Chapt. Object.

Figures & Tables

Trnspcy. Acetates

Masters

1

I. Anatomy and Histology

Clinical Focus, pp.768-769; Systems Interactions, p.771

1. Upper Respiratory Tract = Nasal Cavity, Pharynx, and Associated Structures

Fig. 23.1, p.734

TA-298

2. Lower Respiratory Tract = Larynx, Trachea, Bronchi, and Lungs

A. Nose and Nasal Cavity

1. External Nose

Fig. 7.10b, p.199

2. Nasal Cavity - Lined with Mucous Membrane of Psuedostratified Ciliated Columnar Epithelium

Fig. 23.2, p.735, Predict Quest. 1

TA-299

a. External Nares = Nostrils

b. Internal Nares = Choanae

c. Vestibule - Lined with Stratified Squamous Epithelium

d. Internasal Septum

e. Hard Palate

f. Nasal Conchae Each with Associated Meatus

g. Paranasal Sinuses

Fig. 7.11, p.200

h. Nasolacrimal Duct

3. Nasal Cavity Functions as Air Passageway, Warms, Moisturizes and Filters Air; Houses Smell Receptors; Resonating chamber for Speech

Fig. 15.10, p.468

B. Pharynx - Common Opening of Digestive and Respiratory Systems

Fig. 23.2, p.735

TA-299

1. Nasopharynx

a. Internal Nares to Uvula

b. Mucous Membrane Similar to Nasal Cavity

c. Opening to Auditory Tubes

Fig. 15.23, p.485

TA-199

d. Pharyngeal Tonsil on Posterior Surface

2. Oropharynx

a. Uvula to Epiglottis

b. Oral Cavity Through Fauces

c. Lined by Stratified Squamous Epithelium

d. Palatine and Lingual Tonsils

3. Laryngopharynx

a. Tip of Epiglottis to Separate Openings to Larynx and Esophagus

b. Lined with Stratified Squamous Epithelium

C. Larynx

Fig. 23.3, p.736

TA-300

1. Nine Cartilages (Most Hyaline Cartilage)

a. Six Paired

b. Three Unpaired

c. Connected by Muscles and Ligaments

2. Lined by Pseudostratified Squamous Epithelium Except True and False Vocal Cords

3. Thyroid Cartilage = Adam's Apple

4. Cricoid Cartilage = Base of Larynx

5. Epiglottis

a. Elastic Cartilage

b. Covers Opening to Larynx During Swallowing

2

6. Vocal Apparatus

Fig. 23.4, p.737

TA-301

a. Arytenoid Cartilages

b. Corniculate Cartilages

c. Cuneiform Cartilages

d. Vestibular Folds - Protective Functions

e. Vocal Folds = True Vocal Cords

1). Surrounding Opening Called the Glottis

2). Inflammation of Mucosal Epithelium = Laryngitis

3). Vibrated by Passage of Air to Produce Basic Sound of Speech

D. Trachea

Fig. 23.5a, p.738; Clinical Note, p.737

TA-302

1. Dense Regular Connective Tissue and Smooth Muscle

2. Reinforced with C-Shaped Pieces of Cartilage

Predict Quest. 2

3. Lined with Pseudostratified Ciliated Columnar Epithelium

Fig. 23.5b, p.738

a. Constant Irritation Can Change to Moist Stratified Squamous Epithelium

b. Loss of Cilia Leads to Loss of Protective Function

E. Tracheobronchial Tree

1. First Branch into R. and L. Primary Bronchi

Fig. 23.6, p.739

TA-303

3

3

2. Conducting Zone

1. R. Bronchus is Shorter, Wider, and more Vertical than the L.
2. Extends from Trachea to Terminal Bronchioles
3. Primary Bronchi to Secondary (Lobar) Bronchi to Tertiary (Segmental) Bronchi to Bronchioles, Then Terminal Bronchioles
4. Less Cartilage, MoreSmooth Muscle as Divisions Are Smaller ñ Asthsma

1. Respiratory Zone

1. Terminal Bronchioles Divide into Respiratory Bronchioles, Then to Alveolar Ducts, Alveolar Sacs, and Alveoli
2. Alveoli ñ Simple Aquamous Epithelium, Macrophages Present

Predict Quest. 3

Fig. 23.7, p.741

TA-304

5

F. Lungs

1. Primary Organs of Respiration

2. Conical Shape

a. Base on Diaphragm

b. Apex 2.5 cm Superior to Clavicle

3. R. Lung Larger than L.

Fig. 23.8, p.742

TA-305

a. R. Lung has Greater Mass

b. R. Lung has Three Lobes and Ten Brochopulmonary Segments

c. L. Lung has Two Lobes and Nine Bronchopulmonary Segments

4

G. Thoracic Wall and Muscles of Respiration

1. Muscles of Inspiration (Diaphragm , Internal Intercostals amd Abdominals)

1. Inspiration ñ Expansion of Rib Cage
2. Anterior-Posterior Dimension also Increased

1. Muscles of Expiration (External Intercostals, Pectoralis minor, Scalenes)
2. Normal Breathing VS Labored Breathing

Fig. 23.9a, p.743

Clinical Note, p.742

Fig. 23.9b, p.743

Fig. 23.9c, p.743

TA-306

TA-306

H. Pleura

Fig. 23.10, p.745

TA-307

1. Lungs Within Thoracic Cavity

2. Each Lung Surrounded by Separate Pleural Membranes

a. Parietal Pleura Covers Inner Thoracic Wall, Superior Surface of Diaphragm and Mediastinum

b. Visceral Pleura Covers Surface of Lung

c. Pleural Membranes Become Continuous at Hilum

3. Pleural Cavity Filled with Pleural Fluid

a. Acts as Lubricant

1. Helps Hold Pleural Membranes Together
2. Lung Volume Increases as Thoracic Cavity Expands

I. Blood Supply

1. Pulmonary Circulation

a. Pulmonary Arteries Carry Deoxygenated Blood to Alveoli for Gas Exchange

b. Pulmonary Veins Carry Oxygenated Blood Back to Heart

2. Bronchial Circulation

a. Bronchial Arteries Carry Oxygenated Blood to Tissues of Respiratory Passages Down to Bronchioles

b. Bronchial Veins Carry Deoxygenated Blood from Proximal Bronchi to Azygous System

c. Distal Bronchial Drainage Enters Pulmonary Veins

J. Lymphatic Supply

1. Superficial Lymphatic Vessels
2. Deep Lymphatic Vessels
3. Cancer Spreads Through These Vessels

II. Ventilation

6

7

8

1. Pressure Differences and Air Flow

1. Ventilation = Process of Moving Air Into and Out of Lungs

2. Flow Proportional to Pressure Difference Between Atmospheric Air and Alveolar Air

1. Pressure and Volume

1. General Gas Law
2. As Volume Increases, Air Pressure Decreases

1. Air Flow into and out of Alveoli

1. Flow Inversely Proportional to Resistance to Flow - Related to Bronchiolar Constriction

2. Inspiration Occurs When Thoracic Volume Increased

3. Expiration Occurs When thoracic Volume Decreased

2. Changing Alveolar Volume

Clinical Note, p.746

Table 23.1, p.747

Fig. 23.11, p.748

Fig. 23.11b-c, p.748

Fig. 23.11d, p.748

TA-308

TA-308; TA-309

TA-309

1. Primary Determinants

a. Elastic Recoil of Tissues

b. Surface Tension of Fluid Film Lining Alveoli

2. Normally Resisted by

a. Surfactant Which Reduces Surface Tension

Clinical Note 1, p.749

b. Intrapleural Pressure Below Atmospheric Pressure

III. Measuring Lung Function

Clinical Note 2, p.749; Fig. 23.12, p.750; Predict Quest. 4

TA-310

9

A. Compliance of the Lungs and the Thorax

1. Compliance = Measure of the Expansibility of the Lungs and Thorax

Clinical Note, p.750

a. Volume Increase for Each Unit of Pressure Change in Intrapulmonary Pressure

b. Normal Value is 0.13L per cm Water

2. The Greater the Compliance the Easier it is to Expand the Lungs

3. Abnormally High Compliance Results from Loss of Elastic Tissue as in Emphysema

4. Abnormally Low Compliance Results from

a. Deposition of Inelastic Fibers - Pulmonary Fibrosis

b. Collapse of the Alveoli - Respiratory Distress Syndrome and Pulmonary Edema

c. Airway Obstruction - Asthma, Bronchitis, Lung Cancer

d. Deformities of the Thoracic Wall - Kyphosis and Scoliosis

10

B. Pulmonary Volumes and Capacities

1.Volumes Measured Using Spirometry

Fig. 23.13a, p.751

a. Tidal Volume

Fig. 23.13b, p.751

TA-311

1). Volume of Air Moved During Normal Inspiration or Expiration

2). About 500 ml

b. Inspiratory Reserve Volume

1). Volume of Air Inspired Forcefully After Inspiration of Tidal Volume

2). About 3000 ml

c. Expiratory Reserve Volume

1). Volume of Air Expired Forcefully After Expiration of Tidal Volume

2). About 1100 ml

d. Residual Volume

1). Volume of Air Remaining in Respiratory Passages Following Maximum Forced Expiration

2). About 1200 ml

3. Pulmonary Capacities (Sum of Two or More Pulmonary Volumes)

Fig. 23.13b, p.751

TA-311

a. Inspiratory Capacity

1). Tidal Volume Plus Inspiratory Reserve Volume

2). Maximum Volume a Person can Inspire After a Normal Expiration

3). About 3500 ml

b. Functional Residual Capacity

1). Expiratory Reserve Volume Plus Residual Volume

2). Amount of Air Remaining in the Lungs After Normal Expiration

3). About 2300 ml

c. Vital Capacity

1). Sum of Inspiratory Reserve Volume, Tidal Volume and the Expiratory Reserve Volume

2). Maximum Volume of Air that Can Be Expelled After Maximum Inspiration

3). About 4600 ml

d. Total Lung Capacity

1). Sum of Inspiratory Reserve Volume, Expiratory Reserve Volume, Tidal Volume and Residual Volume

2). About 5800 ml

4. Volumes of Vital Capacity Influenced by

a. Sex - Adult Females 20-25% Below Adult Males

b.Age - Greatest in Young Adults

c. Body Size

1). Tall > Short

2). Thin > Obese

d. Physical Conditioning

1). Training Increased by 30-40%

2). Disease Deceased Below Survival (Less than 500 -1000 ml)

11

5. Forced Expiratory Vital Capacity

a. Rate at Which Lung Volume Changes During Measurement of Vital Capacity

b. Clinically Important Pulmonary Test

9

C. Minute Respiratory Volume and Alveolar Ventilation Rate

Predict Quest. 5

1. Minute Respiratory Volume

a. Total Amount of Air Moved Through Respiratory System Each Minute

b. Tidal Volume X Respiratory Rate

c. 500 ml X 12 Breaths/min = 6 L/min

2. Dead Air Space

a. Part of the Respiratory System Where Gas Exchange Does not Take Place

b. Anatomical Dead Air Space (150 ml) - Volume of Respiratory Passages from Nasal Cavity, to Terminal Bronchioles

c. Physiological Dead Air Space (Variable) Anatomical Dead Air Space Plus Volume of Any Non-Functional Alveoli

Clinical Note, p.752

3.Alveolar Ventilation

a. Volume of Air that is Available for Gas Exchange

b. Inspired Air Fills Dead Air Space First

c. AVR = RR (TV - DAS)

IV. Physical Principles of Gas Exchange

System Interactions, p.771

12

A. Partial Pressure

1. Dalton's Law

Table 23.1, p.747

13

2. Partial Pressure of a Gas = Pressure Exerted by Each Gas in a Mixture of Gasses

Table 23.2, p.753

3. Vapor Pressure (P_H2O) = Partial Pressure of Water in the Gaseous Form

14

B. Diffusion of Gases Through Liquids

1. Henry's Law

Table 23.1, p.747

2. Conc. of Dissolved Gas = Partial Pressure of a Gas X Solubility Coef. of the Gas

3. Direction of Diffusion from Higher Partial Pressure toward Lower Partial Pressure

Predict Quest. 6

15

C. Diffusion of Gases Through the Respiratory Membrane

1. Respiratory Membranes of Lungs are in Respiratory Bronchioles, Alveolar ducts and Alveoli

Fig. 23.14a, p.754

2. Structure of Respiratory Membrane

Fig. 23.14b, p.754

TA-312

a. Thin Layer of Fluid Lining Alveolus

b. Alveolar Epithelium (Simple Squamous Epithelium)

c. Basement Membrane of Alveolar Epithelium

d. Thin Interstitial Space

e. Basement Membrane of the Capillary Endothelium

f. Capillary Endothelium (Simple Squamous Epithelium)

3. Respiratory Membrane Thickness (Influences Rate of Gas Diffusion)

a. Normally 0.5 mm

b. Increased by Pulmonary Edema

1). Left Heart Failure

2). Inflammation of Lung Tissues

3). Increased Thickness = Decreased Gas Exchange

4. Diffusion Coefficient

a. Measure of How Easily a Gas Diffuses through a Liquid

b. Through Resp. Membrane Roughly Equivalent to Diffusion Coefficient through Water

c. Carbon Dioxide's Diffusion Coefficient 20 Times Greater than that of Oxygen

5. Surface Area

a. Normally About 70 m²

b. Decreased by Disease, Edema and Atelectasis

6. Partial Pressure Difference

Fig. 23.14b, p.754

TA-312

a. Difference in Partial Pressure of Gas Between Alveolar Air and Pulmonary Blood

b. Direction of Diffusion from Higher Partial Pressure toward Lower Partial Pressure

c. Partial Pressures in Alveolar Air Influenced by Alveolar Ventilation Rate

D. Relationship Between Ventilation and Capillary Blood Flow

1. Blood Not Completely Oxygenated = Shunted Blood

2. Blood Flow Normally Matched to Ventilation

Clinical Note, p.756

a. Decreased Gas Exchange Leads to Decreased P_O2 and Increased P_CO2 in Arteriolar Blood

1). Stimulates Arteriolar Constriction

2). Decreased Blood Flow to Alveoli with Poor Ventilation

b. Increased Ventilation (as in Response to Exercise) Decreases P_CO2 and Increases P_O2

Predict Quest. 7

1). Arteriolar Smooth Muscle Relaxes

2). Blood Flow to Well Ventilated Alveoli Increases

V. Oxygen and Carbon Dioxide Transport in the Blood

A. Oxygen Diffusion Gradients

Fig. 23.15, p.757

TA-313

1. Blood Arriving at Alveoli Has Lower P_O2 (40 mm Hg) than Alveolar Air (104 mm Hg)

2. Blood Leaving Lungs has P_O2 of 95 mm Hg

3. Blood Entering Capillaries Same as Systemic Arterial Blood, Intracellular P_O2 = 20 mm Hg

4. Blood Leaving Capillary Has Lower P_O2 (40 mm Hg)

B. Carbon Dioxide Diffusion Gradients

Fig. 23.15, p.757

TA-313

1. CO₂ Produced as Byproduct of Cellular Respiration

a. Intracellular P_CO2 About 46 mm Hg

b. Interstitial P_CO2 About 45 mm Hg

2. Tissue Capillary P_CO2 Goes from 40 mm Hg at Arterial End to About 45 mm Hg at Venular End

3. Pulmonary Capillary P_CO2 Goes from 45 mm Hg at Arterial End to About 40 mm Hg at Venular End

16

C. Hemoglobin and Oxygen Transport

1. 97% of Total Oxygen Transported in Combination with Hemoglobin; Remaining 3% Oxygen Dissolved

2. Effect of P_O2 - Oxygen-Hemoglobin Dissociation Curve

Fig. 23.16, p.758

TA-314

a. Hemoglobin Saturated at P_O2 $ 80 mm Hg

b. In a Resting Person, at Normal Tissue Capillary P_O2 of 40 mm Hg Hemoglobin is 75% Saturated

c. During Strenuous Exercise, Tissue Capillary P_O2 Drops to 15 mm Hg and Hemoglobin is only 25% Saturated

Fig. 23.17, p.759

TA-315

3. Effect of pH, P_CO2, and Temperature

a. Effect of pH = Bohr Effect

Fig. 23.18, p.760

TA-316

b. Increased CO₂ Leads to Decreased pH

1). Carbonic Anhydrase Enzyme - Reversible Reaction

2). Located in Erythrocytes and Other Cells

c. Increased CO₂, Decreased pH and/or Increased Temperature Lead to Decreased Ability of Hemoglobin to Bind Oxygen (Curve shifted to the Right)

Predict Quest. 8

4. Effect of BPG; 2,3 bisphosphoglycerate (BPG, aka, diphosphoglycerate)

a. Produced by Erythrocytes

b. BPG Decreases Ability of Hemoglobin to Bind Oxygen

c. BPG Levels Increase at High Altitudes

Predict Quest. 9

17

4. Transport of Carbon Dioxide

a. Mechanisms of Transport

1). 8% Dissolved in the Plasma

2). 20% Transported as Carbamino Compounds,

a). Carbamino-hemoglobin

b). Haldane Effect

b. Chloride Shift in Exchange for Bicarbonate Ions

Fig. 23.19a, p.761

TA-317

1. Carbon Dioxide and Blood pH

1. Blood pH = Plasma pH
2. Carbonic Acid Dissociates to Bicarbonate and H⁺
3. Respiratory System Regulates Blood pH by Changing Plasma Carbon Dioxide Levels

Predict Quest. 10

VI. Rhythmic Ventilation

Clinical Focus, pp.768-769

18

A. Respiratory Areas in the Brainstem

1. Medullary Respiratory Center

1. Two Dorsal Respiratory Groups Stimulate Contraction of the Diaphragm
2. Two Ventral Respiratory Groups Are Active During Inspiration and Expiration

Fig. 23.20 p.762

TA-318

1. Pontine Respiratory Group

1. Collection of Neurons in Pons; Exact Function Unknown

Fig. 23.20, p.762

TA-318

b. Pons Centers work Together to Ensure Rhythmic Respiratory Cycles

B. Generation of Rhythmic Ventilation ñ Believed to Be a 3 Step Process

19

VII. Modification of Ventilation

1. Cerebral and Limbic System Control

1. Voluntary Control Over Respiration Possible During Singing, Voluntary Apnea, Voluntary Hyperventilation
2. Emotions Via Limbic System Can Alter Respiration Patterns

1. Chemical Control of Ventilation

1. Chemoreceptors

a. Central Chemoreceptors in Chemosensitive Center of Ventral Medulla Oblongata

b. Peripheral Chemoreceptors in Carotid and Aortic Bodies

2. Effect of pH

Fig. 23.21, p.764

Fig. 23.21, p.764

Fig. 23.22, p.765

TA-319

TA-319

TA-320

a. Chemosensitive Area Bathed in Cerebrospinal Fluid

b. Indirectly Sensitive to Changes in Blood pH

c. Decreased pH Stimulates Respiratory Center and Increases Ventilation

3. Effect of Carbon Dioxide

Predict Quest. 11

a. Major Regulator of Respiration During Resting Conditions

Clinical Note, p.766

b. 5% Increase in P_CO2 of 5 mm Hg Causes 100% Increase in Ventilation

c. Hypercapnia Produces Increased Ventilation

d. Hypocapnia Produces Apnea

e. Exerts Effect on Respiration Through Effect on pH (Carbonic Anhydrase Reaction)

1). Chemosensitive Area is More Important in Regulation of P_CO2 and pH

2). Carotid and Aortic Bodies Responsible for, at Most, 15-20% of Total Response

4. Effect of Oxygen ñ (Normally Small)

Fig. 23.22, p.765

a. P_O2 Must be Reduced to About 50% of Normal Before Large Stimulatory Effect Seen - Oxygen- Hemoglobin Binding Properties Involved

b.Carotid and Aortic Chemoreceptors Respond by Stimulating Respiratory Center

C. Hering-Breuer Reflex

1. Prevents Overinflation of the Lungs

2. Stretch Receptors in Lungs

3. In Adult Humans Important Only When Tidal Volume Large

• 1. Ventilation Increases Abruptly At Onset of Exercise
• 2. Ventilation Increases Further Gradually 4-6 minutes After Onset of Exercise
• 3. Highest Level of Exercise Without Big Change in Blood pH Is Anaerobic Threshold

E. Other Modifications of Ventilation

1. Irritants Can Produce Sneeze or Cough Reflexes

Predict Quest. 12; Clinical Focus, p.746

VIII. Respiratory Adaptations to Training

1. Athletic Performance Increases in Response to Training
2. Increased Cardiovascular Efficiency Results in Greater Blood Flow Through Lungs

IX. Systems Pathology: Asthma

Predict Quest. 13