Fisiologi Sistim Respirasi

I. Struktur dan fungsi

Struktur anatomis TR
Fungsi bagian TR secara spesifik
Hubungan struktur dan fungsi.
Respiratory System Divisions

Upper tract
Nose, pharynx
and associated
structures
Lower tract
Larynx,
trachea,
bronchi, lungs
Nasal Cavity and Pharynx
 Nose and Pharynx

Nose Pharynx
Common opening for
External nose
digestive and
Nasal cavity
respiratory systems
Functions
Three regions
Passageway for air
Nasopharynx
Cleans the air
Oropharynx
Humidifies, warms
air Laryngopharynx
Smell
Along with paranasal
sinuses are
resonating chambers
for speech
 Larynx

Functions
Maintain an open passageway for air movement
Epiglottis and vestibular folds prevent swallowed
material from moving into larynx
Vocal folds are primary source of sound production
Vocal Folds
Trachea
Windpipe
Divides
to form
Primary
bronchi
Carina:
Cough
reflex
 Tracheobronchial Tree
Conducting zone
Trachea to terminal bronchioles which
is ciliated for removal of debris
Passageway for air movement
Cartilage holds tube system open and
smooth muscle controls tube diameter
Respiratory zone
Respiratory bronchioles to alveoli
Site for gas exchange
Tracheobronchial Tree
Bronchioles and Alveoli
Alveolus and Respiratory
Membrane
 Structure of Respiratory
System

The structure can be imagined as:

Covering the surface of a racquetball
court (about 75 m2) with thin plastic
wrap, and stuffing it into a 3- liter
soft drink bottle.
 Structure and function
relationship
The structure serves a good
relationship with the function.

The tremendous large surface area for

gas exchange is needed to supply
the trillions of cells in the body with
adequate amounts of oxygen.
 Lungs

Two lungs: Principal organs of respiration

Right lung: Three lobes
Left lung: Two lobes
Divisions
Lobes, bronchopulmonary segments, lobules
Organ Utama : PARU
Fungsi Utama : GAS
EXCHANGE

STRUKTUR T.R SECARA

FISIOLOGIS
I. CONDUCTING ZONE:
ZONA 0 16
TRACHEA SAMPAI
TERMINAL BRONCHIOLUS
II. RESPIRATORY ZONE
ZONA 17 23
RESPIRATORY
BRONCHIOLUS SAMPAI
ALVEOLAR SACS.
 Respiratory System
Functions
Gas exchange: Oxygen enters blood and
carbon dioxide leaves
Regulation of blood pH: Altered by
changing blood carbon dioxide levels
Voice production: Movement of air past
vocal folds makes sound and speech
Olfaction: Smell occurs when airborne
molecules drawn into nasal cavity
Protection: Against microorganisms by
preventing entry and removing them
 PERBANDINGAN CONDUCTING ZONE DAN RESPIRATORY
ZONE.

1. JARAK.
ORANG DEWASA: JARAK
HIDUNG SAMPAI
TERMINAL
BRONHIOLE : 40 CM.
JARAK TBL SAMPAI
ALVEOLI : KURANG
DARI 1 CM.
2. LUAS PERMUKAAN .
CONDT.ZONE:RENDAH
RESP.ZONE TINGGI.
AKIBAT : DI CONDT.ZONE ,UDARA BERGERAK DG
KECEPATAN TINGGI.

DI RESP.ZONE, UDARA BER-GERAK DG.LAMBAT

KESEMPATAN UTK. DIFUSI.
CONDUCTING ZONE : MEMBAWA / MENGALIRKAN
UDARA MASUK DAN KELUAR T.R.
1. SEBAGAI RANGKA T.R. : MENCEGAH T.R. KOLAPS
DAN MENJADIKAN T.R. OPEN AIR-
WAYS.
2.MEMANASKAN / MELEMBABKAN UDARA INSPIRASI.
3.FILTERING : MENGELUARKAN PARTIKEL ASING
DARI T.R
4. REFLEX : BERSIN DAN BATUK.

:
RESPIRATORY ZONE.
1.TEMPAT PERTUKARAN GAS.
2.FUNGSI METABOLIK : NON RESPIRATORY FUNCTION.
-MENGHASILKAN ENZYM ACE(ANGIOTENSIN CONVERTING
ENZYME) DAN SURFACTANT.
-MENGAKTIFKAN ANGIOTENSIN I MENJADI ANGIOTENSIN II.
-MENGINAKTIFKAN BRADYKININ, SEROTONIN, PGE, PGF2,
NOREPINEPHRINE,HISTAMIN.
:
 II. Ventilation
Ventilation how gas gets into alveoli.
how gases cross blood gas
interface
how gases removed from lung
Mekanisme
Ventilasi
Difusi
Blood flow
 Ventilation

Movement of air into and out of lungs

Air moves from area of higher
pressure to area of lower pressure
Pressure is inversely related to
volume
 VENTILATION
During ventilation AIRFLOW because
of Pressure Gradients.
FLOW = P / R
1. Air flow in response to a pressure
gradient.
2. Flow decreases as resistance
increases
 Inspiration

During inspiration, the thoracic volume

increases when skeletal muscles of
the rib cage and diaphragm contract
pressure inside lung become
lower than the pressure of
atmosphere pressure gradient
air flow into lung.
 Dead Space
Dead space ( ruang rugi ) bag. TR yg
tidak ikut ambil bagian dlm proses gas
exchange.
Ada 2 jenis dead space:
1. Anatomic dead space: volume
conducting airways.
2. Physiologic dead space : volume paru yg
fungsional tidak mengeliminasi CO2.
 Dead space

Anatomic dead space diukur dgn

Fowlers Method. Volume
morphology Paru.

Physiologic dead space diukur dgn

Bohrs method. Merupakan functional
measurement.
 LUNG VOLUME

ALAT PENGUKUR LUNG VOLUME : SPIROMETER

NILAI NORMAL DARI LUNG VOLUME.
 Pulmonary Volumes
Tidal volume
Volume of air inspired or expired during a normal
inspiration or expiration
Inspiratory reserve volume
Amount of air inspired forcefully after inspiration of
normal tidal volume
Expiratory reserve volume
Amount of air forcefully expired after expiration of
normal tidal volume
Residual volume
Volume of air remaining in respiratory passages and
lungs after the most forceful expiration
 Pulmonary Capacities
Inspiratory capacity
Tidal volume plus inspiratory reserve volume

Functional residual capacity

Expiratory reserve volume plus the residual volume

Vital capacity
Sum of inspiratory reserve volume, tidal volume, and
expiratory reserve volume

Total lung capacity

Sum of inspiratory and expiratory reserve volumes
plus the tidal volume and residual volume
 Minute and Alveolar
Ventilation
Minute ventilation: Total amount of air
moved into and out of respiratory system
per minute
Respiratory rate or frequency: Number of
breaths taken per minute
Anatomic dead space: Part of respiratory
system where gas exchange does not take
place
Alveolar ventilation: How much air per
minute enters the parts of the respiratory
system in which gas exchange takes place
PADA POSISI TEGAK
-VENTILASI/UNIT VOLUME : PALING
BESAR DI BAGIAN BAWAH
-UPPER ZONE VENTILASI RENDAH
VENTILASI TERGANTUNG POSISI
BAGIAN DEPENDENT MENDAPATKAN
VENTILASI TERBESAR.
 III. DIFFUSION
Proses difusi perpindahan /transfer
gas melalui blood-gas barier.
Blood gas barrier alveolo-capillary
membrane, yg tebalnya :0,15-0,3 .
Lapisan alveolo-capillary membrane:
alveolar epithelium
basal membrane
capillary endothelium
DIFUSI GAS MELALUI MEMBRAN ALVEOLO-CAPILARY
BERDASARKAN HUKUM FICK
KECEPATAN DIFUSI DITENTUKAN OLEH
- STRUKTUR MEMBRAN
- JENIS GAS
- TEKANAN

1. STRUKTUR MEMBRAN
MEMBRAN ALVEOLO-CAPILLARY TIPIS: 0,15-
3
TOTAL SURFACE AREA PARU LUAS

2. JENIS GAS
CO2 : 20x LEBIH SOLULABLE DARI O2
3. TEKANAN ARAH DIFUSI

P O2(mmHg) P CO2(mmHg)
ALV.GAS 100 40
VENA 40 46

O2 : ALVEOLI DARAH
CO2:: DARAH ALVEOLI
Changes in Partial Pressures
Waktu yg dibutuhkan 1 RBC untuk menempuh
kapiler paru (gas exchange) : 0,75 detik.
Dalam waktu 0,25 detik, P O2 dalam darah
kapiler = P O2 dlm alveoli.
Exercise blood flow meningkat, waktu RBC
menjalani kapiler paru lebih singkat.
Normal tidak ada gangguan.
Jika P O2 menurun (50 mmHg), perbedaan
tekanan lebih kecil (50-20 = 30 mmHg)
O2 bergerak lebih lambat membutuhkan
waktu lebih lama dari 0,25 detik untuk
mencapai tekanan yg sama dg alveoli.
 IV. SIRKULASI T.R.

1. SIRKULASI PULMONALIS.
- BERUPA NET-WORK KAPILER
- DINDING PEMBULUH DARAH TIPIS
- BERJALAN SERI DG SIRKULASI SISTEMIK MENERIMA
SELURUH CARDIAC OUTPUT.
- TEKANAN RENDAH, SISTOLIK: 25 mmHg, DIASTOLIK: 8
mmHg
- MEAN ARTERY PULMONALIS PRESSURE: 15 mmHg.
- RESISTENSI RENDAH, 1/10 RESISTENSI SIR. SISTEMIK.
- MEMBERIKAN VASCULARISASI,SUPPLY NUTRISI
PARENCHYME PARU.
- JUGA SEBAGAI RESERVOIR DARAH DAN FILTER.
 VII.Mekanika pernapasan
Mekanika pernapasan
how the lung is supported and
moved.

Topik forces menggerakkan paru

dan dinding thorax
resistance/ tahanan yg harus
diatasi
 MEKANIKA PERNAPASAN
Pernapasan : - Inspirasi
- Ekspirasi
Inspirasi : Aktif
Otot inspirasi : - Diaphragma
- M. Intercostalis Externa
- M. Scalenus
- M. Sternomastoid
 Inspiration

During inspiration, the thoracic volume

increases when skeletal muscles of
the rib cage and diaphragm contract
pressure inside lung become
lower than the pressure of
atmosphere pressure gradient
air flow into lung.
 Thoracic Walls
Muscles of Respiration
Thoracic Volume
Expirasi : Pasif
Paru dan dinding thorax bersifat elastis mengecil kembali
setelah mengembang secara aktif pd waktu inspirasi.
Exercise dan voluntary hyperventilation : exp. jadi aktif
Otot Expirasi :
* Otot dinding perut: - M. Rectus abdominus, Internal
External obliques, Transversus abdominus.
* M Intercostalis Interna.
 SURFACTANT
Surfactant decreases the surface
tension created by the thin fluid layer
between alveolar cells and the air.

Surfactant decrease WORK of

BREATHING.
- Fungsi Surfactant
1. Menurunkan surface tension
Meningkatkan compliance paru
2. Meningkatkan stabilitas alveoli
3. Menjaga alveoli tetap kering mencegah
transudasi
 VIII. Kontrol pernapasan
Kontrol gas exchange.
3 elemen dasar:
1. Sensors mengumpulkan input dan
diteruskan ke :
2. Central controller koordinasi
informasi, dan mengirim impuls ke :
3. Effectors otot respirasi ventilasi
MEDULA OBLONGATA
1. Dorsal Respiratory Group inspirasi
2. Ventral Respiratory Group expirasi
PONS
1. Apneustic Center : Lower Pons
Apneusis (Prolonged Inspiratory Gasps)
2. Pneumotaxic Center : Upper Pons
- Inhibisi inspirasi
- mengatur volume inspirasi, respiratory rate
- fine tuning of respiratory rhythm
Respiratory Structures in Brainstem
CORTEX CEREBRI
Dalam limit tertentu, cortex dapat mempengaruhi fungsi batang
otak.
Contoh: Voluntary Hyper dan Hypoventilation
Bagian lain Lymbic System dan Hypothalamus Emosi
Pattern of Breathing

EFFECTOR
- Otot Respirasi
- Coordinated Action
 Modification of Ventilation
Chemical control
Cerebral and
Carbon dioxide is
limbic system major regulator
Respiration can be Increase or decrease in
voluntarily pH can stimulate
chemo- sensitive area,
controlled and causing a greater rate
modified by and depth of
emotions respiration
Oxygen levels in blood
affect respiration
when a 50% or
greater decrease from
normal levels exists
Modifying Respiration
Regulation of Blood pH and Gases
 Herring-Breuer Reflex

Limits the degree of inspiration and

prevents overinflation of the lungs
Infants
Reflex plays a role in regulating basic
rhythm of breathing and preventing
overinflation of lungs
Adults
Reflex important only when tidal volume
large as in exercise
SENSOR
1. Central Chemoreceptor
* Permukaan Ventral Medula, dekat tempat keluarnya
N.IX dan N.X
* Stimuli: 1. pH CSF
2. Pa CO2
* Respons : Ventilasi
2. Peripheral Chemoreceptor
a. Carotid Body
b. Aortic Body
- STIMULI :
1. Hypoxia
2. Hypercapnia
3. pH Darah
4. Suhu
5. Blood Flow
6. Zat Farmakologi yg merangsang ganglion
simpatis
Nikotin
7. O2 Utilization
RESPONS :
1. Ventilasi
2. Periferal Vasoconstriction sistemic hypertension
Aortic Body Vasoconstriction pada sirkulasi
pulmonalis pulmonal
hipertensi
 LUNG RECEPTOR (VAGAL SENSORY RECEPTOR)
1. Stretch Receptor
- letak : dalam otot polos T.R
- stimuli : volume

- sifat : slowly adapted

- reflex : 1. Menghambat inspirasi
2. Hering Breuer Reflex
2. Irritant Receptor
- Letak : Sel epitel T.R
- Sifat : Rapidly Adapted
- Stimuli : 1. Gas Irritatif
2. Hiperinflation
- Respons : 1. Bronchoconstriction
2. Rapid, Shallow Breathing

3. Cough Upper
T.R
3. J receptor (juxta capillary receptor)
- Letak : dinding Alv yg berdekatan dg kapiler
- Sifat : Un-myelinated, C-fibers conducted
- Stimuli :
1. Zat kimia yg dilepaskan pada waktu anaphylaxis
shock : histamin
2. Pulmonary edema
- Reflex :
1. Bronchoconstriction 3. dyspnea
2. Apnea-bradycardia-hipotensi
RECEPTOR LAIN :
1. Receptor hidung ( upper airway)
2. Joint Muscle Receptor
3. Gamma System
4. Arterial Baroreceptor
5. Pain, Temperature
RESPONSE TO CO2
Normal : kontrol ventilasi : tekanan CO2 arteri
80% respons datang dari stimulasi central chemoreceptor
1. Very sensitive perubahan 1 mmHg tekanan alveoli CO2
perubahan ventilasi 2,0 3,0 L/menit
2. Hypoxia menimbulkan potensiasi pada hypercapnia
Responses to O2
 Response to Oxygen

1. Tidak begitu sensitive

Tekanan alveoli O2 dibawah 50 mmHg baru
timbul respons
2. Hypercapnia menimbulkan potensiasi dengan
hypoxia
3. Respons terutama dari chemoreceptor perifer
carotid body
 IX. Fisiologi dari respirasi keadaan khusus

1. High altitude.
2. Increased pressure
3. Exercise.
 High altitude
Tekanan barometer akan menurun
secara exponential dengan
meningkatnya ketinggian.
Pada ketinggian 5500 m, tekanan
barometer
380 mmHg dan P O2 udara inspirasi
(380 -47 ) x 21% = 70 mmHg.
Problem pada high altitude HYPOXIA
 Responses to high altitude

1. Hyperventilation.
penyebab timbulnya : stimulasi hypoxic
pada peripheral chemoreceptor.
2. Polycythemia meningkatkan O2
carrying capacity.
3. Shift to the right kurva dissosiasi
OxyHb.
4. Pulmonary vasoconstriction akibat
alveolar hypoxia tekn. arteri
pulmonalis meningkat.
 Increased pressure

Pada waktu menyelam, tekanan akan

meningkat 1 atmosfer untuk setiap 33 ft
( 10 m ) turun kebawah permukaan air.
Tekanan ini tidak berbahaya, selama ada
dlm keseimbangan.
Namun jika rongga yg berisi gas, seperti
paru, telinga tengah, intracranial sinus,
gagal menyeimbangkan tekanan
problem
Problem respirasi pada tekanan tinggi waktu
menyelam

Perbedaan tekanan di dalam dan luar tubuh

compression waktu menyelam
overexpansion waktu naik kepermukaan.
Densitas gas yg meningkat meningkatkan
work of breathing. Akibatnya akan timbul
retensi CO2.

Pencegahan:
waktu naik exhale mencegah overinflation
dan ruptur paru.
 Exercise

Pada waktu exercise, O2 consumption akan

meningkat total ventilation meningkat.
Penyebab hyperventilation : ???
P O2 arteri tidak meningkat pada waktu
exercise.
severe exercise menurun sedikit.
pH arteri tidak berubah pada waktu moderate
exercise. Pada exercise berat, pH menurun
lactic acid yg meningkat akibat anaerobic
glycolysis.
Possible stimuli hyperventilation pada waktu
exercise

1. Passive movement of the limbs.

2. Oscillation in arterial P O2 dan P CO2
stimulasi peripheral chemoreceptor.
3. Central chemoreceptor meningkatkan
ventilasi agar P CO2 arterial stabil.
4. Additional CO2 load yg masuk ke paru
melalui darah vena.
5. Suhu tubuh yg meningkat.
6. Impuls dari motor cortex.
 Kepustakaan

1. Text book of medical physiology. Guyton

& Hall.
2. Respiratory physiology, the essentials.
John B. West.
3. Respiratory physiology. Slonim &
Hamilton.
4. Introduction to respiratory physiology.
Braun, H.A. , Cheney,F.W. , Loehnen, C.P.