Académique Documents
Professionnel Documents
Culture Documents
Charles Tan
Departemen Anestesi, Terapi Intensif & Manajemen Nyeri
Fakultas Kedokteran Universitas Hasanuddin
1
Lecture map
Physiology of respiration
Definitions and structures
Mechanics of breathing
Measurements of pulmonary function
Cellular Respiration, Pulmonary disorders
Blood gases - Diffusion
Neural control of respiration
Hemoglobin (and disorders)
Transport of C02
Acid/base balance
2
Anatomy of Respiratory Tree
3
Longitudinal Section
4
The Thorax and its contents
5
What is Respiration ?
Goals:
What is the respiratory system?
What is respiration?
What are the structural features?
What are their functions?
6
Respiration
Ventilation:
Action of breathing with muscles and lungs
Gas exchange:
Between air and capillaries in the lungs.
Between systemic capillaries and tissues of
the body
02 utilization:
Cellular respiration in mitochondria
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Functions of the Respiratory System
Gas Exchange
O2, CO2
Acid-base balance
CO2 +H2O←→ H2CO3 ←→ H+ + HCO3-
Phonation
Pulmonary defense
Pulmonary metabolism and handling of
bioactive materials
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Inspiratory Movements
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Thoracic Cavity
Diaphragm:
Sheets of striated muscle divides anterior body cavity
into 2 parts.
11
Mechanics of breathing
Gas: the more volume, the less pressure (Boyle’s)
Inspiration:
lung volume increases ->
12
Mechanics of breathing
Intrapleural space:
“Space” between visceral & parietal pleurae.
Visceral and parietal pleurae (membranes) are
flush against each other.
Lungs normally remain in contact with the chest
wall.
Lungs expand and contract along with the
thoracic cavity.
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Pleural Layers – Cross Section
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Mechanics of breathing
Compliance:
This the ability of the lungs to stretch during
inspiration
lungs can stretch when under tension.
Elasticity:
It is the ability of the lungs to recoil to their
original collapsed shape during expiration
Elastin in the lungs helps recoil
15
Inspiration
Inspiration – Active process
Diaphragm contracts -> increased thoracic
volume vertically.
Intercostals contract, expanding rib cage ->
increased thoracic volume laterally.
More volume -> lowered pressure -> air in.
Negative pressure breathing
16
Expiration
Expiration – Passive
Due to recoil of elastic lungs.
Less volume -> pressure within alveoli is just
above atmospheric pressure -> air leaves
lungs.
Note: Residual volume of air is always left
behind, so alveoli do not collapse.
17
Mechanics of breathing
18
Dynamics of Respiration
19
The Pressures
20
X-Ray of Chest
21
Respiration
It is the process by which the body takes in
oxygen and utilizes and removes CO2 from the
tissues into the expired air
It comprises of
Ventilation by the lungs
inspiration and expiration
Gas exchange across alveolar membrane
Diffusion in the alveoli, Fick’s law
Transport of gases by blood (haemoglobin)
Uptake of O2 and release of CO2 by tissues
Diffusion at the cellular level
22
Conducting Zone
Conducting zone:
Includes all the
structures that air
passes through
before reaching the
respiratory zone.
Mouth, nose, pharynx,
glottis, larynx, trachea,
bronchi.
23
Conducting Zone
Conducting zone
Warms and humidifies until inspired air
becomes:
37 degrees
Saturated with water vapor
Filters and cleans:
Mucus secreted to trap particles
Mucus/particles moved by cilia to be
expectorated.
24
Conducting Airways
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Conducting Zone
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Respiratory Zone
Respiratory zone
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Respiratory Zone
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Respiratory Zone
Air duct
Air Sac
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Respiratory Zone
Alveoli
Air sacs
Honeycomb-like clusters
~ 300 million.
Large surface area (60–80 m2).
Each alveolus: only 1 thin cell layer.
Total air barrier is 2 cells across (2 mm)
(alveolar cell and capillary endothelial cell).
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Respiratory Zone
Alveolar cells
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Branching of Airways
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Branching of Airways
33
Branching of Airways
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Branching of Airways
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Respiratory Zone
Respiratory Zone : Respiratory bronchioles,
Alveoli (300 million), Alveolar ducts, Alveolar sacs
Gas Exchange : respiratory membrane
37
Respiratory Zone
38
Ventilation
Mechanical process that
moves air in and out of
the lungs. Insert 16.1
Diffusion of…
O2: air to blood.
C02: blood to air.
Rapid:
large surface area
small diffusion
distance.
39
Bronchial Section - microscopic
40
Higher magnification of Bronchus
41
Terminal Bronchioles - bifurcation
42
Alveoli under microscope
43
Alveoli - higher magnification
44
EM of the alveoli
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Alveoli
46
Cross Section of Alveolus
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Section of Bronchus - schematic
49
The large surface area of alveoli
50
Bronchoscopy
51
Blood Vessels of the Lung
Pulmonary Artery:
Deoxygenated (venous) cardiac output.
Pulmonary capillaries
extremely dense
underground parking garage
Pulmonary Veins:
Oxygenated (arterial) cardiac output.
52
Alveolar capillary interface
53
Alveolar capillary interface - schematic
54
Alveolar capillary interface
55
Surface tension
Surfactant
produced by alveolar type II cells.
Interspersed among water molecules.
Lowers surface tension.
RDS, respiratory distress syndrome, in
preemies.
First breath: big effort to inflate lungs!
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Surface tension
57
Pulmonary Function
Spirometry
Breathe into a closed system, with air, water,
moveable bell
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Lung Volumes
59
Lung Volumes
Tidal volume (TV): in/out with quiet breath (500 ml)
60
Lung Volumes
Inspiratory reserve volume (IRV): extra
(beyond TV) in with forced inspiration.
61
Lung Capacities
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Pulmonary disorders
Restrictive disorder:
Vital
capacity is reduced.
Less air in lungs.
Obstructive disorder:
Rate of expiration is reduced.
Lungs are “fine,” but bronchi are
obstructed.
63
Disorders
Air/ Fluid in the pleural space
Pneumothorax
Hydrothorax
Pyothorax
Hydropneumothorax
Restrictive disorder:
Black lung from coal mines.
Pulmonary fibrosis: Tuberculosis
too much connective tissue.
64
Pneumothorax – collapse lung
65
Obstructive Sleep Apnea
OSA
Normal
66
Pulmonary Disorders
67
Disorders
Asthma:
Obstructive
Inflammation, mucus secretion, bronchial
constriction.
Provoked by: allergic, exercise, cold and
dry air
Anti-inflammatories, including inhaled
epenephrine (specific for non-heart
adrenergic receptors), anti-leukotrienes,
anti-histamines.
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Disorders
Emphysema:
Alveolar tissue is destroyed.
Chronic progressive condition
Cigarette smoking stimulates
macrophages and WBC to secrete
enzymes which digest proteins.
Or: genetic inability to stop trypsin
(which digests proteins).
69
Blood Gases
Barometers use mercury (Hg) as convenience to
measure total atmospheric pressure.
Sea level: 760 mm Hg (torr)
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Blood Gases
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Blood Gases
72
Blood Gases
But inside you, the air is saturated with water
vapor.
PH 0 = 47 mm Hg at 37 degrees
2
So, inside you, there is less P02:
P02 = 105 mm Hg in alveoli.
In constrast, alveolar air is enriched in
CO2, as compared to inspired air.
PCO = 40 mm Hg in alveoli.
2
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Blood Gases
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Blood Gases
75
Blood Gases
O2 electrodes can measure dissolved O2 in
a fluid. (also CO2 electrodes)
Good index of lung function.
Arterial P0 is only slightly below alveolar P0
2 2
Arterial P0 = 100 mm Hg
2
Alveolar P0 = 105 mm Hg
2
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Ventilation – Perfusion Matching
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System Overview
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Circulation Overview
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Ventilation and Perfusion
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Perfusion
Geometry of vascular tree
R = ŋ/r4
Passive factors affecting PVR
PA pressure
LA pressure
effect of lung volume on PVR
Local factors regulating Q and matching V/Q
HPV
pH/pCO2
83
Capillary Sheet
84
Capillary Recruitment
Normal
Recruitment Dilatation
85
Tissue Respiration
87
Blood gases
Most O2 is in hemoglobin
0.3 ml dissolved in plasma +
19.7 ml in hemoglobin
20 ml O2 in 100 ml blood!
But: O2 in hemoglobin-> dissolved ->
tissues.
Breathing pure O2 increases only the
dissolved portion.
- insignificant effect on total O2
- increased O2 delivery to tissues
88
Pulmonary Circulation
89
Neural control
Respiratory centers
In hindbrain
- medulla oblongata
- pons
Automatic breathing
90
Neural control
I neurons = inspiration
E neurons = expiration
I neurons -> spinal motor neurons ->
respiratory muscles.
E neurons inhibit I neurons.
91
Neural control
Also
voluntary breathing controlled by the
cerebral cortex.
92
Chemoreceptors
Oxygen: large “reservoir” attached to
hemoglobin.
So chemoreceptors are more sensitive to
changes in PC0 (as sensed through changes
2
in pH).
Ventilation is adjusted to maintain arterial
PC02 of 40 mm Hg.
Chemoreceptors are located throughout the
body (in brain and arteries).
93
Chemoreceptors (CTZ)
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Hemoglobin
Each hemoglobin has 4 polypeptide chains
(2 alpha, 2 beta) and 4 hemes (colored
pigments).
In the center of each heme group is 1 atom
of iron that can combine with 1 molecule 02.
(so there are four 02 molecules per
hemoglobin molecule.)
280 million hemoglobin molecules per RBC!
95
Hemoglobin
96
Hemoglobin
Oxyhemoglobin:
Ferrous iron (Fe2+) plus 02.
Deoxyhemoglobin:
Still ferrous iron (reduced).
No 02.
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Hemoglobin
Carboxyhemoglobin:
Carbon monoxide (CO) binds to heme
instead of 02
Smokers
98
Hemoglobin
Loading:
Load 02 into the RBC.
Deoxyhemoglobin plus 02 -> Oxyhemoglobin.
Unloading:
Unload 02 into the tissues.
Oxyhemoglobin -> deoxyhemoglobin plus 02.
99
Hemoglobin
Loading/unloading depends on:
P02
Affinity between hemoglobin and 02
pH
temperature
100
Hemoglobin
Dissociation curve: % oxyhemoglobin saturation
at different values of P0 . 2
Sigmoidal
At low P0 small changes produce large
2
101
Oxyhemoglobin Dissociation Curve
Insert fig.16.34
102
Hemoglobin
103
Hemoglobin
Arteries: 97% saturated (i.e. oxyhemoglobin)
Veins: 75% saturated.
Arteries: 20 ml 02 /100 ml blood.
Veins: ~ 5 ml less
Only 22% was unloaded!
Reservoir of oxygen in case:
don’t breathe for ~5 min
exercise (can unload up to 80%!)
104
Hemoglobin
105
Hemoglobin
Anemia:
Hemoglobin below normal.
Polycythemia
Hemoglobin above normal.
Altitude adjustment.
106
Disorders
Sickle-cell anemia:
fragile, inflexible RBC
inherited change: one base pair in DNA -> one
aa in beta chains
hemoglobin S
protects vs. malaria; african-americans
Thalassemia:
defects in hemoglobin
type of anemia
107
RBC
RBC
no nucleus
no mitochondria
108
C02 Transport
C02 transported in the blood:
- most as bicarbonate ion (HC03-)
- dissolved C02
- C02 attached to hemoglobin
(Carbaminohemoglobin)
109
C02 Transport
C
• arbonic anhydrase in RBC promotes
CA
H20 + C02 <- H2C03 <- HC03-
low PC0 2
110
C02 Transport
Chloride shift:
Chloride ions help maintain electroneutrality.
HC03- from RBC diffuses out into plasma.
RBC becomes more +.
Cl- attracted in (Cl- shift).
H+ released buffered by combining with
deoxyhemoglobin.
Reverse in pulmonary capillaries
111
Acid-Base Balance
Alkalosis: pH up
Acidosis: pH down
112
Acid-Base Balance
Hypoventilation:
PC0 rises, pH falls (acidosis).
2
Hyperventilation:
PC0 falls, pH rises (alkalosis).
2
113
Acid-Base Balance
114
Acid-Base Balance
115
Other Functions of the Respiratory System
116
Other Functions: cont
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