1 Lungs

Made of resilient elastic fibers Rest on the diaphragm The Lung-Thorax Unit Lungs and thorax normally operate together Natural resting position Lungs are somewhat expanded Thorax is somewhat compressed Lung Mechanics Lungs expand as a result of enlarging structure around them Diaphragm contracts to enlarge the vertical dimension Rib cage is elevated to enlarge the transverse dimension. A closed system is needed for the lungs to expand Closed System Thoracic cavity holding lungs is supported by muscle and bone Lungs not held to the walls by ligaments or cartilage Bottom of cavity completely sealed by diaphragm Air can only enter or leave lungs via bronchial tree extending into upper respiratory pathway Lung and Thoracic Walls Lungs and inner thoracic walls are completely covered by a pleural lining Lining connects lungs to thorax for coordinated movement The outer surface of each lung is covered by visceral pleura Chest wall covered by parietal pleura Pleura Pleural Linings Visceral pleurae Parietal pleurae Mediastinal pleura Diaphragmatic pleura Costal pleura Apical pleura Pleural Linings Visceral pleurae - Lining that encases the lungs Parietal pleurae - Thoracic wall lining Mediastinal pleura - Covers the mediastinum Diaphragmatic pleura - Covers the diaphragm Costal pleurae - Covers inner surface of rig cage

2 Apical pleurae - Covers the superior-most region of the rib cage Pleura Visceral and parietal pleurae are continuous with each other This sheet provides an airtight seal needed to permit lungs to follow thorax movement Cuboidal cells between pleurae produce surfactant Pleura and Breathing Surface tension keeps pleural linings together Surfactant Fluid consistency Surface tension in lungs reduced Slippery connection between lungs and thoracic wall Low-friction gliding action of lungs with the thorax Mechanics of Respiration Involve muscles of inspiration and expiration Will cover anatomy as well as physiology Pressures in Respiratory Pump Alveolar Pressure Pressure within the lungs Pleural Pressure Pressure within the thorax, but outside the lungs Abdominal Pressure Pressure within the abdomen Boyles Law Mechanics of Inhalation Aerodynamic Components Air flows from regions of higher pressure to regions of lower pressure At rest, the pressure in the lungs (alveolar pressure) equals atmospheric pressure Mechanics of Inhalation Because of pleural linkage, the lungs and thorax move as a unit Any increase in thoracic volume leads to a stretching of the lungs Increase of alveolar air volume and a decrease in alveolar pressure Mechanics of Inhalation Alveolar pressure must be decreased sufficiently below atmospheric pressure for passive inhalation Expand thorax

3 Muscles expand thorax Quiet inspiration requires only one muscle Diaphragm Forced inspiration requires many muscles Accessory Mechanics of Inhalation Muscular control of inhalation can overcome Resistance to airflow from the upper respiratory tract Resistance of damaged respiratory tissues Elastic recoil of the lungs-thorax unit Muscles of Inhalation Inspiration Diaphragm is the main inspiratory muscle Diaphragm Location Floor of the thoracic cavity Separates the stomach from the thorax Lungs rest on it Shaped like a dome Diaphragm Most important inhalatory muscle Composed of muscles and a dense bundle of tendons Diaphragm The diaphragm can be placed under voluntary control (hold your breath) Primarily under Autonomic control Diaphragm has bilateral innervation Phrenic nerve Phrenic Nerve Phrenic nerves Nerve travels Innervates the diaphragm Right and left sides Central Tendon Intermediate region of diaphragm Shaped like a three pointed leaf Thin but strong aponeurosis Has no contractile qualities Diaphragm muscle fibers radiate from attachment to central tendon

4 Central Tendon Depends on radiating fibers of diaphragm to account for movement Muscle contraction causes central tendon to be pulled down and forward Diaphragm: Muscular Attachments Origins Sternal Attachments: xiphoid process Costal attachments: ribs 7-12 Vertebral Attachments: upper lumbar vertebrae All insert into central tendon Action Pulls the central tendon down Increases the vertical dimension Accessory Muscles of Inspiration Increase in amount of air we are able to process Resting respiration can be performed without accessory muscles Accessory Muscles of Inspiration External Intercostals Internal Intercostals Interchondral Portion External Intercostals External Intercostals Originate on the lower edge of one rib Insert on the upper edge of the rib below Not seen close to sternum Action Elevates the lower rib where it attaches Lift ribcage when you inhale Couple the ribs together External Intercostals Innervation Anterior division of 12 pairs of thoracic nerves Thoracic Intercostal Nerves T2-T6 Thoracoabdominal Intercostal Nerves T7-T11 Also innervates internal intercostals

5 Internal Intercostals Predominantly muscles of expiration Serves to lower the ribs Compress ribcage when you exhale Sternal portion active during forced inspiration Helps to keep the sternum parallel to vertebral column during inspiration Internal Intercostals Originates in inferior margin of ribs 1-11 Course down and lateral to superior surface of the ribs below Starts at sternum, not seen near vertebrae Internal Intercostals Posterior Thoracic Muscles of Inspiration Levatores Costarum Serratus Posterior Superior Levator Costarum Shortening these muscles tends to elevate the rib cage Considered thoracic muscles Brevis: originate on vertebrae C7 through T11 Courses down and out Inserts into rib below Elevates ribs 1-12 Longis: originates on vertebrae T7-T10 Courses down and out Inserts into second rib posterior to its insertion Serratus Posterior Superior Contribute to elevation of rib cage Lateral insertion provides mechanical advantage Origin: C7; & T1- T3 Insert angles of ribs 2 - 5 Accessory Respiration Muscles: Neck Sternocleidomastoid Scalenes Functions: Thoracic control for respiration Stability and control of neck flexion and extension Sternocleidomastoid

6 Origin: Mastoid process of temporal bone Inserts: Sternum & clavicle Action: Isolated contraction rotates head toward side of contraction Bilateral contraction elevates sternum and rib cage Scalenes Origin: Cervical Vertebrae (C3-C7) Anterior, Medius, Posterior Insertion: Posterior portion of 1st & 2nd ribs Action: Increases superior-inferior dimension of thorax Muscles of the Upper Arm and Shoulder Pectoralis Major Pectoralis Minor Serratus Anterior Subclavius Levator Scapulae Rhomboideus Major Rhomboideus Minor Trapezius Pectoralis Major

Origins (2): Along the length of the sternum at the costal cartilages Anterior surface of clavicle Insertion: fan-like to crest of humerus Action: Elevates the sternum Increases the transverse dimension of the rib cage Pectoralis Minor Origins: Ribs 2-5 near chondral portion Insertion: upward to scapula Action: Increases the transverse dimension of the rib cage Actions for both major and minor are only assumed based on origin and insertion

7 Serratus Anterior and Subclavius

Serratus Anterior Origin: Ribs 1-9 Insert: up and back to Scapula Subclavius Origin: Clavicle Insert: oblique and medial to 1st rib Action of Both Elevate rib cage

Muscle of Back Provide support for respiration and speech Trapezius Levator Scapulae Rhomboideus Major Minor Latissumus Dorsi Seratus Posterior Inferior Quadratus lumborum Expiration and Musculature Expiration At Max Inhale: Rib cage elevated Diaphragm flattened RECOIL Expiration Compression of Rib cage Lowered Relaxation of diaphragm Into dome shape Muscles of Thorax The rib cage can be pulled down by: Internal Intercostals Transversus Thoracis Innermost Intercostals Internal Intercostals Origin:

8 Superior margin of each rib Insertion: Inferior surface of the rib above Action: Support rib cage and protects ribs within Lowers rib cage Transversus Thoracis Origin: Sternum Insert: Inner surface of ribs 2 - 6 Action: Resist elevation of the rib cage Decrease the volume of the thoracic cavity Posterior Thoracic Muscles Subcostals Origin & Insertion: Ribs (may span more than one rib) Parallel to internal intercostals Found on inner posterior wall of thorax Serratus Posterior Inferior Origin: Thoracic (T11,T12) & lumbar vertebrae (L1-L3) Insertion: Lower five ribs Action of both: Pull the rib cage down Posterior Thoracic Muscles Abdominal Muscles & Respiration Abdominal aponeurosis tendinous structure in anterior position of abdomen Attachment points Linea alba xiphoid to pubic symphysis Linea semilunaris Abdominal Muscles & Respiration Transversus Abdominis Internal Oblique Abdominis External Oblique Abdominis Rectus Abdominis Transversus Abdominis Origin: Vertebral column via the thoracolumbar fascia Insertion:

9 Courses laterally to transversus abdominis aponeurosis to inner surface of ribs 6-12 Action: Reduces the volume of the abdomen Deepest anterior abdominal muscles Transversus Abdominis Internal Obliques Origin Inguinal Ligament and Iliac Crest Insertion lower ribs Action Compress Abdomen External Obliques Most superficial and largest Origin Lower seven ribs Insertion Iliac Crest and Inguinal Ligament Action Compress abdomen Rectus Abdominis Prominent midline muscles of the abdominal region Origin: Pubis inferiorly Insertion: Courses up Rectangular segments Xiphoid process of sternum Cartilage of last rib (7) and false ribs Action: Abdomen compression/distention Muscle contracted during sit-ups Chapter 4 Physiology of Respiration Respiration Humans are capable of quiet respiration as well as forced inspiration and expiration Quiet inspiration - Utilizes the diaphragm and external intercostals Forced inspiration - Uses many of the accessory muscles Passive expiration Elasticity of lungs restore them to a resting position after inspiration

10 Active expiration - Uses muscular effort to compress thoracic cavity/lungs just a bit farther Expiration Expiration is the process of eliminating the waste products of respiration Forces active during respiration: Torque Elasticity Gravity Torque Torquing twist of a shaft while one end held stable Torquing occurs in the rib cage during elevation Elasticity of cartilage allows it tends to return to its original condition after being torqued Elasticity Elasticity Lungs Chondral portion of ribs Allows ribs & lungs to snap back to resting position after being stretched Gravity Gravity Natural force Pulls ribs back to resting position after expansion Pulls abdominal organs/muscles inferiorly Allows more room for lung expansion Affected by weight More when lying down Measurement of Respiration Respiratory Measures: Rate of air flow Volume Capacities Pressure Spirometer Tube connected to a container with opening at the bottom Container sits inside another container of H20 Patient exhales into the tube Gas enters the air chamber and displaces the water

11 Chamber rises Amount of water that was displaced provides estimate of the air that was required to displace it Changes charted on the recording drum Pulmonary Function Tests Spirometry (KOKO Spirometrics) Digital computations now Measures: Tidal volume Vital capacity Functional residual capacity Rates of airflow for inhale or exhale Passive or forced Spirometer U-tube Manometer Measures pressure Subject places tube in mouth and blows Force of expiration will cause water in column to rise Measurement of displacement is in inches or centimeters of water Important Respiratory Terms Rate of Flow - the time it takes for air to enter and leave the lungs Measured as cubic centimeters per second or minute Volume - quantity of gas involved in gas exchange Measured in liters, milliliters, cubic centimeters, or cubic inches Four Stages of Gas Exchange 1. Ventilation Actual movement of air in the respiratory pathway 2. Distribution Air is distributed to the 300,000,000 alveoli 3. Perfusion At the alveoli, the oxygen-poor vascular supply from the right pulmonary artery is perfused (distributed) to the 600,000,000 capillaries that supply the alveoli 4. Diffusion Refers to the actual exchange of the gases across the alveolarcapillary membrane Respiratory Cycle Quiet respiration

12 Adults complete between 12 to 18 cycles of respiration per minute Newborn 40-70cpm Child 25 cpm Adolescent 20cpm Respiratory cycle One inspiration and one expiration Quiet tidal breathing is a quiet breathing pattern Developmental Processes in Respiration Cartilaginous airway (trachea) is complete by the time of birth Number of alveoli increases from about 25 million at birth to over 300 million by age 8. Airways grow exponentially in diameter and length until thorax growth is complete Expansion results in residual air volume capacity in adults Respiratory Volumes Measured in cc 1 liter = 1000ml = 1000cc Tidal Volume (TV) - Volume of air exchanged in one cycle of respiration Amount of air inspired and expired in a normal breathing cycle Residual Volume (RV) - Volume of air remaining in the lungs after a maximum exhalation (not in newborns) Respiratory Volumes Inspiratory Reserve Volume (IRV) Amount of air that can be inhaled after a tidal inspiration Expiratory Reserve Volume (ERV) Amount of air expired after a tidal expiration Resting lung volume Respiratory Capacities Vital Capacity (VC) - Amount of air that can be inhaled after a maximal exhale VC = IRV+ERV+TV Functional Residual Capacity (FRC) - Amount of air in the lungs after passive exhale (FRC = ERV+RV) Total Lung Capacity - Amount of air the lungs are capable of holding at the height of maximum inhale (=all lung volumes) Capacities Normal speakers use a small amount of their total vital capacity when speaking

13 Normal speakers use almost twice the air volume for speech that they use for quiet, normal or (tidal) breaths Respiratory Volumes and Capacities Effect of Age on Volumes Vital capacity is a function of body weight, age, and height Vital capacity increases steadily with body growth up to about age 20 Holds constant until age 25 Begins a steady decline of ~ 100 ml/year after 25 Females have smaller vital capacities throughout the life span Pressures of the Respiratory System Atmospheric Intraoral Subglottal Alveolar Intrapleural Respiratory Pressures Atmospheric (Patm) - Pressure on the earths surface Intraoral (Pio) - Pressure in the mouth (almost the same as Patm when mouth is open and vocal folds closed) Alveolar (Pal) - Pressure present within individual alveolus Intrapleural (Ppl) - Pressure present between visceral and parietal pleurae (negative throughout respiration) Subglottal (Ps) - Pressure below the vocal folds During normal respiration with open vocal folds & closed mouth Assume that subglottal and intraoral pressures = alveolar pressure Assume subglottic pressure = intraoral pressure Alveolar Pressure Pressure measurements made relative to atmospheric pressure e.g., +3 cm H2O means that, through muscular effort, +3 cm H2O has been generated above and beyond atmospheric pressure Way to measure alveolar pressure is by having an individual swallow a balloon and breathe Pressure changes within the trachea produce analogous changes in the esophagus; pressure sensor in balloon permits estimation of air pressure below the vocal folds Alveolar Pressure Diaphragm pulled down for tidal inspiration

14 Equalizes with Patm by inspiratory flow During expiration (recoil), pressure at the alveolar level becomes positive with reference to the atmosphere, Increasing to +2 cm H2O during quiet tidal breathing ALVEOLAR MEMBRANE

Surfactant: Protects the alveolus by reducing pressure Promotes airflow Facilitates effort-free respiration Low-friction contact between parietal and visceral pleurae During respiration Oxygen is perfused into the bloodstream across the alveolar-capillary membrane Carbon dioxide is perfused into the alveolus Summary of Pressure System Respiratory system is playing against relatively stable atmospheric pressure Contraction of the diaphragm and muscles of inspiration expands the thorax which causes alveolar pressure to drop relative to atmospheric pressure As alveolar pressure drops, air courses into the lungs thereby expanding the lungs Summary Relaxing muscles of inspiration permits natural recoil Thorax returns to original position Relaxed diaphragm returns to relatively elevated position in the thorax Recoil of chest obeys this law: The greater you distend or distort material, the greater is the force required to hold it in that position, and the greater is the force with which it returns to rest Intrapleural/alveolar pressure increases relative to atmospheric pressure Finally air leaves the lungs Effects of Posture on Speech Vital capacity influenced by postural adjustment and body position. When the body is placed in a reclining position Abdominal contents shift Reduces resting lung volume Force of gravity on the abdomen increases the effort required for inspiration Pressure Controls for Speech

15 1. Subglottal pressure to drive the vocal folds Voice onset and maintenance 2. Thoracic & Subglottic micro-control Make subtle changes in pressure for linguistic purposes such as syllable stress Muscles of expiration are used to capitalize upon the expiratory reserve volume for speech Checking Action Muscular Activity Electromyography measures and records the electrical activity associated with muscular contraction. During inspiration, the diaphragm and external intercostals are active. Continued activity from these muscles during expiration checking action Controlled exhale for phrasing and sustained phonation