The Respiratory SystemThe Respiratory System

Presented by: Martin Ponciano, LVN, DSD, MSPresented by: Martin Ponciano, LVN, DSD, MSBased on Based on Memmler’s The Human Body in Health and Memmler’s The Human Body in Health and

Disease, 11Disease, 11thth Edition Edition

Process of obtaining oxygen from Process of obtaining oxygen from environment andenvironment and

delivering it to cellsdelivering it to cells

• Pulmonary ventilationPulmonary ventilation

• External exchange of gasesExternal exchange of gases

• Internal exchange of gasesInternal exchange of gases

Phases of RespirationPhases of Respiration

Overview of respiration. In ventilation, gases are moved into and out of the lungs. In external Overview of respiration. In ventilation, gases are moved into and out of the lungs. In external exchange, gases move between the air sacs (alveoli) of the lungs and the blood. In internal exchange, exchange, gases move between the air sacs (alveoli) of the lungs and the blood. In internal exchange, gases move between the blood and body cells. The circulation transports gases in the blood.gases move between the blood and body cells. The circulation transports gases in the blood.

Checkpoint 18-1:Checkpoint 18-1: What are the What are the three phases of respiration?three phases of respiration?

Conducts air into lungsConducts air into lungs

• Nasal cavitiesNasal cavities

• PharynxPharynx

• LarynxLarynx

• Trachea (windpipe)Trachea (windpipe)

The Respiratory SystemThe Respiratory System

The respiratory The respiratory system. (A) system. (A) Overview. (B) Overview. (B) Enlarged section of Enlarged section of lung tissue showing lung tissue showing the relationship the relationship between the alveoli between the alveoli (air sacs) of the (air sacs) of the lungs and the blood lungs and the blood capillaries. (C) A capillaries. (C) A transverse section transverse section through the lungs.  through the lungs.  Zooming In: What Zooming In: What organ is located in organ is located in the medial the medial depression of the depression of the left lung?left lung?

Question:Question:

True or False?: The two gases True or False?: The two gases involved in the external exchange involved in the external exchange of gases that takes place in the of gases that takes place in the respiratory system are COrespiratory system are CO22 and O and O22..

Answer:Answer:

True: The two gases involved in the True: The two gases involved in the external exchange of gases that external exchange of gases that

takes place in the respiratory takes place in the respiratory system are COsystem are CO22 and O and O22..

• Nostrils (nares)Nostrils (nares)• Nasal cavitiesNasal cavities

– Mucous membraneMucous membrane• Filters foreign bodiesFilters foreign bodies• Warms airWarms air• Moistens airMoistens air

– ConchaeConchae• Nasal septumNasal septum• SinusesSinuses

The Nasal CavitiesThe Nasal Cavities

Naso- and Oropharyngeal CavitiesNaso- and Oropharyngeal Cavities

Checkpoint 18-2:Checkpoint 18-2: What happens to What happens to air as it passes over the nasal air as it passes over the nasal mucosa?mucosa?

Throat (pharynx) carries air to respiratory Throat (pharynx) carries air to respiratory tract and foodtract and food

to digestive systemto digestive system• NasopharynxNasopharynx– Superior portionSuperior portion

• OropharynxOropharynx– Middle portionMiddle portion

• Laryngeal pharynxLaryngeal pharynx– Inferior portionInferior portion

The PharynxThe Pharynx

Larynx (voice box) is located between the Larynx (voice box) is located between the pharynxpharynx

and tracheaand trachea• Cartilage frameworkCartilage framework– Thyroid cartilage (Adam’s apple)Thyroid cartilage (Adam’s apple)

• Vocal folds (vocal cords)Vocal folds (vocal cords)– Used for speechUsed for speech

• GlottisGlottis• EpiglottisEpiglottis

The LarynxThe Larynx

Movements of the Vocal CordsMovements of the Vocal Cords

Trachea (wind pipe) conducts air between Trachea (wind pipe) conducts air between larynx and lungslarynx and lungs

• Framework of separate cartilagesFramework of separate cartilages

• Horseshoe shapedHorseshoe shaped

• Open at back for expansion during Open at back for expansion during swallowingswallowing

The TracheaThe Trachea

Checkpoint 18-3:Checkpoint 18-3: What are the What are the scientific names for the throat, scientific names for the throat, voice box, and windpipe?voice box, and windpipe?

Checkpoint 18-4:Checkpoint 18-4: What are the What are the three regions of the pharynx?three regions of the pharynx?

• Trachea divides into two primary bronchi Trachea divides into two primary bronchi that enterthat enter

the lungsthe lungs

• HilumHilum

• Epithelial tissue liningEpithelial tissue lining– PseudostratifiedPseudostratified– CiliaCilia

The BronchiThe Bronchi

BronchiBronchi

Checkpoint 18-5:Checkpoint 18-5: The cells that line The cells that line the respiratory passageways help the respiratory passageways help to keep impurities out of the lungs. to keep impurities out of the lungs. What feature of these cells enables What feature of these cells enables them to filter impurities and move them to filter impurities and move fluids?fluids?

Question:Question:

The air-conducting passageways The air-conducting passageways of the respiratory tract are lined of the respiratory tract are lined with what type of tissue? with what type of tissue?

a. stratified squamous epitheliala. stratified squamous epithelialb. pseudostratified epithelialb. pseudostratified epithelialc. squamous epithelialc. squamous epithelial

Answer:Answer:

b. pseudostratified epithelialb. pseudostratified epithelial

• MediastinumMediastinum• LobesLobes

– Bronchial treeBronchial tree– BronchiolesBronchioles

• AlveoliAlveoli• DiaphragmDiaphragm• PleuraPleura

– Parietal pleuraParietal pleura– Visceral pleuraVisceral pleura– Pleural spacePleural space

The LungsThe Lungs

Checkpoint 18-6:Checkpoint 18-6: In what structures In what structures does gas exchange occur in the does gas exchange occur in the lung?lung?

Checkpoint 18-7:Checkpoint 18-7: What is the name What is the name of the membrane that encloses the of the membrane that encloses the lung?lung?

• Ventilation of lungsVentilation of lungs

• Exchange of gasesExchange of gases

• Transport of gases in bloodTransport of gases in blood

The Process of RespirationThe Process of Respiration

• Inhalation (inspiration) is active phaseInhalation (inspiration) is active phase

• ComplianceCompliance

• Exhalation (expiration) is passive phaseExhalation (expiration) is passive phase

• Lung capacityLung capacity

Pulmonary VentilationPulmonary Ventilation

Pulmonary Pulmonary ventilation. ventilation.

(A)Inhalation. (A)Inhalation. (B)Exhalation(B)Exhalation.  .  

Zooming In: Zooming In: What muscles What muscles are located are located between the between the ribs?ribs?

InspirationInspiration

ExpirationExpiration

Checkpoint 18-8:Checkpoint 18-8: What are the two What are the two phases of breathing? Which is phases of breathing? Which is active and which is passive?active and which is passive?

• Diffusion is movement of molecules from Diffusion is movement of molecules from higher to lower concentrationhigher to lower concentration

• External exchangeExternal exchange– Gases move between alveoli and capillary Gases move between alveoli and capillary

bloodblood

• Internal exchangeInternal exchange– Gases move between blood and tissuesGases move between blood and tissues

Gas ExchangeGas Exchange

Gas exchange. (A) External exchange between the alveoli and the blood. Oxygen diffuses into Gas exchange. (A) External exchange between the alveoli and the blood. Oxygen diffuses into the blood and carbon dioxide diffuses out, based on concentrations of the two gases in the the blood and carbon dioxide diffuses out, based on concentrations of the two gases in the alveoli and in the blood. (B) Internal exchange between the blood and the cells. Oxygen diffuses alveoli and in the blood. (B) Internal exchange between the blood and the cells. Oxygen diffuses out of the blood and into tissues, while carbon dioxide diffuses from the cells into the blood.out of the blood and into tissues, while carbon dioxide diffuses from the cells into the blood.

Checkpoint 18-9:Checkpoint 18-9: Gases move Gases move between the alveoli and the blood between the alveoli and the blood by the process of diffusion. What is by the process of diffusion. What is the definition of diffusion?the definition of diffusion?

• Most oxygen in capillary blood binds to Most oxygen in capillary blood binds to hemoglobinhemoglobin

• Oxygen must separate from hemoglobin to Oxygen must separate from hemoglobin to enter cellsenter cells

Transport of OxygenTransport of Oxygen

Checkpoint 18-10:Checkpoint 18-10: What substance What substance in red blood cells carries almost all in red blood cells carries almost all of the oxygen in the blood?of the oxygen in the blood?

• 10% is dissolved in plasma and fluid in red blood cells10% is dissolved in plasma and fluid in red blood cells• 15% is combined with protein of hemoglobin and plasma 15% is combined with protein of hemoglobin and plasma

proteinsproteins• 75% dissolves in blood fluids and is converted to 75% dissolves in blood fluids and is converted to

bicarbonate ionbicarbonate ion– First combines with water to form carbonic acidFirst combines with water to form carbonic acid– Carbonic acid ionizes (separates) into hydrogen and Carbonic acid ionizes (separates) into hydrogen and

bicarbonate ionsbicarbonate ions– Carbonic anhydrase enzyme speeds conversionCarbonic anhydrase enzyme speeds conversion– Buffers blood to keep pH steadyBuffers blood to keep pH steady

Transport of Carbon DioxideTransport of Carbon Dioxide

Checkpoint 18-11:Checkpoint 18-11: What is the main What is the main form in which carbon dioxide is form in which carbon dioxide is carried in the blood?carried in the blood?

Question:Question:

In what structure of the In what structure of the respiratory system does most respiratory system does most gas exchange take place?gas exchange take place?

a. bronchiolesa. bronchiolesb. pleuraeb. pleuraec. alveolic. alveoli

Answer:Answer:

c. alveolic. alveoli

Fundamental respiratory patternFundamental respiratory pattern

• Controlled by central nervous system Controlled by central nervous system centerscenters– Partly in medulla (main control center), partly in Partly in medulla (main control center), partly in

pons (modifies patterns set in the medulla)pons (modifies patterns set in the medulla)

• Modified by receptors detecting changes in Modified by receptors detecting changes in blood chemistryblood chemistry

Regulation of RespirationRegulation of Respiration

• Control center is located in medulla and Control center is located in medulla and pons of brain stempons of brain stem

• Motor nerve fibers extend into spinal cordMotor nerve fibers extend into spinal cord

• Fibers extend through phrenic nerve to Fibers extend through phrenic nerve to diaphragmdiaphragm

Nervous ControlNervous Control

Nervous Control of Nervous Control of RespirationsRespirations

Checkpoint 18-12:Checkpoint 18-12: What part of the What part of the brain stem sets the basic pattern of brain stem sets the basic pattern of respiration?respiration?

Checkpoint 18-13:Checkpoint 18-13: What is the What is the name of the motor nerve that name of the motor nerve that controls the diaphragm?controls the diaphragm?

• Central chemoreceptorsCentral chemoreceptors– Located near medullary respiratory centerLocated near medullary respiratory center– Respond to raised CO2 level (hypercapnia)Respond to raised CO2 level (hypercapnia)

• Peripheral chemoreceptorsPeripheral chemoreceptors– Located in neck and aortic archLocated in neck and aortic arch– Respond to oxygen level considerably below Respond to oxygen level considerably below

normalnormal

Chemical ControlChemical Control

Checkpoint 18-14:Checkpoint 18-14: What gas is the What gas is the main chemical controller of main chemical controller of respiration?respiration?

Lung CapacityLung Capacity

• HyperventilationHyperventilation– High oxygen level and low CO2 level High oxygen level and low CO2 level

(hypocapnia)(hypocapnia)– Increases blood pHIncreases blood pH

• HypoventilationHypoventilation– Insufficient air in alveoliInsufficient air in alveoli– Decreases blood pHDecreases blood pH

Abnormal VentilationAbnormal Ventilation

• Measured in breaths per minuteMeasured in breaths per minute

• Adults: 12 to 20Adults: 12 to 20

• Children: 20 to 40Children: 20 to 40

• Infants: more than 40Infants: more than 40

Breathing PatternsBreathing Patterns

• HyperpneaHyperpnea• HypopneaHypopnea• TachypneaTachypnea• ApneaApnea• DyspneaDyspnea• OrthopneaOrthopnea• Kussmaul respirationKussmaul respiration• Cheyne-Stokes respirationCheyne-Stokes respiration

Some Terms for Altered BreathingSome Terms for Altered Breathing

• Eupnea: normal breathingEupnea: normal breathing• Hyperpnea: deeper, more rapid breathingHyperpnea: deeper, more rapid breathing• Hypopnea: slow, more shallow breathingHypopnea: slow, more shallow breathing• Tachypnea: abnormally rapid rate of breathingTachypnea: abnormally rapid rate of breathing

– > 20 breaths per minute> 20 breaths per minute• Bradypnea: abnormally slow rate of breathingBradypnea: abnormally slow rate of breathing

– <10 breaths per minute<10 breaths per minute DyspneaDyspnea

◦ Aka SOB (shortness of breath)Aka SOB (shortness of breath)◦ Difficult or labored breathingDifficult or labored breathing◦ Usually one of the first symptoms of heart failureUsually one of the first symptoms of heart failure

Apnea: spontaneous absence of respirationApnea: spontaneous absence of respiration◦ Sleep apnea syndromesSleep apnea syndromes

Group of disordersGroup of disorders Potentially fatalPotentially fatal Breathing repeatedly stops during sleepBreathing repeatedly stops during sleep

Long enough to decrease significant amount of oxygen in blood Long enough to decrease significant amount of oxygen in blood Snoring may be a symptomSnoring may be a symptom

Breathing Patterns (cont.)Breathing Patterns (cont.)

• Orthopnea: dyspnea that is relieved by Orthopnea: dyspnea that is relieved by sitting uprightsitting upright

• Kussmaul respirationKussmaul respiration– deep, rapid respiration characteristic of deep, rapid respiration characteristic of

acidosisacidosis

• Cheyne-Stokes respirationCheyne-Stokes respiration– Pattern of alternating periods of hypopnea or Pattern of alternating periods of hypopnea or

apnea, followed by hyperpneaapnea, followed by hyperpnea– Frequently seen in those who are dyingFrequently seen in those who are dying

Breathing Patterns (cont.)Breathing Patterns (cont.)

Question:Question:

What is the medical term for What is the medical term for temporary cessation of temporary cessation of breathing?breathing?

a. dyspneaa. dyspneab. apneab. apneac. hypopneac. hypopnea

Answer:Answer:

b. apneab. apnea

AsphyxiaAsphyxia◦ Body cannot get need air to functionBody cannot get need air to function◦ Life-threateningLife-threatening◦ Quick ↓ in OQuick ↓ in O22 levels levels

◦ ↑ ↑ in COin CO22 levels levels

AsphyxiationAsphyxiation◦ Aka suffocationAka suffocation◦ Interruption of normal breathing resulting in Interruption of normal breathing resulting in

asphyxiaasphyxia◦ Can be caused by obstruction, drowning, Can be caused by obstruction, drowning,

smothering, choking, or inhaling gases (CO) instead smothering, choking, or inhaling gases (CO) instead of airof air

Results of Inadequate Breathing: Results of Inadequate Breathing: Lack of OxygenLack of Oxygen

Chronic obstructive pulmonary disease (COPD)Chronic obstructive pulmonary disease (COPD)◦ Partial obstruction due to damage to bronchiPartial obstruction due to damage to bronchi◦ Related to several lung disordersRelated to several lung disorders

Ex. Chronic bronchitis & emphysemaEx. Chronic bronchitis & emphysemaRespiratory function is impairedRespiratory function is impaired

◦ Reduce exchange of oxygen & carbon dioxideReduce exchange of oxygen & carbon dioxide◦ Traps air which may lead to over inflation of parts of Traps air which may lead to over inflation of parts of

lungslungsPatients have a history of:Patients have a history of:

◦ SmokingSmoking◦ Dyspnea, where labored breathing occurs and gets Dyspnea, where labored breathing occurs and gets

progressively worseprogressively worse◦ Coughing and frequent pulmonary infectionsCoughing and frequent pulmonary infections

COPD victims develop respiratory failure COPD victims develop respiratory failure accompanied by hypoxemia, carbon dioxide accompanied by hypoxemia, carbon dioxide retention, and respiratory acidosisretention, and respiratory acidosis

COPDCOPD

• InfectionInfection

• AllergiesAllergies

• Environmental factorsEnvironmental factors

• Lung cancerLung cancer

Disorders of the Respiratory SystemDisorders of the Respiratory System

• Paranasal sinusesParanasal sinuses– SinusitisSinusitis– PolypsPolyps

• Nasal septumNasal septum– Deviated septumDeviated septum

• Mucous membranesMucous membranes– EpistaxisEpistaxis

Disorders of the Nasal Cavities andDisorders of the Nasal Cavities andRelated StructuresRelated Structures

• Upper respiratory infection (URI)Upper respiratory infection (URI)• Common cold (acute coryza)Common cold (acute coryza)• Respiratory syncytial virus (RSV)Respiratory syncytial virus (RSV)• CroupCroup• InfluenzaInfluenza• PneumoniaPneumonia

– BronchopneumoniaBronchopneumonia– Lobar pneumoniaLobar pneumonia– Pneumocystis pneumonia (PCP)Pneumocystis pneumonia (PCP)

• TuberculosisTuberculosis

InfectionInfection

Hypersensitivity to allergensHypersensitivity to allergens

• Watery discharge from eyes and noseWatery discharge from eyes and nose

• Seasonal or chronicSeasonal or chronic

• Inflammation of airway tissuesInflammation of airway tissues

• Spasm in bronchial tubesSpasm in bronchial tubes

Hay Fever and AsthmaHay Fever and Asthma

Also called chronic obstructive lung disease Also called chronic obstructive lung disease (COLD)(COLD)

• Includes both chronic bronchitis and Includes both chronic bronchitis and emphysemaemphysema

• Normal air flow obstructedNormal air flow obstructed• Reduced exchange of oxygen and carbon Reduced exchange of oxygen and carbon

dioxidedioxide• Air trapping and overinflation of lungsAir trapping and overinflation of lungs• DyspneaDyspnea

Chronic Obstructive PulmonaryChronic Obstructive PulmonaryDisease (COPD)Disease (COPD)

Also called crib deathAlso called crib death

• Unexplained deathUnexplained death

• Seemingly healthy infantSeemingly healthy infant

• Under 1 year oldUnder 1 year old

• Usually occurs in sleepUsually occurs in sleep

Sudden Infant Death Syndrome Sudden Infant Death Syndrome (SIDS)(SIDS)

Checkpoint 18-15:Checkpoint 18-15: What does COPD What does COPD mean and what two diseases are mean and what two diseases are commonly involved in COPD? commonly involved in COPD?

Covers a range of inflammatory disordersCovers a range of inflammatory disorders

• Acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) or shock lung(ARDS) or shock lung– Usually appears in adultsUsually appears in adults

• Respiratory distress syndrome of the Respiratory distress syndrome of the newbornnewborn– Formerly called hyaline membrane diseaseFormerly called hyaline membrane disease– Appears in premature newbornsAppears in premature newborns

Respiratory Distress Syndrome Respiratory Distress Syndrome (RDS)(RDS)

• Lung cancerLung cancer– Most common cause of cancer-related deathsMost common cause of cancer-related deaths– Most important cause is cigarette smokingMost important cause is cigarette smoking

• Cancer of larynxCancer of larynx– Linked to cigarette smoking and alcohol Linked to cigarette smoking and alcohol

consumptionconsumption– High cure rate High cure rate

CancerCancer

• PleurisyPleurisy– Inflammation of pleuraInflammation of pleura

• PneumothoraxPneumothorax– Air in pleural spaceAir in pleural space

• HemothoraxHemothorax– Blood in pleural spaceBlood in pleural space

Disorders Involving the PleuraDisorders Involving the Pleura

• Tissues lose elasticity, become more rigidTissues lose elasticity, become more rigid

• Decreased compliance, lung capacityDecreased compliance, lung capacity

• Increased susceptibility to infectionIncreased susceptibility to infection

• Increased incidence of emphysemaIncreased incidence of emphysema

• Reduced capacity for exerciseReduced capacity for exercise

Age and the Respiratory TractAge and the Respiratory Tract

• BronchoscopeBronchoscope

• Oxygen therapyOxygen therapy

• Suction apparatusSuction apparatus

• Tracheostomy tubeTracheostomy tube

• Artificial respiration apparatusesArtificial respiration apparatuses

Special Equipment for Respiratory Special Equipment for Respiratory TreatmentTreatment

Question:Question:

What is the medical term for an What is the medical term for an accumulation of air in the accumulation of air in the pleural space? pleural space?

a. pneumothoraxa. pneumothoraxb. pleurisyb. pleurisyc. atelectasisc. atelectasis

Answer:Answer:

a. pneumothoraxa. pneumothorax

End of PresentationEnd of Presentation