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Transcribed by Leslie Afable

March 27, 2014

Organ Systems Lecture 15 Structure and Function of the Respiratory System by Dr. Evgeny Pavlov Slide 1 Structure and Function of the Respiratory System Dr. Schiff ..Dr. Pavlov who has come here under great hardship by the way, all the snow that was supposed to hit us yesterday that didnt and missed the city completely, its where he is coming from which is Halifax, Nova Scotia. So hes joining the department. So Dr. Pavlov will be going over respiration physiology and a week later, digestion and liver so you will be seeing a lot of him. Have fun. Dr. Evgeny Pavlov Alright thanks. Yes, Im not sure, should we wait a few minutes because he mentioned a lab or something right? That people will be coming? People in the back, can you hear me well? Is it better? Ok. Yeah, I will try to speak louder anyway. Its tricky, because 2 hours in a row Im not really used to that like a lecture in the morning and then now again (mumbles). Pretty exhausting but I guess I will have to get used to it. So this is our first lecture in the respiratory physiology course and so today like the first lecture will be kind of an overview of the general features of structure and function of the respiratory system. Slide 2 Respiratory System (Function) Lectures Dr. Evgeny Pavlov It will be one of the five lectures which we will have for the physiology part and so like I said, the first one is an overview which will be now and the second will be a more in depth look at the mechanics of breathing. So basically reviewing the forces which underlie the movement of the lungs. The third one will be a lecture about gas exchange, how gas gets in and out of the organism. The fourth will be control of breathing, about neuronal control of respiration. The last one will be kind of a review session, we will talk again about different parts of respiration. Context of stress or some kind of disease, we will review some examples for that. Slide 3 Textbooks Dr. Evgeny Pavlov So the textbooks, so pretty much I tried to make these lectures, you know, kind of follow, more or less, at least for the first four lectures. For the first four lectures they will be following more or less the main textbook that Johnson.. ..like part 3 for respiratory physiology. And there are some parts, especially for the 5th lecture there will be some issues like taken from Guyton and Hall like in terms of you know, disease and stress conditions for respiration. Slide 4 Additional Reading (Watching) Dr. Evgeny Pavlov And I also would recommend like for those, like I know you have little time, but for those who are curious it is very nice additional reading which is John West Respiratory Physiology. You dont need that for exams but I guess its really interesting in a way, like it really explains everything really nicely and it also has on the YouTube you can find lectures for you know, all the parts and its a really clear nice explanation for the respiratory physiology. Its pretty much classics of the field except its like 14 hour lectures so I guess its a bit hard but you dont have to do everything but if you have some questions you might look it up and have nice 1

Transcribed by Leslie Afable

March 27, 2014

clear explanation for different issues. But obviously you are welcome to contact me if you need. Slide 5 Objective: Describe the mechanics and structure/function relationship in breathing Dr. Evgeny Pavlov So again going for todays lecture, for the first one, what we will be doing is like general. Describe the mechanics and structure and function relationship in breathing. So first well look at some physical principles which kind of produce and which are responsible for the movement of air in and out of the lungs and specifically in and out of alveoli. Then we will look at the function of the epithelial lining and cilia in the airway systems. Look a little bit into the anatomy of alveoli in the context of physiology and gas exchange. Then we will look, you know the respiratory system, and we will look at how it looks in respect to diffusion of gases in lungs and tissues. And again, look at the conducting airway system and look at pulmonary circulation. Again, its all like it pretty much covers everything except neuronal control but we will speak a little bit for each so were not really going in depth like on the second, third, fourth lecture we will do more with more details. Slide 6 Function of the Respiratory System Dr. Evgeny Pavlov So first lets kind of mention a few important things, so first the function of the respiratory system. It is a, you know, I guess its pretty self evident that the primary function is to provide the body with oxygen and remove carbon dioxide. So this is the essence of the respiratory system and this is essentially what we will be talking about like most of the time. So we will not go into any other roles but they do exist and I guess I will just kind of mention them here. They are all kind of related to this gas delivery primary role but in different ways. So it is also, in addition to this primary role, it plays a role of a FILTER SYSTEM which is it protects the lungs and the body from different contaminations like gas and particles so essentially like a physical filter. So it also works as an immune defense system, again breathing in the air is like a very big stress because you know it comes with all this pollutants and bacteria and everything so it needs to have a very strong immune system in the respiratory system to protect against that. There is another system which is the metabolic system, I will mention it at the end of this lecture, a little bit about like different synthesis which occurs and the signaling role which is played by the respiratory system in terms and in respect to blood circulation. And one of the other roles would be vocalization. So again, formally it belongs to.. Uh.. again we will not be looking at it carefully but it does belong to one of the functions of the respiratory system that in order to speak, we need to move air in and out and this is one of the roles which again, it is not primary and we will not go in to review it in any more details. Slide 7 Why Do We Need Oxygen? Dr. Evgeny Pavlov Before we go to the topic of the lectures about the gas transport, what we kind of need to mention, I just want to clarify like why do we need oxygen? Right? Its kind of.. Again, I assume its pretty clear but I just want to repeat it in a somewhat simple way. So why do we need oxygen? So when I look at it the simplest 2

Transcribed by Leslie Afable

March 27, 2014

way to introduce it would be the burning of the carbon fuel to produce heat, for example. Like here is the very simple reaction describing like how heat is produced from methane, right? From the gas. So here you would see you need carbon fuel, you need oxygen, and you produce CO2 and water. This is like a very simple reaction essentially but it describes very well why we need oxygen. Slide 8 Cellular Energy Metabolism Dr. Evgeny Pavlov So essentially exactly the same thing. So this is energy production, like heat in burning methane. And this is pretty much the same energy production burning glucose, which is also carbon. Its a little bit complicated but essentially theyre like similar types of molecules so burning glucose and consuming oxygen and producing energy, not in the form of heat but in the form of ATP. But if you look at the end equation, its like essentially the same right? So pretty much you have carbon and you need oxygen to make it useful. So pretty much here its way more complicated and you dont need to know all these pathways, you probably had them somewhere in a biochemistry course or you will have. But for the purpose of todays lecture, its important to understand that essentially you need oxygen in order to make ATP. So oxygen is NOT a source of food because here glucose is a source of food, right? But to burn glucose you need oxygen. One of the key concepts here which I kind of STRESS in why the respiratory system that is important is that our organs dont have a place to store ATP. So pretty much we cannot really have any source of ATP. What we can store is glucose and it kind of immediately goes through burning into ATP and use. And what this means is that it actually.. ..oxygen needs to be present in the organism all the time. Its a REAL-TIME PROCESS, like we cannot store oxygen anywhere and we cannot store ATP. This is kind of important to understand for the physiology of the respiratory system that it is like it really needs to be perfectly timed in terms of transport of the gases in like you know, all these processes which occur. And this essentially, I just want to make clear because like we do really need oxygen like immediately. For example, imagine this is a heart cell which needs to beat all the time otherwise the heart will stop and you cut off oxygen like within couple of minutes thats what happens. So you really dont have a luxury to be like without oxygen. The respiratory system provides that, not just access of oxygen but very good timing for that. Bringing this in and taking this out. If this is in anyway messed up, its really big trouble almost immediately. Slide 9 Respiratory System: Overview Dr. Evgeny Pavlov So again, to overview, this is a simple cartoon which summarizes kind of the whole thing which we will be talking about. And there are like a few steps which occur. So the whole purpose of the system is to bring oxygen from the environment which is outside here, through the lungs, to blood, and to the cells where they can be consumed as I just described, right? Where we use oxygen and release Co2. And there are like 3 kinds of steps which we will talk about separately. Which are.. ..the first is gas exchange between lungs and the environment. So like breathing in air into the lungs. So this is the model for the lungs. This process is called ventilation so its the work of the lungs. The second step is here, the gas exchange between the lung and blood here, so after oxygen gets in it needs to be 3

Transcribed by Leslie Afable

March 27, 2014

getting into the blood and this is a simple diffusion mechanism and it can get in. Then the third one is gas transport from the lungs to the organs and back and this is the third process which is provided by pulmonary circulation. Slide 10 Respiratory System: Ventilation Dr. Evgeny Pavlov So going to the first one is ventilation which is like you know, its fairly straight forward. Slide 11 Gas Exchange Between Lungs and the Environment Dr. Evgeny Pavlov Pretty much ventilation is getting air in and out and this is the simple model for the lung. Its really very intuitive so pretty much the bigger the lungs, air goes in, you kind of expend the lungs and you let air in. You contract the lung, air goes out. But I just want to put like some equation which is like very simple and it describes the process in more kind of a scientific way if you wish. So basically the key, the ideal gas equation, which says that if you have some compartment the pressure of the gas in this compartment multiplied by volume of this compartment equals like this nRT, so pretty much its proportional to the temperature. Dont worry about this gas constant here. So pretty much when its applied to the lungs what happens is that if you can see that this is pressure, this is the volume of the lungs, and this is pressure, since temperature is the body temperature, so it means that this relationship is actually always constant in the lungs. Now you can kind of see how simple physics applies here that you could, pretty much you would have lungs and you always have pressure outside as BAROMETRIC PRESSURE. As you breathe in, you increase the volume and this thing drops so pressure gets less than barometric, it gets in and the opposite is true because you kind of squeeze the lungs and pressure goes up and it goes in. So its really a very simple breathing described in a simple equation. Slide 12 Mechanics of the Lung: Lung Volumes and Capacities Dr. Evgeny Pavlov Essentially all these changes in the lung, they define all these kinds of ways lungs function. This is just a summary of different volumes which lungs can take. All these different volumes describe certain conditions of how lungs would behave. Like all these have different definitions. Ill just mention for example, this TLC (total lung capacity), this is the whole lung volume and it can be kind of split into RV (residual volume) and you know kind of VC (vital capacity). This is, out of the big volume, this is how much we can physically use (VC), and there is always like this small volume which stays (RV). Pretty much this is the difference for this vital capacity, it is between breathing in and full breathing out and there are still some. One of the key volumes here, like please remember, all of them are kind of very easy to remember because they are all kind of recorded in these words right? But one of the very important ones is TIDAL VOLUME, so this is what happens in normal breathing. So when we just kind of rest and dont do anything, so thats how much of the lung capacity we use so pretty much this is the normal breath. You can kind of appreciate how much our lungs have of the reserve. So pretty much thats how much we normally breathe with every breath. So this going up and down here 4

Transcribed by Leslie Afable

March 27, 2014

is every breath here, and here is like pretty much the total. So we can increase our lung breathing like kind of dramatically. Slide 13 Measuring Lung Volumes: Spirometer Dr. Evgeny Pavlov This is how this all can be measured. Like a simple machine called a SPIROMETER can measure most of these parameters and Ill just mention the tidal volume for example. So what would happen here, the person has a mouthpiece and its connected to, you know, to the chart recorder essentially through this system. When you have this closed chamber and when you breathe in and out it kind of lifts up and down and kind of draws this line here. So essentially in real-time with proper calibration, you can tell what this volume is just by looking at this recorder and this would be the tidal volume the person is breathing in. You have this thing, and obviously you can record a lot of volumes as well by just using this simple machine. Except certain, like you know this residual volume you cant really measure but we wont go into that how it will be done. So its not very tricky but just dont have time. Slide 14 Typical Volumes and Flow Rates of the Lungs Dr. Evgeny Pavlov So, uhh.. Also like some typical volumes I just want to point out and some important characteristics of the lungs in terms of different compartments. So it has few things so alveolar gas, this is the useful volume of the lung which in a normal person is about like 3000 ml. Then there is also the volume which is called anatomic dead space which is the volume of the airway for the lungs, again this is a very important parameter as well as we will see in lecture 3. Also important, like other important numbers I guess to know is tidal volume and again this is the typical volume of the air which we would breathe every time like with every breath. Again, its much less the total volume. So normally we would replace very little of the air. Then we would have the blood volume which is about 70 ml and this also can be translated into RATE. So pretty much these are the single volumes but pretty much thats how much you move the stuff. If you imagine this is frequency of the number of breaths you take, pretty much if every single breath you take is 50 mls then multiply that by the normal rate it would be like the rate of ventilation. So this is the volume and this is the rate, so pretty much, and they also are easily translated by using the frequency of breath into rate of total ventilation which is moving total air in and out and alveolar ventilation. So again, useful parameters. And so, well talk about them dont worry at the moment. Slide 15 Abbreviations and Symbols for Pulmonary Function Dr. Evgeny Pavlov As I said, the first lecture is an introduction so Im just trying to go through definitions and things like that. And theres also these abbreviations and symbols, so look at the TEXTBOOK for example. They are more or less, the same in every textbooks but its also nice if you get familiar here. They are very simple so pretty much youve seen all these different volumes already. But then its also like Pvalue. So P stands for PRESSURE and all these kinds of pressures you see. Then V stands for different VOLUMES. V-dot stands for RATES OF VENTILATION. For example, like you have volume and you multiply it by number of breaths, you get the 5

Transcribed by Leslie Afable

March 27, 2014

rate of air movement, so this would reflect V-dot and you know. Its also like the location so it would be you know like alveolar or arterial so these are capital or small letters and you know, specifically for certain gas so all these types of things. So like I said, look it up but its not too much to explain actually. I guess I will just give you a couple of examples again this is (UNCLEAR WORD), if you want to get the ventilation rate of the total expired area just multiply the volume by the frequency and then you get this V-dot. Then also like one of non-trivial things I guess is the partial pressure of the gas. If you can see there is a lot of P like P-oxygen, P-Co2, so all these things are actually partial pressures and how the partial pressures of the gas differs from total pressure of the gas is the following. So pretty much you would have for example, the total pressure, if this is atmospheric and you want to define out of this mix what would be the pressure of for ex, oxygen? So what you need to do is you need to use this equation. So if you have 25% of oxygen, then pretty much the pressure of the partial pressures of oxygen would be of the total pressure of the gas. Lets say we had some lower pressure, like for simplicity sake, 25% oxygen with 600mm Hg would give you 150 mm Hg of partial pressure of oxygen, right? So like if total pressure was 600. Something like that. So this is partial pressure of the gas, ok? Slide 16 Airflow between Alveoli and the Environment Dr. Evgeny Pavlov So now like airflow, so we will discuss like when you have to get air from outside you know into the lungs, into alveoli, and this is provided by you know, the airways, and they split into upper airways and lower airways. I guess you had your anatomy part so you know this part pretty well so I will just mention a couple of things with relation to the role in physiology for that. Slide 17 Upper Airways Dr. Evgeny Pavlov So probably for upper airways, again they play a filter function and things like that but I guess the most important in terms of physiology is that they actually condition.. ..the upper airways condition air so they humidify and warm it up before it reaches the lungs. And this is important because we do need air to be like roughly you know, body temperature and we want it to be humidified so we want it to be saturated with water and all these conditions are happening in the upper airways and this is a fairly important part of the respiratory system. Slide 18 Lower Airways Dr. Evgeny Pavlov Then in terms of lower airways, they consist of the trachea and get split into these branches and end up with alveoli. But again, in terms of function, one of the important things which we need to consider here is that these airways.. Obviously they are tubes so they provide flow through for the air but actually they are very important for defense as well because they are covered with this mucus layer so they are not really kind of just walls. So they have this layer which traps a lot of stuff like it can trap bacteria and different particles and then after they are trapped, it gets moved through these cilia cells so they spin in such a way that it gets moved back to the throat and up so it can be spit up or swallowed and in this way the airways kind of help to clean the lungs and to protect them from all the pollutants so this is a very important defensive function for the lower airway 6

Transcribed by Leslie Afable system.

March 27, 2014

Slide 19 Key Points (Ventilation) Dr. Evgeny Pavlov So these are key points for the ventilation, for the first part. So we can see what happens. Use the ideal gas law to explain how pressures are changed with the volume of the lungs and pretty much this is constant so pretty much with an increase in volume you have a drop in pressure and the opposite. So working lungs can be characterized by different volumes which kind of follow out of the first equation. Then the airways system, which is highly branched and there are a couple of things which we will discuss in more detail but at this point I will just mention that with branching you not only get more and more tubes, you actually increase.. ..each tube gets smaller and smaller in size but the cross section of the total area is increased with the number of branches. So its kind of like they really spread out and they become much bigger and it will be important in the second lecture where I explain the resistance of the airway system. One of the kinds of other roles of the airway system is not just to deliver oxygen but also to defend lungs. You know, just because of the cross section area increases so actually the resistance of the airway system, which we will discuss in more detail, it actually drops dramatically if you look at the more branching of this system. Slide 20 Respiratory System: Diffusion Dr. Evgeny Pavlov Second step, so after we discuss ventilation, air getting in and out.. ..so second step what needs to happen after oxygen is being delivered into the lungs, it needs to get into the blood right? This is the passive process of gas exchange between lungs and blood. The whole process is called DIFFUSION. Slide 21 Law of Gas Diffusion & Henrys Law Dr. Evgeny Pavlov Before we talk about specifically the lungs, I just want to mention one law which is kind of the key law which guides the diffusion of the gas across the barrier. So pretty much its like any barrier, it doesnt need to be a barrier between alveoli and of blood, but for any barrier so pretty much the rate of gas diffusion is proportional to the pressure difference between different sides of the barrier, and then its also directly proportional to the surface area and inversely proportional to the thickness. Dont worry about D we will not go into that. Whats important here, actually are a couple of things. This is a very simple law, it just tells you what the relationship is. But its like very intuitive. So the bigger the area, the faster will be the transfer rate and the same as the thickness. The thinner it is, the better it goes through. But the only thing which kind of is important for our respiratory physiology is that when we talked about a pressure difference on different sides, this is for general law right? But in the case of this place here (REFERS BACK TO PREVIOUS SLIDE 20 ENTITLED RESPIRATORY SYSTEM: DIFFUSION). So we would have lungs which would be air and you would have blood which is actually liquid. (REFERS BACK TO THIS CURRENT SLIDE) and this is important because you cannot have a pressure of the gas in liquid because pressure is the property of the gas, whereas liquid is a different state of matter. So this equation will not make sense unless you use the Henrys law. 7

Transcribed by Leslie Afable

March 27, 2014

Slide 22 Henrys Law Dr. Evgeny Pavlov Pretty much what Henrys law does is that it establishes.. So pretty much in liquid for example take oxygen, it cannot be an oxygen pressure in liquid, it can only be concentration of the oxygen molecule dissolved in blood, right? So this is C, but actually it is directly proportional to the pressure of the gas on the surface of the liquid. So its a pretty important notion, its a straight forward equation but it like really explains how physiology is described because a lot of physiology is described in terms of pressure of the gas in the blood for example. It doesnt really make sense unless you realize that actually when they talk about pressure, they are just talking about that, so really they talk about concentration right? But I will give you a few examples a little bit later. But for now if you take this into account, it becomes possible to use. So pretty much (goes back to slide: law of gas diffusion and henrys law) this pressure here is actual concentration but its directly proportional to the pressure we are talking about. Slide 23 Terminal Bronchiole & Alveolus Dr. Evgeny Pavlov Like now well talk about the structure, so pretty much like the first 2 things, like the surface area. So how does surface area get big? It gets big because of this gigantic branching. So you have a bunch of branching, it starts with the trachea and then there are like 24 steps like multiplying, so its 10 to the power of.. .you know, 2 to the power of 24 actually in the end. So its a really large number of alveoli and each of them is kind of a small ball. So combine surface area of the lungs actually is really the size of 50 square meters on average. So its like the size of you know, its a pretty dramatic size, so its like 100 square meters. So its like a really big surface area just because of the many branches. Each of them have this alveoli at the end. So pretty much this end here corresponds to this alveoli and you have like really many, many millions of those in the body. Slide 24 Alveoli & Capillary Network Dr. Evgeny Pavlov Like how does it happen? So pretty much now you would need to have a diffusion so you would have all this alveoli which have a gigantic surface area and they are all surrounded by blood vessels and pretty much, these 2 things together provide a really big surface area and they like to fulfill this equation to speed up the rate of diffusion of the gas from alveoli to the blood. Slide 25 Alveoli & Capillary Network Dr. Evgeny Pavlov There is a second step so pretty much this kind of shows the relationship. So its like a similar picture except this is a real kind of image. So you would have all these alveoli cross sectioned. So this is like a thin section of the alveoli and then you can see that all these bubbles here are individual alveolis and you can see here how they all are connected really closely to the network of capillaries. So all the dots here are capillaries. Slide 26 Alveolar Destruction in Emphysema Dr. Evgeny Pavlov This is kind of an example of the importance of the surface area. 8

Transcribed by Leslie Afable

March 27, 2014

For example, if alveoli are destructed by emphysema, you can see that actually alveoli get much bigger but the surface area.. ..although they are bigger.. ..so you would have much more gas inside the lungs so you would have much more oxygen because the volume gets bigger, right? But since the surface area gets much smaller, because its all fused (?), then you get much worse gas exchange. In this case, despite the large amount of gas inside of the lungs, you cant really get good oxygenation of the tissue and its like a really big problem. Slide 27 Alveoli and Capillary Junction Dr. Evgeny Pavlov Until seconds or so we discussed the surface area, so the second critical parameter is the thickness of the barrier. So it needs to be very thin and this is another important feature of the alveoli and the capillaries of the blood that actually the distance between alveoli, which is like outside here and the capillary here which is inside here, is like really, really thin and its kind of provided by a very unique anatomical structure which you probably discussed in some detail in anatomy. But you can see here that this is the capillary wall, it has like 2 cells, epithelial and endothelial. And you can see these cells that are kind of very funny shaped with a cell body and nuclei and you have this very long kind of membrane which kind of encloses the whole capillary for one cell. And the same, it goes for endothelial, so you would have also the cell body and membrane going out. So these 2 membranes, they are really like all together they make it like really thin. So this is a zoomed in area of the so this is blood, so this is plasma and erythrocyte and you can see how close they are. So pretty much they can diffuse less than a micron of surface area for air for oxygen or for co2 to diffuse in and out. Thats how its provided, like very kind of thin barrier. So all together you would see the surface area the size of the tennis court and thickness less than 1 micron. So combine them together they make this phenomenally efficient system for gas diffusion and this essentially underlies the kind of nature of the this very well working process of gas exchange. Slide 28 Fast Oxygen Exchange Between Blood & Alveoli Dr. Evgeny Pavlov Here I will give you one example of how efficient it is. We will talk some more in the third lecture about it but here it is like the efficiency of the system you can see how it happens in terms of.. Heres an example for oxygen so you would have this as a capillary. So pretty much blood like comes, after oxygen is used up it comes to the lungs here so you can see PO2 is 40 mm Hg, again, this is as I mentioned this equation here, uses Henrys law so you would actually talk about concentration of the oxygen here actually, but for the simplicity of presentation and its much easier to understand if you just replace it with partial pressure. So just to relate to whats happening in the alveoli. So anyway, it arrives here and its much less partial pressure for oxygen compared to alveoli partial pressure. So then immediately what you start is you start the process of diffusion. Since concentration of oxygen is much higher in alveoli you would have it in equilibrium in such a way that in the end it equilibrates to, to uh.. So it kind of matches(?) right, so this enriched blood, like blood enriched with oxygen it goes back into the system and comes back again, gets a new batch of oxygen. 9

Transcribed by Leslie Afable

March 27, 2014

I guess one of the things to comment here, which I think its a pretty straight forward slide, but one of the things to comment is that actually there is a lot of spare capacity for this diffusion process. Its so efficient that actually as you can see, blood gets equilibrated at the very beginning of the blood travel across the contact area. So pretty much it gets here with no oxygen or very low oxygen and then like it moves only of the length and its already good to go. This is another feature, because lungs they really, as I mentioned.. ...so we need to really have oxygen. So when lungs have a lot of this spare system, like this you know, back up system as we talked about tidal volume or in this case about efficiency in diffusion, that actually you would have a lot of spare capacity for the diffusion to occur. Pretty much like of it is not really used. So a very efficient system. Slide 29 Key Points (Diffusion) Dr. Evgeny Pavlov So anyways, key points for diffusion. So we talked about the law of diffusion so its like directly proportional. Like the diffusion rate is directly proportional to the surface area and inversely proportional to the thickness of the barrier. The area is very large and the walls are very thin to again, fulfill this requirement for efficient diffusion. Another thing is Henrys law which says the relationship between gas partial pressure and the concentration of the molecule dissolved in the liquid and says that actually that these are very equivalent things just linked by a constant, and thats why just based on the Henrys law and respiratory physiology gauges, are usually described in units of pressure. So pretty much the diffusion is directly proportional to differences in pressure between alveolar gas and the blood. So its pretty much all I guess, fairly simple. Slide 30 Respiratory System: Circulation Dr. Evgeny Pavlov Yeah, and so just move into the last subject of the first lecture. So pretty much after we fulfill these requirements after we have gas getting in diffused so it gets into the blood and then it needs to be transported down to the cells and then likewise after co2 is produced it needs to be carried back. So this will be the whole lecture in like lecture 3 about the circulation system. So this process is like obviously it is fulfilled by blood so its like circular so its like the pulmonary circulation system. But well talk much more about this but here we will just mention like few key features which kind of distinguish pulmonary circulation which are important to kind of realize. Slide 31 Typical Volumes and Flows of the Lungs Dr. Evgeny Pavlov So first are the FLOW RATES. So pretty much one of the important parameters for the circulatory system is how fast the blood is passed and pretty much one of the important things here is not the absolute values of these rates. For the rate of how air is exchanged, so essentially how (mumbled) ventilation tells you, like the amount of oxygen which has been delivered to the lungs and this kind of needs to be matched with the amount of blood flow through the vessels because you would like to deliver oxygen and pretty much if these 2 things are mismatched, it creates a problem because you kind of can deliver more 10

Transcribed by Leslie Afable

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oxygen than you can take by blood so the opposite can be true. This again we will talk about in lecture 3, but for here just know that this ratio between ventilation like delivering air here, and blood flow which is in millimeters per minute. So this is essentially pumping the liquid and this is pumping the air but they are like roughly matched again. The reason for that is just because we need to have this constant delivery which needs to be very much synchronized. Slide 32 Pulmonary and Systemic Circulations Dr. Evgeny Pavlov The second important feature which is distinct for the pulmonary respiratory system, so just comparing to.. So this is kind of the whole cycle. So you have systemic circulation on the right and then pulmonary on the left. You can see here that its kind of.. uhh.. blood after getting through systemic tissues, when it gets to the lungs its kind of uhh received.. So all blood has to go through the lungs which is put simple right? Lungs receive complete cardiac output unlike systemic circulation because systemic circulation goes to different organs. But here, and this also, I think its very self evident because you need all blood to rebuild its oxygen content so really it all needs to go through pulmonary circulation which is quite distinct from systemic which as I said goes into different places. Then another important feature is the difference in pressures for these 2. As you can see, like the pumping pressure for pulmonary circulation is much lower compared to the pressure in systemic circulation and there are a couple of explanations for that so first you dont really need to pump blood too far like in the lungs they are roughly on the same level compared to the heart. Second, its very important because when we discussed the gas diffusion exchange, these capillaries where blood goes through and where diffusion occurs are very thin so which means that actually they are not very strong in terms of holding the pressure. They kind of can expand and contract really easily and for that reason, this pressure cannot be really high because if this happens, it can just damage the capillary. So it is really a distinct feature for the pulmonary compared to systemic circulation. Slide 33 Metabolic Function of the Lungs Dr. Evgeny Pavlov One of the.. In the concept of blood circulation, so as I mentioned, we will talk about blood carrying oxygen in later lectures but for today just to complete for the non-respiratory functions of the lung, I just mentioned one which is the metabolic system which is provided by circulation so it should rather be the metabolic function of the respiratory system rather than lungs here (title of slide). But anyway, I will just give you one example. So this is like blood.. Cells in the blood are really good participants in signaling and in signaling metabolism because since all blood flows through the lungs, they are perfectly positioned to change the amount of certain components in the lungs. I will not go through all of them, I guess what you could do is.. Well you dont have to know actually any of those. I will just give you one example, ANGIOTENSIN which is responsible for maintaining the tone of the vessel, so you can see that actually although it can be converted from I to II by specific enzyme ANGIOTENSIN CONVERTING ENZYME, this all can be happening in the lungs and since all blood goes through the lungs, this process is very efficient so 11

Transcribed by Leslie Afable

March 27, 2014

it can do it really quickly and this is one of the reasons like how lungs.. No sorry not lungs but how pulmonary circulation, how they kind of fulfill this metabolic function. Slide 34 Key Points (Pulmonary Circulation) Dr. Evgeny Pavlov So key points to review for pulmonary circulation. This is getting closer to the end of the first lecture. So the pressure within pulmonary circulation is much lower compared to the systemic circulation. The capillaries are exposed to alveolar pressure, whereas pressure around the extra-alveolar vessels are lower. So these couple of things we will talk more about it, yeah I guess I probably shouldnt even mention it in this lecture because I kind of.. I want to introduce them but we will talk more about specific functions of the pulmonary circulation but this is kind of related. These points for example, like pulmonary vascular resistance which is how easily you can pump blood through the pulmonary circulatory system actually it is low, it falls even more when cardiac output increases because (mumbles) on the capillaries. So what happens actually, it is like when, as I mentioned, these capillaries they are very thin and very easy to manipulate in terms of the diameter and pretty much what happens is there is a phenomenon which we will talk more about in lecture 3, but they are very dynamic structures. So when you depend on how hard you push blood through the system, you will change the resistance and you will see this is kind of a very interesting dynamic system in the pulmonary circulation. The fourth point we will talk about today is that the pulmonary circulation has a metabolic function, and most notably converts angiotensin I to angiotensin II by a specific enzyme. Slide 35 Respiratory System: Summary Dr. Evgeny Pavlov So again, this is all for the first lecture which would be the summary of what we talked, like 3 steps. So it would have gas exchanged between lungs and the environment, which is ventilation. Then diffusion here so pretty much a large surface area and thin barrier and then you would have gas transport from the lungs to organs and back through pulmonary circulation. Yeah, and I guess what I want to do is probably we will take like a little break, you have lecture right after, so the second goes right away. So maybe like 5 minutes? And then we will go to the second lecture. Ok.

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