Functional Anatomy of the Respiratory System Pulmonary Ventilation Pulmonary Ventilation inflow and outflow of air between the

he atmosphere and the lungs Muscles for Respiration: Diaphragm External Intercostal muscles Sternocleidomastoid Muscles Anterior Serrati Scalene muscles Abdominal Rectus musles Internal Intercostals Lung Expansion and Contraction 2 ways: Diaphragm Movement or lengthen or shorten chest cavity Ribs Elevate or depress increase or decrease antero-posterior diameter of chest cavity Normal quite breathing is accomplished almost entirely by first method. Diaphragm Movement During INSPIRATION: Diaphragm contracts and pulls lower surface of the lung downward During EXPIRATION: Diaphragm relaxes accompanied by elastic recoil of lungs, chest wall and abdominal structures During heavy breathing, extra force is achieved mainly by contraction of abdominal muscles Ribs Movement During INSPIRATION Ribs project almost entirely forward from an original downward position Sternum also moves forward away from spine Anteroposterior (AP) diameter increases to 20%

 Muscles that elevate ribs: External intercostals Sternocleidomastoid Anterior Serratus Scalene Muscles PRESSURES Lungs are elastic collapses like a balloon when there is no force to keep it inflated There are no attachments between the lungs and the ribcage except at hilum Lungs float in pleural fluid Lymphatics provide slight suction between visceral surface of lung pleura and parietal surface of thoracic cavity Pleural Presure Pressure of fluid in the narrow space between lung pleura and chest wall pleura Slightly negative pressure At beginning of inspiration: -5 cmH20 The amount needed to hold the lungs open During inspiration: -7.5cmH20 As negativity increases, lung volume increases to 0.5L Alveolar Pressure Pressure of air inside the lung alveoli Open glottis pressures are equal at 2 atm For inspiration inward flow of air into alveoli the pressure must fall to a value slightly below atmospheric pressure (below 0) During inspiration: alv pressure drops to -1cmH20 = 0.5 L of air Compliance Compliance is the extent to which lungs expand for each unit of increase in transpulmonary pressure = 200mL/ 1 cmH20 change in transpulmonary pressure Work of breathing Equivalent to Work of Inspiration 3 fractions: 1. That required to expand the lungs against the lung and chest elastic forces = compliance work 2. That required to overcome the viscosity of the lung and chest wall structures =tissue resistance work

3. The required to overcome airway resistance during the movement of air into the lungs = airway resistance work Pulmonary volumes and capacities Spirometry process of studying pulmonary ventilation, recording the volume movement of air into and out of lungs Pulmonary Volumes: 1. Tidal Volume: vol. of air inspired/expired with each normal breathing = 500 mL 2. Inspiratory Reserve Volume maximum extra volume of air that can be inspired over and above normal tidal volume = 300 mL 3. Expiratory Reserve Volume : maximum extra volume of air that can be expired forcefully after end of a normal tidal expiration = 1.1L 4. Residual Volume : volume of air remaining in the lungs after most forceful expiration = 1.2L Pulmonary Capacities Two or more volumes togethere Inspiratory Capacity : TV + IRV = 3.5L Functional Residual Capacity: ERV+RV = 2.3L Vital Capacity : IRV + TV + ERV = 4.6L Total Lung Capacity: VC + RV = 5.8L

All pulmonary volumes and capacities are about 20-25% less in women than in men. Pulmonary Gas Exchange and Gas Transport Physiologic Anatomy One of the most important problems in all the respiratory passages is to keep them open to allow easy passage of air to and from the alveoli Trachea with cartilage rings 5/6 of the way around Bronchi walls have less extensive cartilage plates Bronchioles no plates. Diameter <1.5mm, all smooth muscles Kept expanded by same transpulmonary pressures that expand the alveoli All areas of the trachea and bronchi not occupied by cartiliage plates, walls are composed of smooth muscles

Resistance to flow is greatest NOT in the minute air passages of terminal bronchioles but in some of the larger bronchi near to the trachea. Smaller airways are easily occluded ; smooth muscles = contract easily Pulmonary Circulatory System Pulmonary Vessels Pulmonary artery (5 cm, thin, 2x VC, 1/3 aorta) Right and Left main pulmonary branches lungs Large compliance (7 mL/mmHg) Allows pulmonary arteries to accommodate 2/3 of stroke volume output of Right Ventricle Bronchial Vessels arterial supply to the lungs 1/3 of cardiac output Supplies supporting tissues (CT, septa, bronchi) Drains to pulmonary veins Pulmonary vs. Alveolar Ventilation Pulmonary Ventilation Inflow and outflow of air between the atmosphere and the lung alveoli Alveolar Ventilation Rate at which new air reaches the areas in the lung where it is in proximity to the pulmonary blood or gas exchange areas (alveolar sacs, ducts, respiratory bronchioles) Diffusion of Gases Diffusion Random molecular motion of molecules with energy provided by kinetic motion of the molecules All molecules are continually undergoing motion except in absolute zero temperature Net diffusion Product of diffusion from high to low concentration Gas Pressures Partial Pressure Pressure is directly proportional to the concentration of gas molecules; caused by impact of moving molecules against a surface In respiration, theres mixture of gases: O2, N2, CO2

 Rate of diffusion of each gas is directly proportional to the pressure caused by each gas alone AIR = total Pressure 760 mmHg 79% N, 21% O2 = PP N = 600mmHg , PP O2 =160mmHg Gas Pressure in Fluid Determined by its concentration and by solubility coefficient If gas is repelled, pressure increases HENRYs LAW : Pressure = concentration solubility coefficient Solubility of Gases in body temp. O2 = 0.024 CO2 = 0.57 - 20x more soluble than O2 CO = 0.018 N2 = 0.012 He = 0.008 Factors that affect Rate of Gas Diffusion thru Respiratory Membrane Respiratory Unit: Respiratory bronchiole Alveolar ducts Atria Alveoli (300 Million in both lungs) (0.2mm) *their membranes make up the respiratory membrane Respiratory Membrane Layers: 1. Layer of fluid lining alveolus (surfactant) 2. Alveolar epithelium 3. Epithelial basement membrane 4. Interstitial Space 5. Capillary basement membrane 6. Capillary endothelial membrane Overall thickness: 0.2um (ave: 0.6 um) Total surface area: 70 m2 1. Thickness of membrane Inc. in edema and fibrosis

2. Surface area of membrane Dec. in removal of lung and emphysema 3. Diffusion coefficient of Gas in substance of membrane Gas solubility 4. Pressure difference Difference between partial pressure of gas in alveolia and pressure of gas in pulmonary capillary blood Ventilation-Perfusion Ratio A concept developed to help us understand respiratory exchange where there is imbalance between alveolar ventilation and alveolar blood flow Areas in lung with well ventilation but no bloodflow or excellent blood flow but no ventilation Va alveolar ventilation Q blood flow Va/Q = normal If Va is 0 (zero), but with perfusion: Va/Q = 0 If Va is present, but no perfusion Va/Q = infinity In both: there is no gas exchange Normal person : Upright: Va and Q are less in Upper part but Q is more At top of lung: Va/Q 2.5x > as ideal = physiologic dead space (ventilation but less blood flow) At bottom: Va is less than Q Va/Q is 0.6 < as ideal = physiologic shunt COPD patient: Smoker, emphysema, alveolar walls destroyed Wasted blood flow = severe shunting Transport of O2 and CO2 Pressure differences causes gas to diffuse Alveolus Capillaries Tissues(fluid) Tissues(cells) pO2 104mmHg 95mmHg 40mmHg 5-40(ave 23) mmHg CO2 can diffuse about 20 times as rapidly as O2 Transport of O2 in blood:

 97% of O2 from lungs to tissues are carried in combination with hemoglobin O2 combines loosely and reversibly with heme pO2 O2 combines with heme (pulm capi) pO2 O2 is released (tissue capillaries) Control of Respiration Control of Respiration Central o Respiratory Center o Bilaterally in the medulla oblangata and pons o Dorsal Respiratory Group dorsal medulla Mainly inspiration and rhythm of breathing o Ventral Respiratory Group ventrolateral medulla Either inspiration or expiration o Pneumotaxic Center dorsal superior pons Controls rate and pattern of breathing Dorsal Respiratory Group Generates basic rhythm of respiration Operates on a ramp signal Begins weakly and increases steadily for about 2 seconds, then ceases abruptly for next 3 secs. Turns off excitation of diaphram, allows elastic recoil 2 ways of control: 1. Control of rate of increase of ramp signal 2. Control of limiting point at which ramp signal ceases Pneumotaxic Center Control switch off point of inspiratory ramp If strong, inspiration is 0.5 seconds, filling lungs only slightly Primary function is to limit inspiration Ventral Respiratory Group Inactive during normal quiet respiration No participation in rhythm control

 Contributes to respiratory drive when pulmonary ventilation increases Some neurons excite inspire Other neurons excite expire Useful in heavy breathing Chemical Substances Oxygen No significant direct effect, instead, regulates respiration on its effect on peripheral chemoreceptors Carbon Dioxide Potent indirect effect Excess concentration in blood acts directly on respiratory center itself Hydrogen Excites sensory neurons in chemosensitive areas Cannot cross blood brain barrier Peripheral Chemoreceptors special nervous chemical receptors located in several areas outside brain Detects changes in oxygen concentration in blood Transmits nervous signals to the respiratory center to the brain Mostly in Carotid bodies and Aortic bodies Decreased arterial O2 concentration in blood Increased CO2 and H ion concentration Factors that Affect Respiration Voluntary control One can hyperventilate/hypoventilate Nervous pathway for voluntary control passes directly from cortex and down the corticospinal tract, not through the respiratory center Effect of Irritant receptors in Airways Epithelium in trachea, bronchi, bronchioles sensitive Cause cough and sneeze Also cause bronchial constriction as in BA and Emphysema Function of lung J receptors Sensory nerve endings in alveolar walls, in juxtaposition to pulmonary capillaries

 Excitation gives feeling of dyspnea Effect of brain edema Activity of respiratory center may be decreased or inactivated by acute brain edema due to blockage of blood supply Anesthesia Most prevalent cause of respiratory depression and arrest Eg Na pentobarbital, morphine overdose Abnormalities in Respiratory Control Periodic breathing (e.g. Cheyne-Stokes breathing) Waxing and waning respiration 40-60 seconds Due to: Long delay of transport of blood carrying O2 As in severe heart failure Increase negative feedback gain Brain damage