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Upper Airway

Nose
Nares/nostrils – opening of the nose
Nasal septum – separates the right and left sections of
the nose
Vibrissae – hair follicles that filters the inspired air
Oral Cavity
An alternative portal of entry for air into the respiratory tract.
Main function: to move food from the mouth into the esophagus in the
process of swallowing.
Vestibule – the outer portion of the oral cavity that consists of the lips,
gums and teeth.
Hard and soft palate
Tonsils – play a role in immune defense and protection from foreign
matter.
Uvula – fleshy appendage that hangs down from the soft palate.
Pharynx
Nasopharynx
Oropharynx
Laryngopharynx
Serves as a conduit to the lower airways
Lower Airway and Lungs

Lungs – cone-shaped, spongy structure with a


narrow end at the top and wide bases at the
bottom.
Surface area: about the size of a tennis court (approx.
70 – 100 m2)
file:///var/www/apps/scribd/scribd/tmp/Pictures/lungs.jpg
Larynx – also known as voice box
Functions:
Provide a pathway for airflow from the upper airways into the
lower airways
To separate air from food or liquids preventing aspiration
Serve as a site for resonance of spoken voice
Trachea – composed of C-shaped cartilaginous
rings that provide firm support.
Bronchi – large, cartilage-containing airways that
serve as the central passageway to the right and
left lungs.
Alveoli – tiny grapelike sacs
serves as functional unit where gases are exchanged.
Alveolar capillary interspace – separates the alveolus
from the pulmonary capillary
Pores of Kohn – small openings between the alveoli
file:///var/www/apps/scribd/scribd/tmp/Pictures/brnchits1.jpg
Pleura– provide a cover for the lungs and line the
thoracic wall.
Composed of:
Visceral pleurae – cover the lung parenchyma
Parietal pleurae – cover the outside of the lungs and are
in contact with the thoracic cage
Pleural space – contains serous fluids that allows
the layers to move easily and without friction
during normal ventilation
file:///var/www/apps/scribd/scribd/tmp/Pictures/pe1.jpg
Thoracic Cage –
Maintain pressure and tension that are necessary for
normal ventilation

Mediastinum – houses the trachea, esophagus,


heart, pulmonary lymphatics, great blood vessels
and thymus glands
Substances important in
maintaining alveolar integrity
1. Surfactant
acts to lower surface tension and prevent collapse of
the alveoli.
Promotes expansion and stability of the alveoli.
Protective, waterproof material that may prevent the
movement of fluid across the alveolar-capillary
membrane during the respiratory cycle.
2. Alpha 1- antitrypsin
A glycoprotein produced by the liver that plays a
significant role in maintenance of the pulmonary tissue
Primary function: inhibit natural proteolytic enzymes
Respiratory Muscles

Inspiratory Muscles
Diaphragm– the major muscle in the act of breathing
Able to facilitate lung expansion by moving downward during
inspiration.
External intercostal muscles – located between the ribs
Able to further enlarge the thorax during inspiration by creating an
upward and outward motion of the lower ribs.
Scalene and sternocleidomastoid muscles
Used during labored breathing to raise the first two ribs
and sternum in an effort to increase the size of the
thoracic cavity.
Respiration
-provides the body with a means of gas exchange

can be divided into 3 parts:

a. Ventilation
b. Perfusion
c. Diffusion
Ventilation
-movement of air between the atmosphere and
respiratory portion of the lungs

Control of breathing:
1. Central Receptors
*medulla oblongata
*pons
2. Chemoreceptors
3. Lung Receptors
Lung Receptors
a. Stretch receptors
-respond to changes in pressure in the walls of
the airways.
-location: smooth muscle layers

Inflation reflex
Hering-Breuer reflex – serves to regulate the
depth of breathing by limiting lung inflation.

b. Irritant receptors
Stimulation leads to airway constriction
Location: airway epithelial cells
c. Juxtacapillary or J receptors

-sense lung congestion


-responsible for rapid shallow breathing that
occur with pulmonary edema, pneumonia.
Location: alveolar wall
Perfusion

-the flow of the blood through the lungs


Diffusion

-transfer of gases between the air-filled spaces in


the lungs and the blood
Gas Exchange and Gas
Transport
Oxygen is transported in two forms:
1. chemical combination with hemoglobin

Hemoglobin
-serves as a transport vehicle for oxygen.
-it binds oxygen in the pulmonary capillaries and
release it in the tissue capillaries.
- 1gm of hemoglobin= 1.34ml of oxygen

2. dissolve state (1%)


Ratio of Oxygen dissolve:
*for every 1mmHg of PO2 present in the alveoli,
0.003ml of O2 becomes dissolved in 100ml of
plasma
Carbon dioxide Transport

CO2 is transported in 3 forms:

1. As dissolved CO2 (10%)


2. attached to hemoglobin (30%)
3. as bicarbonate (60%)
*lungs restore the oxygen content of the arterial blood and remove carbon dioxide from
the venous blood.

file:///var/www/apps/scribd/scribd/tmp/Pictures/gasxchnge4.png
*The blood carries oxygen and carbon dioxide in a dissolve state and combination with
hemoglobin.
file:///var/www/apps/scribd/scribd/tmp/Pictures/gasxchnge3.jpg

*Oxygen and carbon dioxide are dissolved in plasma.


ALTERATIONS
in RESPIRATORY SYSTEM
and FUNCTION
Respiratory Tract Infection
Common Cold
-viral infection of the upper respiratory tract
which is usually lasts for 7 days.

-period of communicability: first 3 days after the


onset of symptom file:///var/www/apps/scribd/scribd/tmp/Pictures/colds.jpg

S/S:
a. headache
b. generalized malaise
c. fever
d. exhaustion
Sinusitis
-inflammation of paranasal sinuses
-classified as: file:///var/www/apps/scribd/scribd/tmp/Pictures/sinusitis.jpg

a. acute- lasts from 1day to 3weeks


b. sub acute- 3weeks to 3 months
c. chronic- 3 months and beyond

S/S:
a. facial pain
b. headache
c. purulent nasal discharges
d. fever
e. decrease sense of smell
Influenza
-viral (influenza A and B) infection that can affect both the
upper and lower respiratory tracts.
-incubation period: 1-4days; 2 days being the average
-period of communicability: 1st day to 5th day of illness

S/S:
a. abrupt onset of fever and chills
b. malaise and muscle aching
c.headache
d. profuse,watery nasal discharges
e. non productive cough
f. sore throat
Pneumonia
-inflammation of parenchymal structure of the lung, such
as the alveoli and bronchioles
-can be atypical (viral) and typical (bacterial)
-classified as: CAP and HAP
file:///var/www/apps/scribd/scribd/tmp/Pictures/pnemonia.jpg

S/S:
a. chills
b. fever
c. severe malaise
d. purulent sputum
e. elevated WBC
f. patchy or lobar infiltrates
Tuberculosis
-infectious disease caused by the M. Tuberculosis
a. M. Tuberculosis hominis (human
tuberculosis)
b. M. Tuberculosis Bovis (bovine tuberculosis)
-acquired by drinking milk from infected
cows.
file:///var/www/apps/scribd/scribd/tmp/Pictures/tb2.jpg
file:///var/www/apps/scribd/scribd/tmp/Pictures/tb1.jpg

S/S:
a. low grade fever
b. night sweats
c. dyspnea/orthopnea
d. easy fatigability
e. f. weight loss file:///var/www/apps/scribd/scribd/tmp/Pictures/tb3.jpg

g. cough initially dry


but later become productive
with purulent/blood tinged
Disorders of Lung
Inflation
Pleural Effusion
-abnormal collection of fluid in the pleural cavity
-the fluid may be a transudate (hydrothorax), exudate,
purulent drainage, blood (hemothorax), emphyema (pus).
file:///var/www/apps/scribd/scribd/tmp/Pictures/pe1.jpg
*normally, only a thin layer (<10ml-20ml) of serous fluid
separates the visceral and parietal layers of the pleural
cavity.
file:///var/www/apps/scribd/scribd/tmp/Pictures/pe2.jpg
S/S of Pleural Effusion:

a. dullness, flatness during percussion


b. diminished breath sounds
c. dyspnea
d. pleuritic pain
e. mild hypoxemia
Pneumothorax file:///var/www/apps/scribd/scribd/tmp/Pictures/pneumo1.jpg

-air enters the pleural cavity


-may be classified as:

a. Spontaneous Pneumothorax
-occurs when an air-filled bleb
or blister in the lung surface
b. Traumatic Pneumothorax

-may be caused by penetrating or nonpenetrating


injuries (fracture and dislocation)

c. Tension Pneumothorax

-occurs when the intrapleural pressure exceeds


atmospheric pressure (atelectasis)
S/S of pneumothorax:

a. chest pain
b. increase RR
c. dyspnea
d. increase HR
e. asymmetry of the chest
f. hyprresonant sound
g. hypoxemia
Atelectasis
-refers to the incomplete expansion of the lung or portion
of a lung.

Manifestations:
a. tachypnea
b. tachycardia
c. dyspnea
d. cyanosis
e. hypoxemia
f. diminished chest expansion
Obstructive airway
Disorders
Bronchial Asthma

-chronic inflammatory airway disease


-caused by allergens, RTI, emotional upsets,
chemical, etc.

S/S: airway obstruction characterized by:


a. wheezing
b. breathlessness
c. chest tightness
d. cough
COPD

-denotes a group of respiratory disorders


characterized by chronic and recurrent obstruction
of air flow in the pulmonary airway.
1. Emphysema (pink puffers)

-characterized by lung elasticity and abnormal


enlargements of air spaces distant to the terminal
bronchioles with destruction of the alveolar walls and
capillary beds.

-Causes: smoking
Antitrypsin deficiency
2. chronic Bronchitis (blue bloaters)

-obstruction caused by inflammation of the major


and small airway.
Pink Puffer file:///var/www/apps/scribd/scribd/tmp/Pictures/pinkpuffer.jpg

S/S:

a. dyspnea
b. increased ventilatory effort
c. barrel chest
d. pursed lip breathing noted
e. weight loss
Blue Bloaters
file:///var/www/apps/scribd/scribd/tmp/Pictures/BlueBloater.jpg

S/S:
a. hypoxemia
b. cyanosis
c. shortness of breath
d. prolonged expiratory respiration
e. pulmonary hypertension
f. cor pulmonale
g. clubbing of fingers
3. Bronchiectasis
-abnormal dilation of the large bronchial associated with
infection and destruction of the bronchial walls.

4. Cystic Fibrosis

- an autosomal recessive disorder involving secretion


in the exocrine glands, and epithelial lining of the
respiratory, GI and reproductive tract.
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GASTROINTESTINAL
and HEPATOBILIARY
SYSTEM
file:///var/www/apps/scribd/scribd/tmp/Pictures/GIT.jpg
file:///var/www/apps/scribd/scribd/tmp/Pictures/git2.jpg
Four parts of digestive system:

1. Upper Gastrointestinal Tract


2. Middle Gastrointestinal Tract
3. Lower Gastrointestinal Tract
4. Accessory Organs
Neural Control Mechanism

Gastrointestinal function is controlled by the


enteric nervous system, which lies entirely within
the wall of the GIT, and by parasympathetic and
sympathetic of the ANS.
Chewing and Swallowing

Chewing begins the digestive process; it breaks


the food into the particles of a size that can be
swallowed.

Salivary Amylase- enzyme present in the saliva


that mixes starch-containing foods.
Swallowing

Swallowing Reflexes:

-Swallowing Center (medulla and lower


pons)
-Trigeminal (V)
-Glossopharyngeal (IX)
-vagus (X)\
-hypoglossal (XII)
Phases of Swallowing:

1. Oral Phase
-bolus is collected at the back of the mouth so that the
can lift upward until it touches the posterior wall of the
pharynx

2. Pharyngeal Phase
-soft palate is pulled upward

3. Esophageal Stage
-food enters the esophagus and stretches its walls.
Motility
The motility of the Git propels food products and fluids along
its length, from mouth to anus, in a manner that facilitates
digestion and absorption.

A. Gastric Motility
Motility of the stomach results in the churning and grinding
of solid foods and regulates the emptying of the gastric
contents, or chyme, into the duodenum.

They occur at a frequency of 3-5 contractions/minute, each


with a duration of 2-20 seconds.

=Cholecystokinin (CCK) and gastric inhibitory peptide


-hormones which are thought to control gastric emptying.
Small Intestine Motility
Small intestine is the major site for digestion and absorption.

Regular peristaltic movements begin in the duodenum.


Peristaltic movements (approximately 12/minute in the
jejunum); (approx. 9/minute)

Colonic Motility
Movements in the colon are of two types:

a. haustrations
*fecal mass are exposed to the intestinal surface
b. propulsive mass movements
*fecal contents moving forward as a unit
Defecation

*Defecation is controlled by the action of two


sphincters, the internal and external anal
sphincters. (cortex)

*Defecation also is controlled by defecation


reflexes, intrinsic myenteric reflex and
parasympathetic reflex.
Secretory Function

Each day, approximately 7000ml of fluid is secreted into


the GIT.

Approximately 50-200ml of this fluid leaves the body in


the stool, the remainder is reabsorbed in the small and
large intestine. @
Salivary Secretions

Saliva is secreted by the salivary gland. (parotid,


submaxillary, sublingual and buccal)

=Functions of Saliva:
a. protection and lubrication
b. antimicrobial action (lysozyme)
c. aids in digestion of dietary starches (ptyalin and
amylase)
Gastric Secretions

a. hydrochloric acid (20meq/ml each hour)


b. pepsinogen
c. intrinsic factor-necessary for the absorption of vit. B12
d. mucus

-secreted by Oxyntic and Pyloric glands


Intestinal Secretions

a. alkaline mucus-protects the duodenum from the acid


content
b. peptidases-enzyme that separates amino acid
c. disaccharides-enzymes that split sugars

The small intestine secretes digestive juices and receives


secretions from the liver and pancreas by Brunner's
glands.
Digestion and Absorption

Digestion is the process of dismantling foods into their


constituent parts.
Digestion requires hydrolysis, enzyme cleavage, and fat
emulsification.

Absorption is the process of moving nutrients and other


materials from the external environment of the GIT into
the internal environment.
Carbohydrate Absorption

Carbohydrates must be broken down into


monosaccharides before they can be absorbed from the
small intestine. @

Fat Absorption

Pancreatic Lipase-breaks down triglycerides


Bile salt- act as a carrier system for the fatty acids and fat
soluble vitamins

Steatorrhea-fatty stools
Protein Absorption

Pepsinogen- digests protein

Proteins are broken down further by pancreatic


enzymes (trypsin, chymotrypsin, carboxypeptidase
and elastase)
Alterations in
Gastrointestinal Function
Manifestations of Gastrointestinal
Disorders
a. anorexia-represents a loss of appetite.

b. Nausea- an ill-defined and unpleasant subjective


sensation.

c. vomiting or emesis- the sudden and forceful oral expulsion


of the contents of the stomach.

d. GIT bleeding
Bleeding from the GIT can be evidenced by blood that
appears in the vomitus or the feces.

Hematemesis-blood in the vomitus


Melena- blood that appears in the stool
DISORDERS
of the
ESOPHAGUS
Dyspahgia
-refers to the difficulty in swallowing.

Odynophagia- painful swallowing

Achalasia- failure of the lower sphincter to relax

@
Esophageal Diverticulum
Diverticulum- an outpouching of the esophageal wall
caused by weakness of the muscularis layer.
@

Gastroesophageal Reflux Disease


(GERD)
-refers to backward movement of gastric contents into
the esophagus.

@
Disorders
of the
Stomach
Gastritis
-refers to the inflammation of the gastric mucosa.
-Classified as:

a. acute Gastritis
-refers to transient inflammation of the gastric mucosa

b. Chronic Gastritis

-characterized by the presence of glandular epithelium


atrophy of the stomach.
-has 4 types: Autoimmune, Multifocal, H. Pylori and
Chemical Gastropathy

@
Ulcer Disease
A. Peptic Ulcer
-a term used to describe a group of ulcerative disorders that
occur in areas of the upper GIT that are exposed to acid-
pepsin secretions.

-2 common forms of Peptic Ulcers:


1. Duodenal Ulcer
2. Gastric Ulcers
a. Zollinger-Ellison Syndrome
b. Stress Ulcer (Curling's Ulcer) and (Cushing's Ulcer)
-Gastrointestinal ulcerations that develop in relation
to major physiologic stress.
Disorders of the Small
and Large intestines
Irritable Bowel Syndrome
-used to describe a functional gastrointestinal disorder
characterized by a variable combination of chronic and
recurrent intestinal symptoms

The condition is characterized:


a. persistent and recurrent symptoms of abdominal pain
b. altered bowel function
c. flatulence
d. bloatedness
e. nausea and anorexia
f. anxiety or depression

A hallmark of irritable bowel syndrome is abdominal pain that


is relieved by defecation
Inflammatory Bowel Disease

-used to designate two related inflammatory


intestinal disorders: Crohn's disease and
ulcerative colitis

Both diseases produce inflammation of the bowel.


Crohn's Disease

-is recurrent, granulomatous type of inflammatory


response that can affect any area of the
gastrointestinal tract from the mouth to the anus.

@
Ulcerative Colitis

-a nonspecific inflammatory condition of the colon

Ulcerative proctitis- ulceration of the rectum alone

Proctosigmoiditis- ulceration of the rectum and sigmoid


colon

Pancolitis-ulceration of the entire colon.

@
Infectious Colitis

-Caused by:

a. Clostridium difficile

b. Escherichia Coli serotype O157:H7.


Diverticular Disease

Diverticulosis

-a condition in which the mucosal layer of the


colon herniates through the muscular layer.

@
Appendicitis

-inflammation of the appendix


-cause is unknown, it is rethought to be related to
intraluminal obstruction of the fecalith

Appendicitis has an abrupt onset, with pain referred to


the epigastric or periumbilical area.
Peritonitis
-an inflammatory response of the serous membrane that
lines the abdominal cavity and covers the visceral
organs.

Causes:
Bacterial invasion
Chemical irritation

S/S:
a. translocation of extracellular fluid into the peritoneal
cavity
b. nausea and vomiting
c. pain and tenderness
d. shallow breathing
e. rigid and boardlike abdomen
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