Respiratory Tract, Ventilation, Gas Exchange PDF

Chapter 35 Respiratory Tract 1 Copyright © 2022, Elsevier Inc. All Rights Reserved.  2 Objectives  List the generalized functions of the respiratory...

Chapter 35 Respiratory Tract 1 Copyright © 2022, Elsevier Inc. All Rights Reserved.  2 Objectives  List the generalized functions of the respiratory system.  List and locate the organs of the respiratory system.  Identify, describe, and correlate the anatomy of the nose with its specialized functions.  List the anatomical divisions of the pharynx, the openings into and between its divisions, and its functions.  List the anatomical divisions, cartilages, and muscles of the larynx.  Describe the structures and functions of the trachea, bronchi, bronchioles, and alveoli. Copyright © 2022, Elsevier Inc. All Rights Reserved.  3 Objectives  Identify the lobes, bronchopulmonary segments, gross surface anatomy, and generalized functions of the lungs.  Discuss the structures and functions of the thorax and mediastinum in respiration.  Discuss disorders associated with the respiratory tract. Copyright © 2022, Elsevier Inc. All Rights Reserved.  4 Respiratory System  Main Functions  Provides large area for gas exchange between air and circulating blood  Moves air along respiratory passageways to and from gas-exchange surfaces of the lungs  Protects respiratory surfaces from dehydration, temperature changes, and pathogens  Produces sounds for speaking, singing, and other forms of communication  Aids in sense of smell Copyright © 2022, Elsevier Inc. All Rights Reserved.  5 Structural and Functional Organization  Upper respiratory tract  Nose, nasopharynx, oropharynx, laryngopharynx, larynx  Lower respiratory tract  Trachea, all bronchial tree segments, lungs  Conducting zone  All respiratory passageways from nose to bronchioles  Respiratory zone  Bronchiole, alveolar ducts, alveoli  Accessory structures  Oral cavity, rib cage, respiratory muscles Copyright © 2022, Elsevier Inc. All Rights Reserved. 6 Structural Plan of the Respiratory System Copyright © 2022, Elsevier Inc. All Rights Reserved.  7 Structure of the Nose  External  Bony, cartilaginous frame covered by skin containing sebaceous glands  Surrounded by maxilla at its base  Nasal bones (2) meet and are surrounded by the frontal bone, forming root of nose  Internal portion  Palatine bones separate nasal and mouth cavities  Cribriform plate separate roof of nose from cranial cavity  Divided by septum  Made of perpendicular plate of ethmoid bone, vomer bone, septal nasal and vomeronasal cartilages Copyright © 2022, Elsevier Inc. All Rights Reserved.  8 Structure of the Nose (cont’d)  Interior portion, continued  Each nasal cavity divided into 3 passageways  Superior, middle, inferior meatuses formed by turbinates from lateral walls of internal nose  Anterior nares  Vestibule  Lined with skin containing vibrissae, sebaceous glands, sweat glands  Posterior nares  Respiratory mucosa  Olfactory epithelium  Paranasal sinuses  Frontal, maxillary, ethmoid, sphenoid Copyright © 2022, Elsevier Inc. All Rights Reserved.  9 Nasal Septum & Paranasal Sinuses Copyright © 2022, Elsevier Inc. All Rights Reserved.  10 Functions of the Nose  Passageway for air going to and from lungs  Air entering through nasal cavity is  Filtered  Warmed and moistened  Chemically examined  Sinuses  Lighten skull  Serve as resonating chambers for speech Copyright © 2022, Elsevier Inc. All Rights Reserved.  11 Sequence of Airflow  Through nose into pharynx:  Anterior nares  Vestibule  Inferior, middle, superior meatuses (simultaneously)  Posterior nares Copyright © 2022, Elsevier Inc. All Rights Reserved.  12 Pharynx  Tubelike, muscular structure  Extends from base of skull to esophagus  Nasopharynx, oropharynx, and laryngopharynx  Contains seven openings  Tonsils  Pharyngeal, palatine, lingual  Functions  Digestive, respiratory, speech Copyright © 2022, Elsevier Inc. All Rights Reserved.  13 Subdivisions of the Pharynx  Nasopharynx – from internal nares to posterior edge of soft palate  Lined by ciliated respiratory epithelium  Contains pharyngeal tonsil and entrances to auditory tubes  Oropharynx – from soft palate to base of tongue  Lined by stratified squamous epithelium  Contains the palatine tonsils  Laryngopharynx – from base of tongue at level of hyoid bone to entrance of esophagus  Lined by stratified squamous epithelium Copyright © 2022, Elsevier Inc. All Rights Reserved.  14 Larynx  Location  Between root of tongue and upper end of trachea  Structure  Nine cartilages attached to one another and to surrounding structures by muscle  Lined with ciliated respiratory mucosa that forms two pairs of folds  Vestibular folds (upper folds)  Vocal folds (lower folds)  Vestibule  Cavity above the vestibular folds  Ventricle  Middle portion of cavity between sets of folds Copyright © 2022, Elsevier Inc. All Rights Reserved.  15 Larynx Copyright © 2022, Elsevier Inc. All Rights Reserved.  16 Laryngeal Cartilages Copyright © 2022, Elsevier Inc. All Rights Reserved.  17 Vocal Folds B and C: From Cox JD: Radiation oncology, ed 9, St. Louis, 2010, Mosby. 35-9: Adapted from Thompson JM, Wilson SF: Health assessment for nursing practice, St. Louis, 1996, Mosby. Copyright © 2022, Elsevier Inc. All Rights Reserved.  18 Muscles of the Larynx  Intrinsic muscles  Insert and originate within larynx  Important in controlling vocal fold length and tension  Regulate shape of pharyngeal inlet  Open and close the glottis  Extrinsic muscles  Insert in larynx but originate elsewhere  Both types play roles in  Respiration  Vocalization  Swallowing Copyright © 2022, Elsevier Inc. All Rights Reserved.  19 Functions of the Larynx  Respiration  Foreign particle removal from inspired air  Warming inspired air  Humidification of inspired air  Prevention of aspiration of solids or liquids  Voice production Copyright © 2022, Elsevier Inc. All Rights Reserved.  20 Trachea  Structure  About 4.5 inches long, extends from larynx to primary bronchi in thoracic cavity  Outer fibrous adventitia  C-shaped cartilage rings with open ends connected by smooth muscle on posterior  Provide firmness plus flexibility for esophageal expansion  Respiratory mucosa  Inferior tracheal cartilage with carina between  Function  Air delivery from outside to lungs Copyright © 2022, Elsevier Inc. All Rights Reserved.  21 Cross-Section of the Trachea Copyright © 2022, Elsevier Inc. All Rights Reserved.  22 Bronchi  Lower end of trachea divides into right and left primary bronchi  Similar structure to trachea  Incomplete rings superior to lungs, but complete rings within lungs  Each primary bronchi  Divides into secondary bronchi, then tertiary, then bronchioles in lungs  Terminal bronchioles  Divide into respiratory bronchioles Copyright © 2022, Elsevier Inc. All Rights Reserved.  23 Bronchioles  As proceed farther along bronchial tree:  Diameter decreases  Percentage of cartilage decreases  Bronchiole  Lung passageway when cartilage has disappeared  Walls dominated by smooth muscle  Sympathetic activation relaxes muscle, causing bronchodilation  Parasympathetic activation contracts muscle, causing bronchoconstriction Copyright © 2022, Elsevier Inc. All Rights Reserved.  24 Structure of the Alveoli  Spongelike  Alveolar pores  Extremely thin-walled  Respiratory membrane  Barrier across which gases are exchanged by alveolar air and blood  Surfactant  Reduces surface tension, preventing alveolar collapse Copyright © 2022, Elsevier Inc. All Rights Reserved.  25 Functions of the Bronchi & Alveoli  Transfer of oxygen to pulmonary blood  Purify air  Mucus blanket  Ciliary escalator Copyright © 2022, Elsevier Inc. All Rights Reserved.  26 Summary of Air Pathway from Nose to Alveolar Sacs  Nares  Multiple branches of  Nasal cavity bronchi  Bronchioles  Nasopharynx  Oropharynx  Terminal bronchioles  Laryngopharynx  Respiratory bronchioles  Larynx  Alveolar ducts  Trachea  Alveolar sacs  Primary bronchi  Secondary bronchi  Tertiary bronchi Copyright © 2022, Elsevier Inc. All Rights Reserved.  27 Lungs  Extend from diaphragm to above clavicles  Hilum  Slit on medial surface where primary bronchi and pulmonary blood vessels enter  Base  Inferior surface (rests on diaphragm)  Apex  Pointed upper margin  Costal surface  Lies against ribs Copyright © 2022, Elsevier Inc. All Rights Reserved.  28 Lobes of the Lungs and Lung Function  Left lung  Superior and inferior lobes  Right lung  Superior, middle, and inferior lobes  Secondary bronchi enter each lobe of each lung  Lobes divided into functional units  Bronchopulmonary segments  Tertiary bronchi enter each segment  Visceral pleura  Function of lungs  Air distribution and gas exchange Copyright © 2022, Elsevier Inc. All Rights Reserved.  29 Lobes and Segments of the Lungs Copyright © 2022, Elsevier Inc. All Rights Reserved.  30 Thorax  Structure  Three divisions, separated by pleura  Pleural divisions  Parts of thoracic cavity occupied by lungs  Mediastinum  Space between lungs  Occupied mainly by esophagus, trachea, large blood vessels, and heart  Function  Respiration  Expansion and contraction of thoracic cavity Copyright © 2022, Elsevier Inc. All Rights Reserved.  31 Questions? Copyright © 2022, Elsevier Inc. All Rights Reserved.  Chapter 36 Ventilation 32 Copyright © 2022, Elsevier Inc. All Rights Reserved.  33 Objectives  List and briefly discuss the regulated and integrated processes that ensure tissues have an adequate oxygen supply and prompt removal of carbon dioxide.  Define pulmonary ventilation and outline the mechanism of normal, quiet inspiration and expiration.  Discuss pulmonary volumes and capacities, and types of breathing; also, define these related terms: tidal volume, expiratory reserve volume, inspiratory reserve volume, residual volume, minimal volume, inspiratory capacity, functional residual capacity, and total lung capacity. Copyright © 2022, Elsevier Inc. All Rights Reserved.  34 Objectives  Explain how spirometry is used to generate information about airflow in an individual and define these related terms: total minute volume, forced expiratory volume, maximum oxygen consumption, and flow-volume loop.  Explain why matching ventilation and perfusion is important for efficient gas exchange in the lungs.  Discuss the regulation of ventilation, including the homeostasis of blood gases and pH, and the primary factors that influence the respiratory control center and thereby control respirations.  Discuss disorders associated with ventilation. Copyright © 2022, Elsevier Inc. All Rights Reserved.  35 Respiratory Physiology  External respiration  Pulmonary ventilation and gas exchange  Transport of gases by the blood  Internal respiration  Gas exchange in systemic blood capillaries between blood vessels and body cells  Cellular respiration  Regulation of respiration Copyright © 2022, Elsevier Inc. All Rights Reserved.  36 Inadequate Oxygen Concentrations  Hypoxia  Low tissue oxygen  Metabolic activities become limited  Anoxia  Supply of oxygen cut off completely  Cells die off quickly  Damage from strokes or heart attacks are a result of anoxia Copyright © 2022, Elsevier Inc. All Rights Reserved.  37 Pulmonary Ventilation  The physical movement of air into and out of the respiratory tract  Primary function to maintain alveolar ventilation  Movement of air into & out of alveoli  Prevents buildup of carbon dioxide  Ensures continuous supply of oxygen  Air moves down pressure gradient  In closed, flexible container (lung), air pressure is altered by changing the volume of container  Increase in volume decreases air pressure  Decrease in volume increases air pressure Copyright © 2022, Elsevier Inc. All Rights Reserved.  38 Pulmonary Ventilation  Volume of lung depends on volume of thoracic cavity  Diaphragm forms floor of thoracic cavity  Relaxed diaphragm is dome-shaped  Pushes up into thorax, compressing lungs  Contraction pulls it downward, increasing volume of thoracic cavity, expanding lungs  Rib cage  Elevation increases volume of thoracic cavity  External intercostal muscles and accessory muscles  Relaxation decreases volume of thoracic cavity  Internal intercostals and other accessory muscles Copyright © 2022, Elsevier Inc. All Rights Reserved.  39 Primary Principle of Ventilation  A fluid (liquid or gas) moves from area where pressure is higher to area where pressure is lower  Pulmonary ventilation requires establishment of two gas pressure gradients  Boyle’s law  Volume of a gas varies inversely with pressure at a constant temperature Contraction of diaphragm (inspiration) Expansion of thorax results in decreased PIP, leading to decreased PA Air moves into lungs when PA drops below PB Copyright © 2022, Elsevier Inc. All Rights Reserved.  40 Primary Principle of Ventilation Copyright © 2022, Elsevier Inc. All Rights Reserved.  41 Pressure Gradients Required for Ventilation Copyright © 2022, Elsevier Inc. All Rights Reserved.  42 Inspiration  Quiet inspiration  Produced by contraction of diaphragm alone or of diaphragm and external intercostals Start of inspiration: intrapleural pressure (PIP) is about 758 mmHg (about 2 mmHg less than atmospheric pressure) PIP decreases further to 756 mmHg with thorax enlargement Thorax movement also expands lungs, which decreases their pressure PA also drops (about 1-3 mmHg), so atmospheric air enters Copyright © 2022, Elsevier Inc. All Rights Reserved.  43 Inspiration Copyright © 2022, Elsevier Inc. All Rights Reserved.  44 Expiration  Passive process that begins when inspiratory muscles relax  Thorax size decreases  PIP increases  PIPalways less than PA to counteract collapse tendency of lungs and recoil efforts of elastic fibers  PIP – PA is called transpulmonary pressure  PA increases and air flows outward Copyright © 2022, Elsevier Inc. All Rights Reserved.  45 Compliance  Compliance is ease with which lungs expand  Greater compliance means easier to fill and empty lungs  Lower compliance requires greater force to fill and empty lungs  Dramatically increases energy needed for breathing  Compliance can be affected by these factors  Loss of supporting tissues due to alveolar damage increases compliance (as in emphysema)  Decrease in surfactant decreases compliance (as in respiratory distress syndrome)  Limits on movements of thoracic cage (as with arthritis) decreases compliance Copyright © 2022, Elsevier Inc. All Rights Reserved.  46 Pulmonary Volumes  Tidal volume (TV)  Amount of air exhaled after normal inspiration  Expiratory reserve volume (ERV)  Largest volume of air that can be forcibly exhaled after TV exhaled  Inspiratory reserve volume (IRV)  Amount of air that can be forcibly inhaled after normal inspiration  Residual volume  Amount of air that cannot be forcibly exhaled Copyright © 2022, Elsevier Inc. All Rights Reserved.  47 Spirometer (1 of 2) Copyright © 2022, Elsevier Inc. All Rights Reserved.  48 Pulmonary Capacities  Vital capacity (VC)  Largest volume of air a person can move into and out of lungs  IRV + TV + ERV  Inspiratory capacity (IC)  Maximal amount of air that can be inspired after a normal expiration  IC = TV + IRV  Functional residual capacity (FRC)  Amount of air at end of a normal respiration without contracting expiratory muscles  FRC = ERV + RV Copyright © 2022, Elsevier Inc. All Rights Reserved.  49 Pulmonary Capacities (cont’d)  Total lung capacity (TLC)  Total amount of air a lung can hold  TLC = TV + ERV + IRV + RV  Alveolar ventilation  Volume of inspired air that reaches alveoli  Anatomical dead space  Passageways occupied by air that don’t participate in gas exchange  Physiological dead space  Anatomical dead space plus any alveoli not able to perform gas exchange  e.g., in emphysema or other pulmonary disease Copyright © 2022, Elsevier Inc. All Rights Reserved.  50 Pulmonary Airflow  Total minute volume  Volume moved per minute (ml/min)  TV x RR = Total minute volume  Forced expiratory volume (FEV)  Volume of air expired per second during forced expiration  Flow-volume loop  Top of loop: expiratory airflow (vertical axis) and expiratory volume (horizontal axis)  Bottom of loop: inspiratory airflow (vertical axis) and inspiratory volume (horizontal axis) Copyright © 2022, Elsevier Inc. All Rights Reserved.  51 Ventilation and Perfusion  Alveolar ventilation  Airflow to alveoli  Alveolar perfusion  Blood flow to alveoli  Ventilation and perfusion match for efficiency  Arteriole and bronchiole diameters react to  Oxygen and carbon dioxide concentrations  Expressed as PO2 and PCO2 , respectively Copyright © 2022, Elsevier Inc. All Rights Reserved.  52 Respiratory Control Centers  Medullary rhythmicity center  Dorsal respiratory group (DRG)  Ventral respiratory group (VRG)  Alterations in breathing rhythm due to inputs to medullary rhythmicity center  Apneustic center in the pons  Abnormally long, deep inspirations  Pontine respiratory group in the pons  May regulate both medullary rhythmicity center and apneustic center  Cerebral cortex  Allows for voluntary alterations to breathing Copyright © 2022, Elsevier Inc. All Rights Reserved.  53 Feedback and Responses  Chemoreceptors monitor changes in oxygen, carbon dioxide, and pH  Peripheral chemoreceptors respond to  Low plasma PO2  High plasma PCO2  Low plasma pH (when plasma acidity exceeds buffering capacity)  Rapid changes  Central chemoreceptors respond to  High CSF PCO2  And/or low CSF pH  Ongoing changes Copyright © 2022, Elsevier Inc. All Rights Reserved.  54 Factors That Influence Breathing  Arterial blood pressure  Respiratory pressoreflex mechanism  Hering-Breuer reflexes  Depth of respirations and volume of tidal air  Blood temperature  Sensory impulses from skin thermal receptors and superficial or deep pain receptors Copyright © 2022, Elsevier Inc. All Rights Reserved.  55 Local Control of Respiration  In the tissues:  Increased activity results in:  Decrease in tissue PO2 and increase in PCO2  Result is more rapid diffusion of O2 into cells, CO2 out of cells  In the lungs:  When alveolar capillary PO2 is low:  Precapillary sphincters constrict, shunting blood to high PO2 pulmonary lobules  When air in bronchioles has high PCO2 bronchioles dilate; when low they constrict  Causes airflow to be directed to lobules with high PCO2 Copyright © 2022, Elsevier Inc. All Rights Reserved.  56 Brain Respiratory Centers  Voluntary control resides in cerebral cortex  Involuntary respiratory centers  Three pairs of nuclei in pons and medulla oblongata  Paired respiratory rhythmicity centers set breathing rate  Dorsal respiratory group (DRG) has inspiratory center  Ventral respiratory group (VRG) has expiratory center  Nuclei in pons  Adjustrespiratory rate and depth in response to sensory stimuli, emotions, speech patterns Copyright © 2022, Elsevier Inc. All Rights Reserved.  57 Brain Respiratory Centers (cont’d)  DRG triggers every breath  Innervates diaphragm and external intercostals  Center stimulates muscles for two seconds  Causes inspiration  Becomes “silent” for three seconds and muscles relax  Causes passive exhalation  VRG functions only during forced breathing Copyright © 2022, Elsevier Inc. All Rights Reserved.  58 Mechanoreceptor Reflexes  Modify activities of respiratory centers during forced breathing  Respond to changes in lung volume or BP  Inflation reflex  Prevents overinflation of lungs  Afferentfibers of vagus nerves inhibit DRG and stimulate VRG  Deflation reflex  Inhibits VRG, stimulates DRG  BP rises, carotid and aortic bodies stimulate DRG, respiration increases Copyright © 2022, Elsevier Inc. All Rights Reserved.  59 Chemoreceptor Reflexes  Receptors in carotid and aortic bodies respond to changes in pH, PCO2 and PO2  Receptors in medulla oblongata respond to pH and PCO2  PCO2 has strongest and most immediate effect  Chemoreceptors respond to pH, especially during exercise, with increase in H2CO3 and lactic acid  Increases in PCO2 and decreases in pH are prime stimulators of respiratory rate increases Copyright © 2022, Elsevier Inc. All Rights Reserved.  60 Control by Higher Centers  Voluntary control of respiratory muscles  Respiration can be suppressed or exaggerated  Control required for singing and talking  Limbic centers of brain  Trigger changes in respiratory depth and rate due to emotional influences  Effects are involuntary Copyright © 2022, Elsevier Inc. All Rights Reserved. Questions? Copyright © 2022, Elsevier Inc. All Rights Reserved. 61  Chapter 37 Gas Exchange and Transport 62 Copyright © 2022, Elsevier Inc. All Rights Reserved. Objectives 63  Demonstrate the principles of partial pressures (Dalton’s law) in explaining the movement of respiratory gases between alveolar air and the blood moving through the pulmonary capillaries.  Discuss the major factors that determine the volume of oxygen entering lung capillary blood.  Explain how blood transports oxygen and carbon dioxide.  Discuss gas exchange in tissue capillaries between arterial blood and cells, and explain the reciprocal effect of oxygen and carbon dioxide on blood gas transport (Bohr vs Haldane effect). Copyright © 2022, Elsevier Inc. All Rights Reserved.  64 Gas Transport  O2 and CO2 have limited ability to dissolve in plasma  Tissues need more O2, and generate more CO2, than can be dissolved  Red blood cells (RBCs) can carry both gases on hemoglobin  CO2 can chemically convert to soluble compound  As gases are removed from plasma, more diffuse in  All reactions are temporary and completely reversible Copyright © 2022, Elsevier Inc. All Rights Reserved. Partial Pressure of Gases  Law of partial pressures (Dalton’s law)  Arterial blood PO2 and PCO2 = alveolar PO2 and PCO2 65 Copyright © 2022, Elsevier Inc. All Rights Reserved. Exchange of Gases in the Lungs  Four determinants of amount of oxygen that diffuses into blood:  Oxygen pressure gradient between alveolar air and blood  Total functional surface area of respiratory membrane  Respiratory minute volume  Alveolar ventilation 66 Copyright © 2022, Elsevier Inc. All Rights Reserved.  67 Exchange of Gases in the Lungs  Structures that facilitate oxygen diffusion from alveolar air to blood:  Alveoli and capillary walls form only a very thin barrier for gases to cross  Alveolar and capillary surfaces are large  Small diameter of pulmonary capillaries  Lung capillaries accommodate a large amount volume of blood at one time Copyright © 2022, Elsevier Inc. All Rights Reserved.  68 How Blood Transports Gases  Oxygen and carbon dioxide  Transported as solutes and part of other chemicals  Hemoglobin (Hb)  Four polypeptide chains (two alpha chains, two beta chains), each with an iron-containing heme group  Carbon dioxide  Can bind with amino acids in chains  Oxygen  Can bind with iron in heme groups Copyright © 2022, Elsevier Inc. All Rights Reserved.  69 Hemoglobin From Patton KT, Thibodeau G: Human body in health & disease, ed 6, St. Louis, 2014, Mosby. Copyright © 2022, Elsevier Inc. All Rights Reserved.  70 Transport of Oxygen  Oxygenated blood  PO2 of 100 mmHg  about 0.3 ml of dissolved O2 per 100 ml  Oxygen-hemoglobin dissociation curve Copyright © 2022, Elsevier Inc. All Rights Reserved.  71 Transport of Carbon Dioxide  About 10% dissolved in plasma  Less than ¼ as carbaminohemoglobin  More than 2/3 as bicarbonate ions  Increase in carbon dioxide in blood leads to increase in acidity Copyright © 2022, Elsevier Inc. All Rights Reserved.  72 Formation of Bicarbonate Copyright © 2022, Elsevier Inc. All Rights Reserved.  73 Systemic Gas Exchange  Takes place between arterial blood flowing through tissue capillaries and cells  Partial pressure gradient  Decreased PO2 accelerates oxyhemoglobin dissociation  Carbon dioxide exchange in opposite direction from oxygen exchange Copyright © 2022, Elsevier Inc. All Rights Reserved.  74 Systemic Gas Exchange Copyright © 2022, Elsevier Inc. All Rights Reserved.  75 Systemic Gas Exchange Copyright © 2022, Elsevier Inc. All Rights Reserved.  76 Cycle of Life  Premature birth  Lack of surfactant, inadequate blood flow to lungs  Specific age groups  Children: CF and asthma  Older adults: COPD, emphysema, decreased flexibility in ribs and sternum Copyright © 2022, Elsevier Inc. All Rights Reserved.  77 The Big Picture  Respiration  Every cell  Exchange of gases  Needs to acquire oxygen between environmental air  Produces and needs to discard and blood carbon dioxide  Gas exchange between  Ventilation blood and individual  Brings air to blood cells  Nervous system  Dependent on structural  Assesses and addresses changes in organization and O2 and CO2 interrelationships  Muscular and skeletal systems  Nervous system  Move and protect thoracic cavity  Cardiovascular system  Immune system  Muscular system  Protects from inhaled pathogens  Immune system Copyright © 2022, Elsevier Inc. All Rights Reserved. Mechanisms of Disease: 78 Disorders of the Upper Respiratory Tract  Inflammation and infection  Upper respiratory infection (general name)  May spread to sinuses or ears  Rhinitis (inflammation of the nasal mucosa)  Pharyngitis, laryngitis, tonsillitis  Anatomical disorders  Deviated septum  Sleep apnea  Epistaxis Copyright © 2022, Elsevier Inc. All Rights Reserved. Mechanisms of Disease: 79 Disorders of the Lower Respiratory Tract  Lower respiratory infection  Acute bronchitis  Pneumonia  Various causes and locations  Tuberculosis (TB)  Lung cancer  Non-small cell and small cell  Metastases common at time of diagnosis Copyright © 2022, Elsevier Inc. All Rights Reserved. Mechanisms of Disease: 80 Disorders Associated With Ventilation  Restrictive pulmonary disorders  Caused by factors in and outside lungs  Obstructive pulmonary disorders  Chronic obstructive pulmonary disease (COPD)  Bronchitis  Emphysema  Asthma Copyright © 2022, Elsevier Inc. All Rights Reserved.  81 Questions? Copyright © 2022, Elsevier Inc. All Rights Reserved.