2 DISSOLVED IN BLOOD

52. SYSTEMIC GAS EXCHANGE CARBON DIOXIDE LOADING ONE CO2 PRODUCED PER O2 CONSUMED TISSUE FLUID CONTAINS HIGH CO2 CO2 DIFFUSES INTO BLOODSTREAM MOST FORMS H+ AND HCO3- CHLORIDE SHIFT HCO3- REPLACED BY Cl- H+ BINDS TO HEMOGLOBIN / OXYHEMOGLOBIN

53. SYSTEMIC GAS EXCHANGE OXYGEN UNLOADING H+ BINDS TO OXYHEMOGLOBIN AFFINITY FOR O2 REDUCED O2 RELEASED ONLY ~22% OF O2 RELEASED REMAINDER IS �VENOUS RESERVE� SUSTAINS LIFE DURING RESPIRATORY ARREST

54. ALVEOLAR GAS EXCHANGE ALVEOLAR GAS EXCHANGE REVISITED O2 BOUND BY HEMOGLOBIN AFFINITY FOR H+ REDUCED H+ RELEASED H+ COMBINES WITH HCO3- REVERSE CHLORIDE SHIFT H+ + HCO3- ? H2CO3 ? H20 + CO2 CO2 DIFFUSES INTO ALVEOLI

55. GAS EXCHANGE REGARDING METABOLIC NEED O2 RELEASED NOT SAME IN ALL TISSUES AMOUNT DIFFERS IN DIFFERENT TISSUES AMOUNT UNLOADED RELATES TO NEED UTILIZATION COEFFICIENT AMOUNT OF O2 UNLOADED GENERALLY ~22% ~80% IN EXERCISING SKELETAL MUSCLES

56. GAS EXCHANGE REGARDING METABOLIC NEED FACTORS AFFECTING O2 UNLOADING RATE [O2] (PO2)IN TISSUE FLUID LOW CONC ? MORE O2 UNLOADED TEMPERATURE ACTIVE TISSUES ARE WARMER INCR TEMP ? MORE O2 UNLOADED BOHR EFFECT ACTIVE TISSUES ? MORE CO2, MORE H+, LOWER pH MORE H+ ? MORE O2 UNLOADED BPG (BIPHOSPHOGLYCERATE) INCR TEMP ? RBC FERMENTATION ? MORE BPG BPG BINDS TO HEMOGLOBIN ? MORE O2 UNLOADED

57. GAS EXCHANGE REGARDING METABOLIC NEED CO2 LOADING RATE LOW OXYHEMOGLOBIN ? MORE CO2 LOADING �HALDANE EFFECT� HIGH METABOLIC RATE DECREASES OXYHEMOGLOBIN CONCENTRATIONS HEMOGLOBIN BINDS TO CO2 BETTER THAN OXYHEMOGLOBIN DOES HEMOGLOBIN BINDS TO MORE H+ THAN OXYHEMOGLOBIN DOES MORE H+ BOUND ? MORE HCO3-

58. RESPRATORY DISORDERS OXYGEN IMBALANCES HYPOXIA OXYGEN DEFICIENCY IN A TISSUE INABILITY TO USE OXYGEN RESULT OF RESPIRATORY DISEASE

59. RESPRATORY DISORDERS OXYGEN IMBALANCES CAUSES OF HYPOXIA HYPOXEMIC HYPOXIA LOW ARTERIAL O2 INADEQUATE PULMONARY EXCHANGE E.G., ALTITUDE, IMPAIRED VENT, CO POISONING, ETC. ISCHEMIC HYPOXIA INADEQUATE CIRCULATION E.G., CONGESTIVE HEART FAILURE ANEMIC HYPOXIA ANEMIA ? REDUCED O2 CARRYING CAPACITY HISTOTOXIC HYPOXIA METABOLIC POISON PREVENTS TISSUES FROM USING O2 E.G., CYANIDE (CN)

60. RESPRATORY DISORDERS CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD) REDUCE PULMONARY COMPLIANCE HYPOXIA (O2 DEFICIENCY) HYPERCAPNIA (EXCESS CO2) RESPIRATORY ACIDOSIS KIDNEYS ?EPO ? RBC PRODUCTION HYPERTROPHY, FAILURE OF RIGHT HEART

61. RESPRATORY DISORDERS CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD) ASTHMA CHRONIC BRONCHITIS EMPHYSEMA

62. RESPRATORY DISORDERS COPD: ASTHMA ALLERGEN ? HISTAMINE RELEASE INFLAMMATION INTENSE BRONCHOCONSTRICTION INCREASED RESISTANCE TO FLOW

63. RESPRATORY DISORDERS COPD: CHRONIC BRONCHITIS GENERALLY CAUSED BY SMOKING (SOMETIMES OTHER EXPOSURE) ENLARGED GOBLET CELLS MORE MUCUS PRODUCTION FEWER CILIA, IMMOBILIZED CHRONIC COUGH SPUTUM (MUCUS & DEBRIS) STAGNANT MUCUS MEDIUM FOR BACTERIA CHRONIC INFECTION, INFLAMMATION

64. RESPRATORY DISORDERS COPD: EMPHYSEMA GENERALLY CAUSED BY SMOKING (SOMETIMES OTHER EXPOSURE) ALVEOLAR WALLS BREAK DOWN LARGER, FEWER AVEOLI DECREASED SURFACE AREA LUNGS LESS ELASTIC EXPIRATION OBSTRUCTED BREATHING REQUIRES MUCH ENERGY

65. RESPRATORY DISORDERS LUNG CANCER MOST DEATHS OF ANY CANCER CARCINOGENS: SMOKING, POLLUTION MOST ORIGINATE IN MUCOUS MEMBRANES OF LARGE BRONCHI TUMOR COMPRESSES AIRWAY, POTENTIAL FOR DISTAL COLLAPSE RAPID METASTASIS POOR CHANCE OF RECOVERY

66. RESPRATORY DISORDERS LUNG CANCER THREE TYPES SQUAMOUS-CELL CARCINOMA BASAL CELLS OF BRONCHIAL EPITHELIUM ADENOCARCINOMA MUCUS GLANDS OF LAMINA PROPRIA SMALL-CELL CARCINOMA CLUSTERS OF CELLS IN PROMARY BRONCHI