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classification

Anatomical classification Upper( nose, nasal cavity, sinuses,& pharynx.) Lower ( larynx,trachea,bronchi, broncheoles,alveoles.) Physiological classification Conducting zone from the nose to bronchioles except respiratory bronchioles. Respiratory zone.

Airway anatomy.

Airway anatomy the trachea.

airway
There are two openings to the human airway. 1.the nose which leads to the nasopharynx . 2. the mouth which leads to the oropharynx. These passages are separated anteriorly the palate , but they join posteriorly in the pharynx.

The pharynx.
The pharynx is a U shaped fibro muscular structure that extends from the base of the skull to the cricoids cartilage. It opens anteriorly in to the nasal cavity, the mouth, the larynx.

The larynx
The larynx is a cartilaginous skeleton held together by ligaments & muscle. It is composed of nine cartilages. The opening of the larynx is called glottis. The epiglottis prevents aspiration by covering the glottis.

Dead space
Areas of ventilation without perfusion. Each inspired breath is composed of gas that contribute to alveolar ventilation ( VA) & gas that become dead space( VD). Thus tidal volume( VT) = VA + VD. In the normal , spontaneously breathing person, the ratio of alveolar-to-dead space ventilation for each breath is 2:1. Physiologic dead space consists of anatomic & alveolar dead space.

Anatomic dead space.


It arises from ventilation of structures that do not exchange respiratory gases; the oronasopharynx to the terminal & respiratory bronchioles. It is approximately 2ml/kg.

Alveolar dead space


It arises from ventilation of alveoli where there is little or no perfusion to the alveoli. physiologic dead space is primarily influenced by changes in alveolar dead space.(because disease changes anatomic dead space little.) Rapid changes in physiologic dead space ventilation most often arise from change in pulmonary blood flow, resulting in decreased perfusion to ventilated alveoli. The most common etiology of acutely increased physiologic dead space is an abrupt decrease in CO( shock), pulmonary embolism.

Areas of perfusion without ventilation.


Physiologic shunt occurs in lung that is perfused but poorly ventilated( the portion of the total cardiac out put that returns to the left heart & systemic circulation without receiving oxygen in the lung.) A small % of venous blood normally bypasses the right ventricle & empties directly in to the left atrium. this anatomic, absolute shunt arises from the venous return from the pleural, bronchiolar,& thebesian veins( this venous drainage accounts for 2 to 5% of the cardiac output.) Anatomic shunts of greatest magnitude are usually associated with- congenital heart disease that cause right to left shunt. -extensive acute lung injury. -consolidated pneumonia.

Shunt.

Function of the respiratory system.


Gas exchange between air & blood Production of sound Regulation of acid base balance. Infection prevention. 1.the mucus used to stick & remove any pathogens & particles. 2. cilia propel mucus & debris to the exterior.

Process of respiration composed of 4 sequential phases.


1. Pulmonary ventilation air movement in & out of the lung. 2. External respiration exchange of gases between air in the alveoli & blood in pul cap. 3. Transport of gases. 4. Internal respiration exchange of gases between blood in systemic cap.& tissue. 5. Cellular respiration.

Minute ventilation.

MV = TV x RR. AV = (TV DV) x RR

Lung mechanics.
The lung natural tendency is to collapse; thus expiration at rest is normally passive because gas flows out of the lungs when they elastically recoil. The thoracic cage exerts an outwarddirected force, & the lungs exert an inward-directed force. Together these forces result in a sub atmospheric intra pleural pressure.

The inward force of the lung ( elastic recoil) consists of-the elastic fibers of lung tissue. -the contractile forces of airway smooth muscles. - the surface tension of alveoli. The outward force of the chest wall is exerted by - the ribs, joints & muscles.

Contd
Because the outward force of the thoracic cage exceeds the inward force of the lung , the overall tendency of the lung is to remain inflated when it resides within the thoracic cage. When the outward & the inward forces on the lung are equal ?

Contd
Atmospheric pressure the pressure of the air surrounding the body at see level (760mmhg). Intra alveolar pressure( intrapulmonary pressure) the pressure within the alveoli. 1.I AP must be lower than ATMP during inspiration. 2.IAP > ATMP during expiration. 3.IAP= ATMP when ?. Intra pleural pressure( intra thoracic pressure ) the pressure with in the pleura sac.( 756mmhg) 1. the pressure exerted outside the lung within the thoracic cavity. 2.IPP < ATMP. 3. IPP does not equilibrate with the ATMP or IAP because there is no communication b/n them.

Negativity of intra pleural pressure.


Both the lungs & thoracic wall are elastic structures i.e. if they are stretched or compressed by some force they will recoil (return to their original size & position when the force is removed.) At rest the lungs are partially stretched( inflated) & are attempting to recoil. At rest the chest wall is compressed & attempting to move out ward.

Trance pulmonary pressure.


IAP IPP is known as trance pulmonary pressure. 760 756 = 4mmhg. This pressure is known as the distending pressure of the alveoli. Pneumothorax 1. intra pleural & intra alveolar pressure are equilibrated with the atmospheric pressure. 2.trance pulmonary pressure gradient no longer exist. 3. no force present to stretch the lung or chest wall as a result the lung collapse.

compliance. Elastic recoil is usually measured in terms of compliance ( C ) it is defined as the change in volume divided by the change in distending pressure. C = change in lung volume/change in transpulmonary pressure.

alveolar-capillary membrane ( respiratory membrane) has the following layers. 1.fluid & surfactant layer. 2.the alveolar epithelium. 3. an epithelial basement membrane. 4. interstitial space b/n the alveolar epithelium & the capillary membrane. 5.capillary basement membrane. 6. the capillary endothelial membrane.

diffusion across alveolar capillary membrane is depending upon-surface area the smaller the lung, the less the overall diffusion. -membrane thickness, the longer the diffusion distance & the lower the diffusion capacity. -pressure gradient across the respiratory membrane is the difference b/n the partial pressure of the gas in the alveoli & in the pulmonary capillary blood. -molecular weight the larger the molecule, the more difficult it will be to pass through the membranes. -solubility CO2 is almost 30x more soluble in water than oxygen is & diffuses more than 20x faster.