A&P PULM PDF

Anatomy Heading 1:THE RESPIRATORY SYSTEM Heading 2: FUNCTIONS OF RESPIRATORY SYSTEM ✩ ✩ ✩ ✩ ✩ ✩ Gas exchange between air & circulating blood Protects respiratory surfaces Allows for speech Provides protection against pathogens Regulate blood volume Help regulate BP and bodily fluid pH Heading 3: str...

Anatomy Heading 1:THE RESPIRATORY SYSTEM Heading 2: FUNCTIONS OF RESPIRATORY SYSTEM ✩ ✩ ✩ ✩ ✩ ✩ Gas exchange between air & circulating blood Protects respiratory surfaces Allows for speech Provides protection against pathogens Regulate blood volume Help regulate BP and bodily fluid pH Heading 3: structures of the upper respiratory system ✩ ✩ ✩ ✩ Nose Nasal cavity Paranasal sinuses Pharynx Heading 4: Review of the nose ✩ Only EXTERNAL PART of the respiratory system ○ Left and right side via nasal septum ✩ Boundaries of the nasal cavity ○ maxilla, nasal, frontal, ethmoid, sphenoid, hard and soft palate Heading 5: Mucosa of the nasal cavity ✩ Lines the nsal cavity ✩ Ciliated pseudostratified columnar epithelium ○ Goblet cells scattered throughout Use: Mucous production Trapping foreign particles = dust & allergens ✩ Rich plexuses of blood vessels ✩ Warms the air as it enters the body Heading 6: Nasal Turbinates (conchae) ✩ Structures projecting medially from the lateral walls of nasal cavity ○ Superior ○ Middle ○ Inferior ✩ USE: ○ Works w/ nasal mucosa to ….. the air Filter Moisten Warm Heading 7: Paranasal sinuses ✩ ✩ ✩ ✩ ✩ Frontal Sphenoid Ethmoid Masillary USE: ○ Warming & filtration just like the nasal mucosa Heading 8: Pharynx (throat) ✩ Connects together: ○ Nasal cavity ○ Mouth ○ Larynx ○ Esophagus ✩ USE: ○ Function as common way for food & air ✩ Separated into 3 different regions: ○ Nasopharynx ○ Oropharynx ○ Laryngopharynx Heading 9: Nasopharynx ✩ Location: ○ Directly posterior to the nasal conchae ✩ USE: ○ ONLY allows for air to pass through Heading 10: Oropharynx ✩ Location: ○ Directly posterior to the oral cavity ✩ USE: ○ Allows for food AND air to pass through Heading 11: Laryngopharynx ✩ Location: ○ Found posterior to the epiglottis and the larynx ✩ USE: ○ Allows for air AND food to pass through Heading 12: Structures of the lower respiratory system ✩ ✩ ✩ ✩ ✩ Layrnx Trachae Bronchial tree Alveoli Lungs Heading 13: Larynx ✩ USE: ○ ✩ Location: ○ ○ ✩ Contains: ○ ○ ○ ○ ○ ○ ○ “Open airway” AND “protector” of the airway Level of C3-C6 Continuous w/ the trachea (windpipe) Thyroid cartilage Cricoid cartilage Arytenoid cartilage Corniculate cartilage Cuneifrom cartilage Epiglottis Vocal cords Heading 14: Structure of the Larynx ✩ All made of HYALINE CARTILAGE EXCEPT epiglottis ✩ Thyroid cartilage = adam’s apple ✩ Epiglottis ○ Elastic cartilage ○ Covers the larynx during swallowing ○ Opens during cough reflex when particles go down the larynx (wrong pipe) Heading 15: Trachea ✩ AKA windpipe ✩ USE: ○ Bring air to the lungs ✩ Location: ○ Comes from the larynx through the neck & into the chest (mediastinum) & sits in the middle of the lungs ✩ Outer part: ○ Composed of c-shaped hyaline cartilage rings ○ Rings are connected by annular ligaments Heading 16: Carina ✩ Location: ○ Lies @ base of trachea & separates the left & right main bronchus ✩ One of the most sensitive areas ✩ COUGH REFLEX often started here Heading 17: Cough Reflex ✩ Protects the lungs from foreign objects & excess secretions ✩ Initiated by irritant receptors in the tracheobronchial walls ✩ Different impulses travel through the vagus nerve (CN X) the other medulla oblongata which integrates the cough reflex Heading 18: Bronchi ✩ Bronchial tree contains ○ 2 main bronchi ○ Multiple subdivisions that branches w/in lungs ✩ Main bronchus → lobar bronchi → segmental bronchi → terminal bronchioles Heading 19: Pulmonary zones ✩ Conducting zone ○ Structures included: Nose to the terminal bronchioles ○ USE: Filters, moistens, warms incoming air Distribute air evenly to all regions of the lungs ✩ Respiratory zone ○ Structures included: Respiratory bronchioles to the alveoli ○ USE: Site of gas exchange Heading 20: Air pathway ✩ Trachea → Main bronchi → Lobar bronchi → segmental bronchi → terminal bronchioles → respiratory bronchioles → alveolar ducts → alveolar sacs → alveoli Heading 21: Alveoli ✩ GAS EXCHANGE ○ Removes the CO2 and O2 supplies the O2 ✩ Responsible conducting gas exchange between the lungs & the circulating blood ✩ Surrounded by the capillaries ✩ Microscopic Heading 22: Cells w/in the alveoli ✩ TYPE 1 alveolar cells ○ made of squamous epithelial cells ○ Line the walls of alveoli ○ USE: structure Nice surface area for Gas exchange Minimal permeability of leaking of fluid ✩ TYPE 2 alveolar cells ○ Made of cuboidal epithelial cells ○ Lies in the internal alveolar surfaces ○ Secretes surfactant (lamellar inclusion bodies) ✩ Alveolar macrophages Heading 23: Pleura ✩ Continuous serous sack that the lungs invade (like a fist in a balloon) ✩ Visceral pleura ○ Tissue covering lung surface itself (to include inot the fissures) ✩ Parietal pleura ○ Tissues covering: inner costal walls Floor (diaphragm) Mediastinum ✩ Pleural space (cavity/sac) ○ Potential space between two layers Heading 24: Left & Right Lungs ✩ Right lungs ○ 3 lobes Right upper (superior) lobe Right middle lobe Right lower (inferior) lobe Separated by oblique & horizontal fissure Smaller than the left - 2/2 liver ✩ Left lung ○ 2 lobes Left upper (superior) lobe Right lower (inferior) lobe Separated by oblique fissure Cardiac notch that accommodates the heart Heading 25: Lungs ✩ Each lung contains: ○ Apex ○ Base ○ Hilum ○ Fissures Right has 2 → horizontal and oblique Left has 1 → oblique ✩ Apex is superior blunt end of the lung that ascends past the 1st rib into the root of the neck ✩ Horizontal fissures: separates superior & middle lobe ✩ Oblique fissures: separates middle lobe & inferior lobe (left and right lungs) ✩ Base is the opposite end that rests on the dome of the diaphragm ✩ Hilum is a wedge shaped area on the mediastinal side of each lung that is the entrance/exit for: ○ Mainstem bronchus and pulmonary vasculature (artery/veins) ○ Nerves (sympathetic & parasympathetic) ○ Lymph nodes ○ Vessels Heading 26: Vasculature of the lungs & pleura ✩ 2 blood supplies/circulation: ○ Pulmonary ○ Bronchial ✩ Right and left pulmonary arteries arise from pulmonary trunk @ the level of the sternal angle ✩ Artery divides @ the root (hilium) → lobar arteries → segmental arteries traveling w/ each level of bronchial tree branching ✩ Arterioles travel w/ the bronchioles & terminate @ the capillary level associated w/ the alveoli Heading 27: Function of theVasculature of the lungs & pleura ✩ Gas exchange ✩ Filter ○ Thrombi & emboli ✩ Metabolize hormones ✩ Blood reservoir ○ ~10% of total circulating blood volume Heading 28: Pulmonary blood supply ✩ Each lung ○ 1 pulmonary artery to bring blood to the lungs Right & left pulmonary arteries Arise from the pulmonary trunk (right ventricle) @ the level of the sternal angle Carries low oxygen to the lungs for oxygenation Follows bronchial tree division → divides into pulm arterioles that form capillary bed for alveoli ○ 2 pulmonary veins draining blood from the lungs Superior & inferior pulm vein (left & right Carry oxygen rich blood from the lungs to the left atrium of the heart Venules from the capillary bed carry blood into the pulmonary veins & drain into the left atrium Heading 29: Bronchial blood supply ✩ Bronchial arteries (not part of pulm artery system) ○ arise from: thoracic aorta aorta Posterior intercostal arteries ○ Supply Tissues of: Lungs Visceral pleura Lymphatic Bronchial tree ✩ Capillaries → bronchial veins → Vena Cava ✩ Bronchial veins return SOME blood from central lung tissue & bronchial tree to AZYGOUS VENOUS SYSTEM ✩ Peripheral blood and visceral pleura blood is returned via PULMONARY VEINS ✩ USE: ○ 2nd function of warming & humidifying incoming air as it moves through conducting airway Heading 30: Lymphatics of the lungs ✩ Two systems ○ Superficial lymphatic plexus ○ Deep lymphatic plexus ✩ Superficial ○ Drains surface lung tissue & visceral pleura into the bronchopulmonary nodes (hilar nodes) ✩ Deep ○ Drains the bronchial tree → pulmonary nodes → hilar nodes ○ USE: Catch plasma proteins & prevents accumulation of fluid in the pleural cavity Heading 31: Nerves of the lungs ✩ Parasympathetic fibers (from CN X - vagus nerve) ○ USE: Convey motor to the smooth muscle of the bronchial tree for Bronchoconstriction Vasodilation of pulm vessels Secretomotor to the glands of the bronchial tree ✩ Sympathetic fibers (sympathetic ganglia of the sympathetic trunks along the spine) ○ USE: Convey motor also to the bronchial muscle for bronchodilation (inhibit the muscle) Vasoconstriction of the pulmonary vessels Inhibitory to the type II (surfactant) alveolar epithelial cells ✩ Visceral afferent fibers are either ○ Reflexive = convey sensation reflexes associated w/ respiratory function ○ Nociceptive ✩ Parietal pleura ○ Nerves come from intercostal nerves & phrenic nerves Heading 32: Thoracic wall ✩ ✩ ✩ ✩ ✩ ✩ Ribs - 12 pair along w/ costal cartilage Vertebrae - 12 thoracic vertebrae Sternum - manubrium, body, & xiphoid Intercostal muscles - external, internal, and innermost Intercostal V.A.N.s - veins, arteries, & nerves Parietal pleura - lining of the cavity Heading 33: Thoracic Cavity ✩ Mediastinum (Central cavity) ○ Heart ○ Trachea ○ Great vessels (aorta/superior vena cava) ✩ Pleural (pulm) cavities ○ Lungs ○ Bronchi ○ Pulm arteries and veins ○ Bronchial arteries & veins Heading 34: Ribs ✩ Bones that form the thoracic cavity (rib cage) ✩ 12 sets ✩ 3 types ○ True ribs (vertebrosternal), ribs 1-7 Attach directly to the sternum via costal cartilage ○ False ribs (vertebrochondral) ribs 8-10 Connection to the sternum is indirect via the cartilage of the rib above it ○ Floating ribs (vertebral, free) ribs 11-12 Do NOT connect to the sternum at all Heading 35: Joints of the thoracic wall ✩ Costovertebral - ribs to vertebrae ✩ Costotransverse - ribs to transverse process of vertebrae ✩ Sternocostal - ribs to sternum via costal cartilage Heading 35: Muscles of the thoracic wall ✩ Serratus Posterior superior ○ Elevates the ribs ✩ Serratus posterior inferior ○ Depresses the ribs ✩ Levator costarum ○ Elevates the ribs ✩ Transversus thoracis ○ Weakly dresses the ribs ✩ Intercostals (external, internal, and innermost) ○ External: elevate during FORCED INSPIRATION ○ Internal: depresses ribs during forced respiration ○ Innermost: depresses ribs during FORCED RESPIRATION ✩ Subcostal ○ Depresses ribs during forced respiration ✩ Diaphragm ○ Primary muscle of inspiration Heading 36: Serratus posterior ✩ Superior muscles ○ Helps to elevate the 1st 4 ribs during inspiration ○ Location: Deep to the rhomboid major, minor, and levator scapulae muscles ✩ Inferior muscles ○ Used to pull down the lower ribs during exhalation ○ Location: Deep to the latissimus dorsi muscle Heading 37: Levatores costarum ✩ Helps to elevate ribs ✩ 12 pairs that attach to each rib ✩ Location: ○ Deep to the iliocostalis lumborum & longissimus thoracis in the lower back Heading 38: Transversus Thoracis ✩ Continuous w/ the transversus abdominis muscles ✩ Provides proprioception information Heading 39: Fascia of the Thoracic wall ✩ Pectoral fascia ✩ Clavipectoral fascia ✩ Endothoracic fascia Heading 40: Nerves of the thoracic wall ✩ Intercostal nerves ✩ Subcostal Heading 41: Vasculature of the thoracic wall ✩ Each rib has an artery & vein on the internal inferior costal groove ✩ Anteriorly the blood drain to the internal thoracic veins ✩ Posteriorly the blood drains to the azygos venous system Heading 42: Structures for ventilation ✩ Inspiration (inhalation) ○ Diaphragm ○ Intercostal muscles ✩ Expiration (exhalation) ○ Passive Heading 43: Diaphragm ✩ Curved musculotendinous sheath ✩ Separates ○ Thoracic cavity from the abdominal cavity (inferiorly & posteriorly ✩ Flat central surface w/ a left and right dome ○ Right dom slight high 2/2 liver ✩ Main muscle of inspiration ○ Helps increase intraabdominal pressure ✩ Attached to sternum, ribs 11 and 12, and part of the lumbar spine ✩ Innervation: phrenic nerve Heading 44: Intercostal muscles ✩ External - 11 pairs ○ Sits in the intercostal spaces ✩ Internal - 11 pairs ○ Run deep & @ right angles to the external intercostal muscles ✩ Innermost - deepest fibers of the internal intercostal ✩ Muscles are used during forced inspiration & experiation Heading 45: Subcostal muscles ✩ Vary in size ✩ Crosses 1-2 intercostal spaces ✩ Run same direction @ internal intercostals Heading 46: Respiratory accessory muscles ✩ Function when needed: ○ Forced respiration (inspiration mostly) ✩ Muscles include: ○ Pectoralis major & minor ○ Scalene (anterior, medius, and posterior ○ Sternocleidomsatoid ✩ Recruited during: ○ Exercise ○ Trouble breathing ○ Various disease states Physiology Heading 1: Basic properties of Gases ✩ Air we breath is a mix of: ○ Nitrogen ○ Oxygen Definition: ✓ Atmospheric pressure: air we breath exerts a combined pressure Sea level = pressure is defined as 1 atm or 760 mmHg or 0 respiratory pressure ○ ✓ Partial pressure: pressure exerted by a single gas, say O2 PO2 ○ ✓ Ventilation: movement of gasses into & out of the lungs through open airways along a pressure gradient riesling from a change in chest volume ✓ Respiratory pressure intrapulmonary (alveolar) pressure: pressure inside the airways and alveoli of the ○ lungs Gases in these areas are in communication with atm pressure Intrathoraic pressure: pressure in the thoracic cavity = to intrapleural pressure Intrapleural pressure: pressure in the pleural cavity ○ Always NEGATIVE ( relation to intrapulmonary pressures) for normal inflated lung ( during inspiration) Ventilation: exchange of gases in the respiratory system Dependent on body position ○ Pulmonary: total exchange of gases between the atmosphere and lungs ○ Alveolar: exchange of gases between alveoli and capillaries ○ Dead air space: space where air is NOT USED IN GASEOUS EXCHANGE Trachea, bronchi, bronchioles ○ Perfusion: flow of blood through the pulm capillary beds and the exchange of gases that occurs there Dependent on body position ○ Low perfusion - can cause hypoxia ○ Diffusion: movement of gases across the alveolar capillary membrane in the respiratory portion of the lung Various factors influence rate of diffusion ○ Administration of oxygen = ↑ rate of diffusion Lung disease → destroy lung tissue = ↓ rate of diffusion ○ ✓ ✓ ✓ ✓ Heading 2: Respiratory pressures ✩ Lungs and chest wall each have elastic properties ○ Oppose each other in pull during inspiration Make the visceral & parietal pleura try to pull apart Pleural fluid & the closed space don’t allow them to separate Heading 3: Respiratory pressures - thoracic cage & respiratory muscles ✩ ENLARGING volume during inspiration of the thoracic cavity initially causes the pressure INSIDE the cavity to fall ○ Pressure gradient between the alveoli and the atmosphere ○ Air moves from high to low pressure areas to equalize on both sides ○ Airways & alveoli are open to the atmosphere → air now flows into them Heading 4: Ventilation & perfusion ✩ Proper exchange of gases between air and the blood ○ Matching of ventilation and perfusion ○ Gas exchange = blood flow ○ Equal amounts of air and blood enter respiratory portion of lungs ✩ Mismatching 2/2 ○ Dead air space ○ Shunting - perfusion w/o ventilation or vice versa ○ V/Q scan used to asses mismatching of ventilation and perfusion Heading 5: O2 and CO2 transport ✩ Lungs = exchange of gases w/ external environment ✩ blood = exchange of gases between lung and body tissues ○ Carried in a dissolved state & in combination w/ Hg ✩ Blood gas measurements are used to determine in the blood (arterial blood gas): partial pressure of Oxygen (PO2) ○ Carbon dioxide (PCO2) ○ Heading 5: O2 transport ✩ Transported in 2 forms ○ Combination w/ hemoglobin ○ Dissolved state ✩ Hemoglobin is main transporter of oxygen (98-99%) & 1% in the dissolved state ○ Oxyhemoglobin = hemoglobin bound to oxygen ○ deoxygenated/reduced hemoglobin = when oxygen is removed ○ 1 gram of hemoglobin = 1.34ml O2 ✩ Transport of oxygen involves 3 parts ○ Transfer form alveoli to pulm capillaries in the lungs ○ Hemoblogin binding and transport ○ Dissociation from hemoglobin in the tissue capillaries Heading 5: CO2 transport ✩ Transported in 3 forms ○ Dissolved CO2 ○ Attached to hemoglobin (30%) Release of oxygen in the tissues allows CO2 to bind and be carried from the tissues Lungs combining of O2 and hemoglobin displaces the CO2 and thus releases the alveoli for gas exchange ○ As bicarbonate Heading 6: Breathing - neurological side ✩ Primarily autonomic ✩ Controlled by respiratory centers in the brainstem Heading 7: Respiratory Center ✩ 2 bilateral aggregates fo respiratory neurons ○ located : pons & medulla ○ Initiate: inspiration / expiration ○ Incorporates afferent impulses into motor responses of the respiratory muscles ○ First group of neurons (dorsal) Used primarily for inspiration Control the activity of the phrenic nerve Drives the 2nd group of neurons (ventral) ○ Second group of neurons (ventral) Inspiratory and expiratory neurons Controls spinal motor neurons and abdominal muscles Heading 8: Breathing regulation ✩ Automatic regulation ○ Chemoreceptors: monitor blood levels of O2, CO2, and pH Adjust ventilation to meet the metabolic changes of the body ○ Lung receptors: monitor breathing patterns & lung function ✩ Voluntary regulation ○ Integrates breathing w/ voluntary act such as: speaking Blowing Singing ○ Causes a temporary suspension of automatic breathing Heading 9: Chemoreceptors ✩ Central chemoreceptors ○ Location Chemo sensitive regions near the respiratory center in the medula ○ Extracellular fluid responds to changes in hydrogen concentration ✩ Peripheral chemoreceptors ○ Location: Carotid and aortic bodies ○ Mainly moinotrs oxygen levels (hypoxia main stimulus) Heading 10: Lung Receptors ✩ 3 types: ○ ○ ○ Stretch Irritant Juxtacapillary Heading 11: Stretch ✩ Location: ○ Smooth muscle layers of the conducting airways ✩ Responds to changes in pressure in the wall of the airways Heading 12: Irritant ✩ Location: ○ Between the airway epithelial cells ✩ Responds to noxious gases, cigarette smoke, inhaled dust, cold air Heading 13: Juxtacapillary receptors ✩ Location: ○ Alveolar wall near the pulmonary capillaries ✩ Sense lung congestion Heading 14: Lung compliance ✩ Ease with which the lungs can be inflated ✩ = change in lung volume w/ a given change in respiratory pressure ○ C=ΔV/ΔP ✩ Determined by elastin & collagen fibers, water content, and surface tension of lungs ✩ W/o lung proper lung compliance air will not move well (part of the recoil Heading 15: Airway compression during forced exhalation ✩ Air way resistance: ○ Does not change much during normal quiet breathing ○ Increases during forced exhalation → vigorous exercise ✩ Airflow through airways: ○ Depends on the distending pressure inside that holds them open ○ Pressures trying to collapse them from the outside ○ Distending pressure MUST be > compressing pressure ○ Compressing pressure > distending pressure Airways will collapse trapping air in the terminal airways ○ ASTHMA & COPD Pressure drop along the smaller airways is magnified & an ↑ in intra-airway pressure is needed to maintain patency ○ purse-lipped breathing is used to increase the expiratory pressure against the airways Heading 16: Lung Volumes ✩ Lung volumes, or the amount of air exchanged during ventilation divided into 3 components: ○ Tidal volume (TV) ○ Inspiratory Reserve Volume (IRV) ○ Expiratory Reserve Volume (ERV) ✩ TV is normally about 500 mL (per breath) ✩ ERV is normally about 1200 mL (after each exhalation) ✩ IRV is normally about 3100 ml (after each TV) Definition: ✓ Tidal volume (TV): Normal resting breath ✓ Inspiratory Reserve volume (IRV): MAXIMUM volume of air that can be forcefully inhaled in excess of the TV ✓ Expiratory Reserve Volume (ERV): MAXIMUM volume of air that can be forcefully exhaled in excess of the TV ✓ Residual Volume (RV): volume remaining in lungs are ERV ✓ Inspiratory Capacity (IC): IRV + TV ✓ Functional Residual Capacity (FRC): RV + ERV ✓ (Forced) Vital Capacity (VC): IRV + TV + ERV ✓ Total Lung Capacity (TLC): Sum of ALL volumes Heading 17: Pulmonary Function Tests ✩ Measure of ventilation w/ respect to time ○ Maximum voluntary ventilation - maximum air breathed over a given time ○ Forced Vital Capacity (FVC) - maximum air that can be rapidly and forcefully EXHALED after full inhalation plotted over time ○ Forced expiratory volume achieved in 1 sec - volume of air exhaled in the 1st sec of FVC Usually expressed as a % of FVC ○ Forced mid expiratory flow rate (FEF) - determined by locating points on volume/ time curve between 25% and 75% of air moved Slope of line represents rate ○ Forced inspiratory flow rate (FIF) - volume inspired from residual volume (RV) @ point of measurement Slope of line represent volume pressure of inspired volume