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Overview of Anatomy and physiology of the Respiratory System Respiration.

n. The process of gaseous exchange between the individual and the environment Three Processes of Respiration. 1. Ventilation. Refers to the movement of gases in and out of the lungs. Inhalation (Inspiration) is voluntary phase Exhalation (Expiration) is involuntary phase

2. Diffusion. The exchange of gases from an area of higher pressure to an are of lower pressure 3. Perfusion. The availability and movement of blood for transport of gases, nutrients and metabolic waste products. The respiratory system is composed of the following structures: 1. The Airways A. Upper Airways Nasal Cavity or Nares Pharynx Larynx or voice box
B. Lower Airways (Tracheobronchial Tree)

Trachea Right and left mainstem bronchi Segmental bronchi Terminal bronchi C. Functions of the Upper Airway: Transport of gases to the lower airways. Protection of the lower airways from foreign matter Warming, filtration and humidification of inspired air.

D. Functions of the Lower Airways Clearance Mechanism Immunologic response Pulmonary Protection in Injury The openings of the nose on the face area are called nostrils or nares. Each nostril leads to a cavity called vestibule
The hair that lines the vestibule are called the vibrissae. The vibrissae filter foreign

objects. The paranasal sinuses are open areas within the skull, lined with mucous membrane. They help in phonation. The different sinuses are as follows: frontal, maxillary, ethmoid and sphenoid The pharynx is the funnel-shaped tube that extends from the nose to the larynx. It is a common opening between the digestive and respiratory system. The three sections of the pharynx are as follows; nasopharynx, oropharynx, and laryngopharynx. From the middle ear, the Eustachian tubes open into the nasopharynx. The larynx is the voice box. The epiglottis covers the larynx. When eating, the epiglottis close, when speaking it opens.
The trachea (windpipe) is 12cm (4 to 5 inches) long. The point at which it divides is

called carina. The trachea and bronchi are lined with cilia and goblet cells. The cilia are microscopic hair-like projections which have rapid, coordinated, unidirectional upward motion.
The cilia sweep out debris and excessive mucous from lungs.

The goblet cells c\secrete 120ml of mucous per day. The mucous secretions entrap debris in the respiratory tract. The right mainstem bronchus is shorter, broader and more vertical than the left.

2. The Pleura The pleurae are serous membranes that enclose the lungs The visceral pleural directly covers the lungs. The parietal pleura lines the cavity of each hemithorax. The pleural space is a potential space between the two pleurae. Only few ml. of serous fluid is found in the pleural space, to serve as lubricant. 3. The Lungs. The right lung has three lobes, while the left lung has two lobes. The two lungs are separated by a space called mediastinum. There are approximately three hundred million aveoli in the lungs.
The right lung is boarder, but shorter due to the presence of the

liver on the right side of the abdomen. Residual volume is the amount of air that remains in the lungs after forceful expiration. It prevents collapse of the lungs during expiration. (1200ml). Tidal volume is the amount of air that moves in and out of the lungs with each normal breath (500ml) Inspiratory reserve volume is the amount of extra air that can be inhaled, beyond the tidal volume. Expiratory reserve volume is the amount of extra air that can be exhaled after a normal breath.
Total lung capacity is the total of all four volume (residual, tidal,

inspiratory reserve and expiratory reserve Volumes). Function residual capacity is the amount of air that remains in the lungs after normal exhalation Pneumocytes. The type I pneumocytes line the aveoli, whereas the type II produce surfactant 4. The Thorax and the Diaphragm

The thorax provides protection for the lungs, heart and great vessels The thorax is made up of 12 pairs of ribs, bounded anteriorly by the sternum and posteriorly by the thoracic vertebrae. The diaphragm is the main respiratory muscle for inspiration. It is supplied by the phrenic nerve. The following are the accessory muscle for inspiration. sternocleidomastoid scalene parasternal trapezius pectoralis muscle

5. Respiratory Centers a. Medulla Oblongata is the primary center. b. Pons contains the following: Pneumotaxic center. Responsible to the rhythmic quality of breathing Apneustic center. Responsible for deep, prolonged inspiration

c. Carotid and aortic bodies

Peripheral chemoreceptors. Take up the work of breathing when the central chemoreceptors in the medulla oblongata are damage. It responds to low oxygen concentration in the blood. Respond to pressures. if the BP is elevated the respiratory rate becomes slow. (HPN leads to respiratory acidosis). If the BP is decreased, the respiratory rate becomes rapid (hypotension leads to respiratory alkalosis). The primary chemical stimulation for breathing is high carbon dioxide level in the blood.

d. Muscles and joints Proprioceptors. Exercise increases respiratory rate.

Physiologic Changes in the Respiratory System with Aging Reduced chest wall compliance that results from increased classification of costal cartilage and decreased strength of intercostals and accessory muscle nd diaphragm. Reduced breathing capacity Reduced vital capacity Increased residual volume Decreased cough reflex Physical Examination Inspection Signs and Symptoms of respiratory distress Speech pattern Chest wall configuration Chest movement Fingers and toes

Palpation Trachea Chest wall Thoracic excursion Tactile fremitus

Percussion Resonance Hyperresonance Dullness

Auscultation Normal breath sounds

a. Bronchial (tracheal) heard over the manubrium in the large tracheal airways.

These sounds are high-pitched and loud. b. Bronchovesicular heard over the bronchi. These sounds are moderatepitched, with moderate-amplitude.
c. Vesicular heard all over the chest and heard best in the bases of lungs. These

sounds are low-pitched and soft. Adventitious breath sounds a. Crackles/rales (fine). high pitched, soft, crackling/popping sound. (rolling strand of hair between fingers) b. Crackles/rales (coarse). Loud/ low- pitched, bubbling, gurgling (sounds like opening Velcro fastener). c. Pleural friction rub. Coarse, low pitched; grating sound. d. Wheeze. high pitched, squeaking sound (sibilant rhonchi). e. Wheeze. low pitched, musical snoring, moaning sound (sonorous rhonchi).