structure and function of the pulmonary system chapter 32 mosby items and derived items © 2010,...
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Structure and Function of the Structure and Function of the Pulmonary SystemPulmonary System
Chapter 32Chapter 32
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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22Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Structures of the Structures of the Pulmonary SystemPulmonary System
AirwaysAirways Blood vesselsBlood vessels Chest wall Chest wall LungsLungs
LobesLobes SegmentsSegments Lobules Lobules
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33Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Structures of the Pulmonary SystemStructures of the Pulmonary System
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Structures of the Structures of the Pulmonary SystemPulmonary System
Conducting airwaysConducting airways Upper airwaysUpper airways
• NasopharynxNasopharynx• OropharynxOropharynx
LarynxLarynx• Connects upper and lower airwaysConnects upper and lower airways
Lower airwaysLower airways• TracheaTrachea• BronchiBronchi• Terminal bronchiolesTerminal bronchioles
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55Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Structures of the Pulmonary SystemStructures of the Pulmonary System
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Structures of the Structures of the Pulmonary SystemPulmonary System
Gas-exchange airwaysGas-exchange airways Respiratory bronchiolesRespiratory bronchioles Alveolar ductsAlveolar ducts Alveoli Alveoli
• Epithelial cellsEpithelial cells Type I alveolar cellsType I alveolar cells
– Alveolar structureAlveolar structure Type II alveolar cellsType II alveolar cells
– Surfactant productionSurfactant production
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Structures of the Pulmonary SystemStructures of the Pulmonary System
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88Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Structures of the Pulmonary SystemStructures of the Pulmonary System
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Structures of the Pulmonary SystemStructures of the Pulmonary System
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Gas ExchangeGas Exchange AlveoliAlveoli
Primary gas-exchange units Primary gas-exchange units Pores of KohnPores of Kohn
• Permit air to pass through the septa from alveolus to alveolusPermit air to pass through the septa from alveolus to alveolus Collateral ventilation and even air distribution Collateral ventilation and even air distribution
Lungs contain approximately 25 million alveoli at Lungs contain approximately 25 million alveoli at birth and 300 million by adulthoodbirth and 300 million by adulthood
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Pulmonary and Pulmonary and Bronchial CirculationBronchial Circulation
Pulmonary circulation has a lower pressure Pulmonary circulation has a lower pressure than systemic circulation (18 mmHg)than systemic circulation (18 mmHg)
Only one third of vessels filled with blood at Only one third of vessels filled with blood at any given timeany given time
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Pulmonary and Pulmonary and Bronchial CirculationBronchial Circulation
Pulmonary artery divides and enters the lung Pulmonary artery divides and enters the lung at the hilusat the hilus
Each bronchus and bronchiole has an Each bronchus and bronchiole has an accompanying artery or arterioleaccompanying artery or arteriole
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Pulmonary and Bronchial Pulmonary and Bronchial CirculationCirculation
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Pulmonary and Pulmonary and Bronchial CirculationBronchial Circulation
Alveolocapillary membraneAlveolocapillary membrane Formed by shared alveolar and capillary wallsFormed by shared alveolar and capillary walls Thin membrane of alveolar epithelium, the alveolar Thin membrane of alveolar epithelium, the alveolar
basement membrane, interstitial space, the basement membrane, interstitial space, the capillary basement membrane, and the capillary capillary basement membrane, and the capillary endotheliumendothelium
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Pulmonary and Bronchial CirculationPulmonary and Bronchial Circulation
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Chest Wall and PleuraChest Wall and Pleura Chest wallChest wall
Skin, ribs, and intercostal musclesSkin, ribs, and intercostal muscles Thoracic cavityThoracic cavity
PleuraPleura Serous membraneSerous membrane Parietal and visceral layersParietal and visceral layers Pleural space (cavity)Pleural space (cavity) Pleural fluidPleural fluid
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Lung FunctionsLung Functions Gas exchangeGas exchange
Supply oxygenSupply oxygen Eliminate COEliminate CO22
Maintain pHMaintain pH Eliminate waterEliminate water Other functionsOther functions
Maintain normal body temperatureMaintain normal body temperature Immune responsesImmune responses Hormone secretionHormone secretion MetabolismMetabolism
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Requirements for Ventilation, Requirements for Ventilation, Perfusion, and DiffusionPerfusion, and Diffusion
Adequate inspired OAdequate inspired O22 – (Fi – (FiOO22)) Ventilation and perfusion of alveoliVentilation and perfusion of alveoli A permeable alveolocapillary membraneA permeable alveolocapillary membrane Adequate blood flowAdequate blood flow Ability to transport OAbility to transport O22 and CO and CO22
Ability of cell to use OAbility of cell to use O22 and eliminate CO and eliminate CO22
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Requirements for Ventilation, Requirements for Ventilation, Perfusion, and DiffusionPerfusion, and Diffusion
Adequate inspired OAdequate inspired O22 – (FiO – (FiO22))
Barometric pressure is 760 at sea level Barometric pressure is 760 at sea level
21% x 760 = partial pressure of O21% x 760 = partial pressure of O22 at sea level at sea level = ~160 mmHg= ~160 mmHg
Barometric pressure is 600 at Salt Lake City Barometric pressure is 600 at Salt Lake City (much lower on Mt. Everest) (much lower on Mt. Everest)
21% x 600 = partial pressure of O21% x 600 = partial pressure of O22 at SLC at SLC = ~126 mmHg = ~126 mmHg
Why we give oxygen at high altitudeWhy we give oxygen at high altitude
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Function of the Pulmonary Function of the Pulmonary SystemSystem
VentilationVentilation Mechanical movement of gas or air into and out of Mechanical movement of gas or air into and out of
the lungsthe lungs Minute volumeMinute volume
• Ventilatory rate multiplied by the volume of air per breathVentilatory rate multiplied by the volume of air per breath
Alveolar ventilationAlveolar ventilation
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Lung Volumes and CapacitiesLung Volumes and CapacitiesBased on Age, Gender, HeightBased on Age, Gender, Height
Dead space: oropharynx to division 16 (about Dead space: oropharynx to division 16 (about equal to ideal body weight)equal to ideal body weight)
Tidal volume (per breath) 400-800 mlTidal volume (per breath) 400-800 ml IRV 3000 ml additional air that could be inhaledIRV 3000 ml additional air that could be inhaled
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Lung Volumes and CapacitiesLung Volumes and CapacitiesBased on Age, Gender, HeightBased on Age, Gender, Height
ERV 1000 ml remaining air ERV 1000 ml remaining air Can be forcefully expired after normal expiration FEVCan be forcefully expired after normal expiration FEV11
Why abdominal thrusts work; expel TV plus ERVWhy abdominal thrusts work; expel TV plus ERV Forced vital capacity (theoretical) Forced vital capacity (theoretical)
TV + IRV + ERV ~4500-5000 ml TV + IRV + ERV ~4500-5000 ml Residual volume constant ~1200 ml Residual volume constant ~1200 ml
Air remaining in alveoliAir remaining in alveoli
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FormulasFormulas
Minute ventilation (or volume/min) Minute ventilation (or volume/min) RR x TV RR x TV RR 16, TV 500 RR 16, TV 500 16 x 500 = 8000 ml/min16 x 500 = 8000 ml/min
Effective minute volume: RR x (TV-DS) Effective minute volume: RR x (TV-DS) 100 lb, RR 16, TV 500 ml100 lb, RR 16, TV 500 ml 16 (500-100) = 6400 ml/min16 (500-100) = 6400 ml/min
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Control of VentilationControl of Ventilation
ANSANS Stimulates smooth muscle (contract relax)Stimulates smooth muscle (contract relax)
• Airway lumen diameterAirway lumen diameter
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TermsTerms
HypoxiaHypoxia Low oxygen in the cellLow oxygen in the cell
HypoxemiaHypoxemia Low oxygen in arterial blood (low OLow oxygen in arterial blood (low O22 saturation) saturation)
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Control of VentilationControl of Ventilation
ChemoreceptorsChemoreceptors Central receptorsCentral receptors
• Reflects PaReflects PaCOCO22
• Stimulated by HStimulated by H++ in cerebrospinal fluid (pH) in cerebrospinal fluid (pH)
Peripheral receptorsPeripheral receptors• Aorta and carotid bodiesAorta and carotid bodies
• Stimulated by hypoxemia (PaStimulated by hypoxemia (PaOO22))
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Control of VentilationControl of Ventilation
Irritant receptors: epithelium of conducting Irritant receptors: epithelium of conducting airwaysairways Cough, bronchoconstriction, decrease RRCough, bronchoconstriction, decrease RR
Stretch receptors: protectiveStretch receptors: protective Decrease RR and volumeDecrease RR and volume
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VentilationVentilation Neurochemical controlNeurochemical control
Respiratory centerRespiratory center• Dorsal respiratory groupDorsal respiratory group
• Ventral respiratory groupVentral respiratory group
• Pneumotaxic centerPneumotaxic center
• Apneustic centerApneustic center
Peripheral chemoreceptorsPeripheral chemoreceptors
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VentilationVentilation Neurochemical controlNeurochemical control
Lung receptorsLung receptors• Irritant receptorsIrritant receptors
• Stretch receptorsStretch receptors
• J-receptorsJ-receptors
ChemoreceptorsChemoreceptors• Central chemoreceptorsCentral chemoreceptors
• Peripheral chemoreceptorsPeripheral chemoreceptors
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Mechanics of BreathingMechanics of Breathing Major and accessory musclesMajor and accessory muscles
Major muscles of inspirationMajor muscles of inspiration• DiaphragmDiaphragm
• External intercostalsExternal intercostals
Accessory muscles of inspirationAccessory muscles of inspiration• Sternocleidomastoid and scalene musclesSternocleidomastoid and scalene muscles
Accessory muscles of expirationAccessory muscles of expiration• Abdominal and internal intercostal musclesAbdominal and internal intercostal muscles
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Muscles of VentilationMuscles of Ventilation
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Overview: Mechanics of BreathingOverview: Mechanics of Breathing Alveolar surface tensionAlveolar surface tension
Function of surfactantFunction of surfactant Elastic properties of lung and chest wallElastic properties of lung and chest wall
Elastic recoilElastic recoil ComplianceCompliance
Airway resistance Airway resistance Airway size Airway size Gas velocity (Poiseuille’s law)Gas velocity (Poiseuille’s law)
Muscular effortMuscular effort
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Mechanics of BreathingMechanics of Breathing
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Surface Tension of WaterSurface Tension of Water Tendency of water molecules to Tendency of water molecules to contractcontract to the to the
smallest possible surface area (bead) with smallest possible surface area (bead) with exposure to airexposure to air
Increased surface tension = increased work of Increased surface tension = increased work of breathingbreathing
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Laplace’s LawLaplace’s Law The smaller a sphere’s radius (alveoli) the The smaller a sphere’s radius (alveoli) the
greater the surface tension and the more difficult greater the surface tension and the more difficult (work) to expand the alveoli (work) to expand the alveoli
P = 2t/rP = 2t/r P = pressure inside a sphere (alveoli)P = pressure inside a sphere (alveoli) t = surface tensiont = surface tension r = radius of a spherer = radius of a sphere
Surfactant reduces fluid surface tension lining Surfactant reduces fluid surface tension lining the alveoli and decreases tendency to collapse, the alveoli and decreases tendency to collapse, preventing atelectasispreventing atelectasis
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ComplianceCompliance A measure of lung and chest wall distensibility or A measure of lung and chest wall distensibility or
“stiffness” “stiffness”
― ― volume of air movedvolume of air moved
― ― force to move the airforce to move the air Low: increased work of inspirationLow: increased work of inspiration
Stiff lungsStiff lungs High: increased work of expirationHigh: increased work of expiration
Baggy lungsBaggy lungs
VolumeC =
Pressure
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Measurement of Gas PressureMeasurement of Gas Pressure Barometric pressureBarometric pressure
Partial pressurePartial pressure Partial pressure of water vaporPartial pressure of water vapor
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Measurement of Gas PressureMeasurement of Gas Pressure
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Measurement of Gas PressureMeasurement of Gas Pressure
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Gas TransportGas Transport Four stepsFour steps
Ventilation of the lungsVentilation of the lungs Diffusion of oxygen from the alveoli into the Diffusion of oxygen from the alveoli into the
capillary bloodcapillary blood Perfusion of systemic capillaries with oxygenated Perfusion of systemic capillaries with oxygenated
bloodblood Diffusion of oxygen from systemic capillaries into Diffusion of oxygen from systemic capillaries into
the cellsthe cells Diffusion of CODiffusion of CO22 occurs in reverse order occurs in reverse order
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Gas TransportGas Transport Distribution of ventilation and perfusionDistribution of ventilation and perfusion
Gravity and alveolar pressureGravity and alveolar pressure Ventilation-perfusion ratioVentilation-perfusion ratio
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Gas Transport: OGas Transport: O22
Oxygen transportOxygen transport Diffusion across alveolocapillary membraneDiffusion across alveolocapillary membrane Determinants of arterial oxygenationDeterminants of arterial oxygenation Oxyhemoglobin association and dissociationOxyhemoglobin association and dissociation
• Oxyhemoglobin dissociation curveOxyhemoglobin dissociation curve
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Gas Transport: COGas Transport: CO22
Carbon dioxide transportCarbon dioxide transport Dissolved in plasmaDissolved in plasma BicarbonateBicarbonate Carbamino compoundsCarbamino compounds
Haldane effectHaldane effect
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Measurement of Gas PressureMeasurement of Gas Pressure
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Measurement of Gas PressureMeasurement of Gas Pressure
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Clinical Manifestations: HypoxemiaClinical Manifestations: Hypoxemia EarlyEarly
TachycardiaTachycardia Mild increase in blood pressureMild increase in blood pressure Diaphoresis (stress response)Diaphoresis (stress response) Confusion (CNS response)Confusion (CNS response) Loss of judgmentLoss of judgment Cyanosis after 5 g desaturationCyanosis after 5 g desaturation
LateLate StuporStupor Decreased BP, myocardium not getting enough ODecreased BP, myocardium not getting enough O22
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Control of Pulmonary CirculationControl of Pulmonary Circulation Hypoxic vasoconstrictionHypoxic vasoconstriction
Caused by low alveolar POCaused by low alveolar PO22
Blood is shunted to other, well-ventilated portions Blood is shunted to other, well-ventilated portions of the lungsof the lungs• Better ventilation and perfusion matchingBetter ventilation and perfusion matching• If hypoxia affects all segments of lungs, the If hypoxia affects all segments of lungs, the
vasoconstriction can result in pulmonary hypertensionvasoconstriction can result in pulmonary hypertension
Acidemia also causes pulmonary artery Acidemia also causes pulmonary artery constrictionconstriction
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Tests of Pulmonary FunctionTests of Pulmonary Function SpirometrySpirometry Diffusion capacityDiffusion capacity Residual volumeResidual volume Functional reserve capacity (FRC)Functional reserve capacity (FRC) Total lung capacityTotal lung capacity Arterial blood gas analysisArterial blood gas analysis Chest radiographsChest radiographs
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Aging and the Pulmonary SystemAging and the Pulmonary System Loss of elastic recoilLoss of elastic recoil Stiffening of the chest wallStiffening of the chest wall Alterations in gas exchangeAlterations in gas exchange Increases in flow resistanceIncreases in flow resistance
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Aging and the Pulmonary SystemAging and the Pulmonary System