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. Upper
respirator
The lower respiratory tract y tract
consists of the larynx,
trachea, bronchi and
Lower
lungs. respirator
y tract
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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)
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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 a passageway for air and food
o a resonating chamber
o a housing for the tonsils
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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Respiratory System Anatomy
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
“Adam’s apple”) and the one below
it (the cricoid cartilage) are
landmarks for making an
emergency airway (called a
cricothyrotomy).
Anterior view of the larynx
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Respiratory System Anatomy
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 back-
ward to close off the glottic
opening during
swallowing.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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
Upper
respiratory tract respirator
Nasal cavity y tract
Pharynx
Larynx
Trachea Lower
Primary bronchi respirator
y tract
Secondary bronchi
Tertiary bronchi
Bronchioles
Alveoli (150 million/lung)
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Respiratory System Anatomy
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).
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
All the branches from the trachea to the terminal
bronchioles are conducting
airways – they do not
participate in gas
exchange.
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Respiratory System Anatomy
The cup-shaped outpouchings which participate in gas
exchange are called alveoli.
The first alveoli don’t appear until
the respiratory
bronchioles
where they are
rudimentary and
mostly
nonfunctioning.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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”).
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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
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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
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Respiratory System Anatomy
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.
o
Each lobe receives it own 2
bronchus that branches into
3o segmental bronchi (which
continue to further divide).
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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Respiratory System Anatomy
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.
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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.
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Understanding Gases
The respiratory system depends on the medium of the
earth’s atmosphere to extract the oxygen necessary for
life.
The atmosphere is composed of these gases:
Nitrogen (N2) 78%
Oxygen (O2) 21%
Carbon Dioxide (CO2) 0.04%
Water Vapor variable, but on average
around 1%
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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.
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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.
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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.
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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.
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Understanding Gases
Boyle’s 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.
o V ∝ 1/P
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Understanding Gases
Dalton’s 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.
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Gas Exchange
Gas Exchange
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Understanding Gases
Henry’s 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
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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 $.
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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.
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Ventilation and Respiration
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.
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Ventilation and Respiration
External respiration in the lungs is possible because of
the implications of Boyle’s 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.
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Ventilation and Respiration
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.
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Ventilation and Respiration
Certain thoracic
muscles participate in
inhalation; others aid
exhalation.
The diaphragm is the
primary muscle of respiration
– all the others are accessory.
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Ventilation and Respiration
The recruitment of accessory muscles greatly depends on
whether the respiratory movements are quiet (normal),
or forced (labored).
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Ventilation and Respiration
(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
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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.
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Airflow and Work of Breathing
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.
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Airflow and Work of Breathing
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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).
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Measuring Ventilation
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.
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Measuring Ventilation
Old and new spirometers used to measure ventilation.
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Measuring Ventilation
A graph of spirometer volumes and capacities
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Measuring Ventilation
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.
o The alveolar ventilation (volume of air/min that actually reaches the
alveoli) = 12 x 350 = 4200ml.
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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.
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Exchange of O2 and CO2
Dalton’s 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 PO is
2
760 x 0.21 = 159.6 mmHg.
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Exchange of O2 and CO2
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.
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Exchange of O2 and CO2
PN2 = 0.786 x 760 mmHg = 597.4 mmHg
PO2 = 0.209 x 760 mmHg = 158.8 mmHg
PH2O = 0.004 x 760 mmHg = 3.0 mmHg
PCO2 = 0.0004 x 760 mmHg = 0.3 mmHg
Pother gases = 0.0006 x 760 mmHg = 0.5 mmHg
Total = 760.0 mmHg
Partial pressures of gases in inhaled air for sea level
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Exchange of O2 and CO2
Henry’s 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.
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Exchange of O2 and CO2
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.
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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.
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Transport of O2 and CO2
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 H2CO3 H+ + HCO3
-
3. 23% is attached to Hb (but not at the same binding sites as oxygen).
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Transport of O2 and CO2
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
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Transport of O2 and CO2
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%
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Transport of O2 and CO2
The relationship between the amount of O2 dissolved in
the plasma and the saturation of Hb is called the
oxygen-hemoglobin saturation curve.
The higher the PO2
dissolved in the plasma,
the higher the SaO2.
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Transport of O2 and CO2
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
3660 Group,
pharmacy. Inc/NewsCom
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Transport of O2 and CO2
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).
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Transport of O2 and CO2
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Transport of O2 and CO2
As blood flows from the lungs toward the tissues, the
increasing acidity (pH decreases) shifts the O2–Hb
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.
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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.
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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.
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Control of Respiration
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.
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Control of Respiration
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.
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Control of Respiration
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.)
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Control of Respiration
(Interactions Animation)
• Regulation of Ventilation
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Response to Pollutants
Initial Response
Mucous layer thickens.
Goblet cells over-secrete
mucous.
Basal cells proliferate.
Advanced Response to Irritation
Normal columnar epithelium
in the respiratory tract
Mucous layer and goblet cells disappear.
Basal cells become malignant & invade deeper tissue.
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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 anti-
inflammatory corticosteroids
are mainstays of treatment.
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Diseases and Disorders
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.
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Diseases and Disorders
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.
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Diseases and Disorders
Normal Lungs Pneumonia Patient
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End of Chapter 23
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