anaphysiopatho

8/12/2019 anaphysiopatho

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ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM

Respiration has two meanings in biology.

At the cellular level it re!ers to the O" re#uiring chemical reactions that ta$e place in themitochon%ria an% are the chie! source o! energy in the eu$aryotic cells.

At the level o! the whole organism it %esignates the process o! ta$ing In O" !rom the

environment an% returning &O" to it.

O" consumptions is %irectly relate% to energy e'pen%iture. Energy re#uirements are usually

calculate% by measuring O" inta$e o! &O" release. Energy e'pen%iture at rest is $nown as

basal metabolism.

(unctional Anatomy o! the Respiratory System

The organs o! the respiratory system inclu%e the nose pharyn' laryn' trachea bronchi an%

their smaller branches an% the lungs which contain the alveoli or terminal air sacs. Since gas

e'changes with the bloo% happen only in the alveoli the other respiratory system structures are

really )ust con%ucting passageways that allow air to reach !or lungs. *owever these

passageways have another important )ob. They puri!y humi%i!y an% warm incoming air. Thus

the air !inally reaching the lungs has many !ewer irritants +such as %ust or bacteria, than when it

entere% the system.


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The -ose

The nose is the only e'ternally visible part o! the respiratory system. uring breathing

air enters the nose by passing through the nostrils or e'ternal nares. The interior the nose

consists o! the nasal cavity %ivi%e% by a mi%line nasal septum. It has three mucosa/covere%

pro)ections or loves calle% conchae which greatly increase the sur!ace area o! the mucosa

e'pose% to the air an% increase the air turbulence in the nasal cavity. It is separate% !rom the

oral cavity below by a partition the palate. Anteriorly where the palate is supporte% by bone is

the har% palate0 the unsupporte% posterior part is the so!t palate. It is surroun%e% by a ring o!

paranasal sinuses locate% in the !rontal sphenoi% ethmoi% an% ma'illary bones which lighten

the s$ull act as resonance chambers !or speech an% pro%uce mucus which %rains into the

nasal cavities.

Pharyn'

The pharyn' +throat, is a muscular passageway about 12cm long that vaguely

resembles a short length o! re% gar%en hose. It serves as a common passageway !or !oo% an%

air an% is continuous with the nasal cavity anteriorly via the internal nares. Air enters the

nasopharyn' !rom the nasal cavity an% then %escen%s through the oropharyn' an%

laryngopharyn' to enter the laryn' below. It consists o! pharyngotympanic tubes which %rain the

mi%%le ear open into the nasopharyn'. &lusters o! lymphatic tissue calle% tonsils are also !oun%

in the laryn'. The pharyngeal tonsil +a%enoi%, is o3locate% high in the nasopharyn'. The

palatine tonsils are in the oropharyn' at the en% o! the so!t palate0 the lingual tonsils are at the

base o! the tongue. These tonsils protect the bo%y !rom in!ection

4aryn'

The laryn' +voice bo', routes air an% !oo% into the proper channels an% plays a role in

speech. It is !orme% by eight rigi% hyaline cartilages an% a spoon/shape% !lap o! elastic cartilage

the epiglottis. The epiglottis protects the superior opening o! the laryn'. I! anything other than

the air enters the laryn' a cough re!le' is triggere% to e'pel the substance an% prevent it !rom

continuing into the lungs. Part o! the mucous membrane o! the laryn' !orms a pair o! !ol%s the

vocal !ol%s or true vocal cor%s which vibrate with e'pelle% air. It then allows us to spea$.

Trachea

Air enters trachea +win%pipe, !rom the laryn' then travels %own its length +15/1"cm, to

the level o! the !i!th thoracic vertebra which is appro'imately mi%chest. It is !airly rigi% because

its walls are rein!orce% with &/shape% rings o! hyaline cartilage which serve a %ouble purpose.

The open parts o! the rings abut the esophagus an% allow it to e'pan% anteriorly when weswallow a large piece o! !oo%. The soli% portions support the trachea walls an% $eep it patent or

open in spite o! the pressure changes that occur %uring breathing.

Main 6ronchi

The right an% le!t main +primary, bronchi are !orme% by the %ivision o! the trachea. Each

main bronchus runs obli#uely be!ore it plunges into the me%ial %epression +bilus, o! the lung on


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its own si%e. The right main bronchus is wi%er shorter an% straighter than the le!t.

&onse#uently it is more common site !or an inhale% !oreign ob)ect to become lo%ge%. 6y the

time incoming air reaches the bronchi it is warm cleanse% o! most impurities an% well

humi%i!ie%. The smaller sub%ivisions o! the main bronchi within the lungs are %irect routes to the

air sacs.

4ungs

The paire% lungs are !airly large organs. They occupy the entire thoracic cavity e'cept

!or the most central area the me%iastinum which houses the heart great bloo% vessels

bronchi esophagus an% other organs. The narrow superior portion o! each lung the ape' is

locate% )ust %eep to the clavicle. The broa% lung area resting on the %iaphragm is the base.

Each lung is %ivi%e% into loves by !issures0 the le!t lung has two lobes an% the right lung has

three. The sur!ace o! each lungs is covere% with a visceral serosa calle% the pulmonary or

visceral pleura an% the walls o! the thoracic cavity are line% by the parietal pleura. The pleural

membranes pro%uce pleural !lui% a slippery serous secretion which allows the lungs to gli%e

easily over the thora' wall %uring breathing movements an% causes the two pleural layers tocling together. A!ter the primary bronchi enter the lungs they sub%ivi%e into smaller an% smaller

braches +secon%ary an% tertiary bronchi an% so on, !inally en%ing in the smallest o! the

con%ucting passageways the bronchioles. The terminal bronchioles lea% into respiratory 7one

structures even smaller con%uits that eventually terminate in alveoli.

The Respiratory Membrane

The walls o! the alveoli are compose% largely o! a single thin layer o! s#uamous

epithelial cells. Alveolar pores connect neighboring air sacs an% provi%e alternate routes !or air

to reach alveoli whose !ee%er bronchioles have been clogge% by mucus or otherwise covere%

with a 8cobweb9 o! pulmonary capillaries. The alveolar an% capillary walls construct the

respiratory membrane +air/bloo% barrier, which has gas +air, !lowing past on one si%e an% bloo%

!lowing past on the other. The gas e'changes occur by simple %i!!usion through the respiratory

membrane : o'ygen passing !rom the alveolar air into the capillary bloo% an% carbon %io'i%e

leaving the bloo% to enter the gas/!ille% alveoli. The !inal line o! %e!ense !or the respiratory

system is in the alveoli. The cuboi%al cells pro%uce a lipi% molecule calle% sur!actant which

coats the gas/e'pose% alveolar sur!aces an% is very important in lung !unction.

Respiratory Physiology

The ma)or !unction o! the respiratory system is to supply the bo%y with o'ygen an% to %ispose

carbon %io'i%e. There are !our events that must occur;

1. Pulmonary ventilation +breathing, : Air moves in an% out o! the lungs wherein gases in

the alveoli are continuously change% an% re!reshe%.

". E'ternal respiration :


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=. Internal respiration :


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or a mismatch between

central respiratory motor

activity an% incoming a!!erent

in!ormation !rom receptors in

the airways lungs an% chest

wall structures

-ausea an% vomiting Results !rom in!ection an%

high gra%e !ever

iarrhea Occurs when there is %amage

to the mucosal lining or brush

bor%er which lea%s to a

passive loss o! protein/rich

!lui%s an% a %ecrease% ability

to absorb these lost !lui%s

?aun%ice Results !rom %amage o! thebloo% e'cessively %estroye%

bloo% cells whose pigment

may be %eposite% in the

tissues.

>se o! accessory muscles I Inspiratory accessory muscles

might be use% with certain

con%itions such as

pneumonia an allergic

reaction causing anaphyla'is

an asthma attac$ or an

obstruction that %oes not allow

a%e#uate air

-asal !laring I Enlargement o! the opening o!

the nostrils %uring breathing. It

is o!ten a sign that increase%

e!!ort is nee%e% to breathe.

&yanosis ue to lac$ o! o'ygen in the

bloo%stream

Poor !ee%ing Result o! %ecrease in the brain

impulses that stimulates the

!unction o! the taste bu%s

because o! the vascular

changes in the cephalic area.

Since the alveoli where !ille%

with !lui%s an% e'u%ates gas

e'change was not


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accomplishe% well

ETIO4OA4 O&&>RE-&E ?>STI(I&ATIO-

Age I Pneumonia $ills an estimate%

1." million chil%ren un%er the

age o! !ive years every year

Se' Occurrence o! the sai%

%isease in prevalent in males

more it is in !emales.

Testosterone may suppress

the immune system by

changing the way men@s

bo%ies allocate importantresources such as ta$ing

energy away !rom the immune

system an% using it !or other

purposes.

In%oor Air Pollution In%oor air pollution !rom

biomass !uels has been

%etermine% to elevate the ris$

o! pneumonia in chil%ren by

appro'imately 5B.

Assessment o! in%oorconcentrations o! particulate

matter or carbon mono'i%e to

in%irect reports o! !uel an%

stove use an% househol%

cigarette smo$ing are %one

Malnutrition This is crucial in the

strengthening o! the immune

system o! the client. Cithout

the su!!icient inta$e o!

vitamins an% minerals that arepresent in the %iet the

%e!ense mechanism o! the

bo%y is wea$ene%0 ma$ing it

susceptible to in!ection an%

invasion o! possible

microorganisms that are

present in the environment.


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This can be attribute% to the

possibility that these

microorganisms are %welling

in the environment itsel!.

&row%ing 4iving in crow%e% con%itions

promotes the transmission o!airborne pathogens. Thus

crow%ing commonly

measure% as the number o!

persons per room in a

%welling unit

P-E>MO-IA

The term pneumonia %escribes in!lammation o! parenchymal structures o! the lung such

as the alveoli an% the bronchioles. Although antibiotics have signi!icantly re%uce% the mortality

rate !rom pneumonias these %iseases remain the si'th lea%ing cause o! %eath in the >nite%

States an% an important imme%iate cause o! %eath in the el%erly an% persons with %ebilitating

%iseases. Etiologic agents inclu%e in!ectious an% nonin!ectious agents.

&lassi!ication

Pneumonias can be classi!ie% accor%ing to the type o! agent +typical or atypical, causing

the in!ection %istribution o! the in!ection +lobar pneumonia or bronchopneumonia, an% setting

+community or hospital, in which it occurs.

Typical pneumonias result !rom in!ection by bacteria that multiply e'tracellularly in the

alveoli an% cause in!lammation an% e'u%ation o! !lui% into the air/!ille% spaces o! the alveoli.Atypical pneumonias are cause% by viral an% mycoplasma in!ections that involve the alveolar

septum an% interstitium o!t the lung. They pro%uce less stri$ing symptoms an% physical !in%ings

than bacterial pneumonia0 there is a lac$ o! alveolar in!iltration an% purulent sputum

leu$ocytosis an% lobar consoli%ation in the ra%iograph. Acute bacterial pneumonias can be

classi!ie% as lobar pneumonia or bronchopneumonia base% on their anatomic pattern o!

%istribution. In general lobar pneumonia re!ers to consoli%ation o! a part or all o! a lung lobe

an% bronchopneumonia signi!ies a patchy consoli%ation involving more than one lobe.

6ecause o! the overlap in the symptomatology an% changing spectrums o! in!ectious

microorganisms involve% pneumonias are increasingly being classi!ie% accor%ing to the setting

+community/ac#uire% or hospital/ac#uire%, in which they occur.


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&OMM>-ITY/A&D>IRE P-E>MO-IA

It is use% to %escribe in!ections !rom organisms !oun% in the community rather than in

the hospital or nursing home. It is %e!ine% as an in!ection that begins outsi%e the hospital or is

%iagnose% within = hours a!ter a%mission to the hospital in a person who has not resi%e% in a

long/term care !acility !or 1= %ays or more be!ore a%mission. &ommunity/ac#uire% pneumonias

may be !urther categori7e% accor%ing to ris$ o! morality an% nee% !or hospitali7ation base% on

age presence o! coe'isting %isease an% severity o! illness as %etermine% by physical

e'amination laboratory an% ra%iologic !in%ings.

&ommunity/ac#uire% pneumonias may either be bacterial or viral. The most common

cause is S. pneumoniae. Other common pathogens inclu%e H. influenza, S. aureus gram/

negative bacilli. 4ess common agents are M. catarrbalis. &ommon viral causes inclu%e the

in!luen7a virus respiratory syncytial virus a%enovirus an% parain!luen7a virus.

The metho%s use% in %iagnosing %epen% on age coe'isting health problems an% the

severity o! illness. In persons younger than F years o! age an% without coe'isting %isease the

%iagnosis is usually base% on history an% physical e'amination chest ra%iographs an%

$nowle%ge o! the microorganisms currently causing in!ections in the community. Sputum

specimens may be obtaine% !or staining proce%ures an% culture. 6loo% culture may be %one !orperson re#uiring hospitali7ation.


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*OSPITA4/A&D>IRE P-E>MO-IA

Also terme% as nosocomial is %e!ine% as lower respiratory tract in!ection that was not

present or incubating on a%mission to the hospital. >sually in!ections occurring = hours or

more a!ter a%mission are consi%ere% hospital/ac#uire%.

G5B o! in!ections are bacterial. The organisms are those present in the hospital

environment an% inclu%e Pseudomonas aeruginosa, S. aureus, Enterobacteria species

Klebsiella species Escherichia coli, an% Serratia. Many o! these have ac#uire% antibioticresistance an% are more %i!!icult to treat.


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