1 sistem respirasi anatomi

8/17/2019 1 Sistem Respirasi Anatomi

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Chapter 22

Lecture

Outline

See PowerPoint Image Slides

for all figures and tables pre-inserted intoPowerPoint without notes.

Copyright (c) The McGraw-Hill Companies, Inc. Permission require !or reprouction or isplay.


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Respiratory System

" natomy of the Respiratory System

" Pulmonary !entilation

" "as #$change and %ransport

" Respiratory &isorders


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Organs of Respiratory System

" 'ose( pharyn$( laryn$( trachea( bronchi( lungs


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"eneral spects

" irflow in lungs # bronchi

→

bronchioles→

al)eoli

" Conducting di)ision

# passages for airflow( nostrils to bronchioles

" Respiratory di)ision

# distal gas-e$change regions( al)eoli

" *pper respiratory tract # organs in head and nec+( nose through laryn$

" Lower respiratory tract

# organs of thora$( trachea through lungs


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'ose

" ,unctions # warms( cleanses( humidifies inhaled air

# detects odors

# resonating chamber that amplifies the )oice

" ony and cartilaginous supports

# superior half nasal bones medially and

ma$illae laterally # inferior half lateral and alar cartilages

# ala nasi flared portion shaped by dense C%(

forms lateral wall of each nostril


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natomy of 'asal Region


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natomy of 'asal Region


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'asal Ca)ity

" #$tends from nostrils to posterior nares

" !estibule dilated chamber inside ala nasi

# stratified s/uamous epithelium( )ibrissae

0guard hairs1

" 'asal septum di)ides ca)ity into right and

left chambers called nasal fossae


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*pper Respiratory %ract


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*pper Respiratory %ract


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'asal Ca)ity - Conchae and eatuses

" Superior( middle and inferior nasalconchae

# 3 folds of tissue on lateral wall of nasal fossa

# mucous membranes supported by thin scroll-li+e turbinate bones

" eatuses

# narrow air passage beneath each conchae # narrowness and turbulence ensures air

contacts mucous membranes


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'asal Ca)ity - ucosa

" Olfactory mucosa # lines roof of nasal fossa

" Respiratory mucosa

# lines rest of nasal ca)ity with ciliatedpseudostratified epithelium

" &efensi)e role of mucosa

# mucus 0from goblet cells1 traps inhaledparticles

" bacteria destroyed by lyso4yme


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'asal Ca)ity - Cilia and #rectile %issue

" ,unction of cilia of respiratory epithelium # sweep debris-laden mucus into pharyn$ to be

swallowed

" #rectile tissue of inferior concha # )enous ple$us that rhythmically engorges with

blood and shifts flow of air from one side of

fossa to the other once or twice an hour to

pre)ent drying

" Spontaneous epista$is 0nosebleed1

# most common site is inferior concha


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Regions of Pharyn$


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Pharyn$

" 'asopharyn$ (pseudostratified epithelium) # posterior to choanae( dorsal to soft palate

# recei)es auditory tubes and contains

pharyngeal tonsil

# 56° downward turn traps large particles 0786 m1

" Oropharyn$ (stratified squamous epithelium)

# space between soft palate and root of tongue(

inferiorly as far as hyoid bone( contains

palatine and lingual tonsils

" Laryngopharyn$ (stratified squamous)

# hyoid bone to le)el of cricoid cartilage


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Laryn$

" "lottis 9 )ocal cords and opening between" #piglottis

# flap of tissue that guards glottis( directs food

and drin+ to esophagus

" Infant laryn$

# higher in throat( forms a continuous airway

from nasal ca)ity that allows breathing whileswallowing

# by age 2( more muscular tongue( forces laryn$

down


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!iews of Laryn$


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'ine Cartilages of Laryn$

" #piglottic cartilage - most superior

" %hyroid cartilage 9 largest: laryngealprominence

" Cricoid cartilage - connects laryn$ to trachea" rytenoid cartilages 021 - posterior to thyroid

cartilage

" Corniculate cartilages 021 - attached toarytenoid cartilages li+e a pair of little horns

" Cuneiform cartilages 021 - support soft tissue

between arytenoids and epiglottis


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;alls of Laryn$

" Interior wall has 2 folds on each side( fromthyroid to arytenoid cartilages

# )estibular folds superior pair( close glottis during

swallowing # )ocal cords produce sound

" Intrinsic muscles - rotate corniculate andarytenoid cartilages

# adducts 0tightens high pitch sound1 or abducts 0loosens low

pitch sound1 )ocal cords

" #$trinsic muscles - connect laryn$ to hyoid

bone( ele)ate laryn$ during swallowing


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ction of !ocal Cords


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%rachea" Rigid tube


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Lower Respiratory %ract


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Lungs - Surface natomy


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%hora$ - Cross Section


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ronchial %ree

" Primary bronchi 0C-shaped rings1 # from trachea: after 2-3 cm enter hilum of lungs

# right bronchus slightly wider and more )ertical0aspiration1

" Secondary 0lobar1 bronchi 0o)erlapping plates1

# one secondary bronchus for each lobe of lung

" %ertiary 0segmental1 bronchi 0o)erlappingplates1

# 86 right( @ left

# bronchopulmonary segment portion of lung

supplied by each


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ronchial %ree

" ronchioles 0lac+ cartilage1 # layer of smooth muscle

# pulmonary lobule

" portion )entilated by one bronchiole

# di)ides into =6 - @6 terminal bronchioles

" ciliated: end of conducting di)ision

# respiratory bronchioles

" di)ide into 2-86 al)eolar ducts: end in al)eolar sacs

" l)eoli - bud from respiratory bronchioles(al)eolar ducts and al)eolar sacs

# main site for gas e$change


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Lung %issue


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l)eolar lood Supply


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l)eolus

,ig. 22.88

b and c


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Pleurae and Pleural ,luid

" !isceral 0on lungs1 and parietal 0lines ribcage1 pleurae

" Pleural ca)ity - space between pleurae(

lubricated with fluid" ,unctions

# reduce friction

# create pressure gradient" lower pressure assists lung inflation

# compartmentali4ation

" pre)ents spread of infection


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Pulmonary !entilation

" reathing 0pulmonary )entilation1 9 onecycle of inspiration and e$piration

# /uiet respiration 9 at rest

# forced respiration 9 during e$ercise" ,low of air in and out of lung re/uires a

pressure difference between air pressure

within lungs and outside body


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Respiratory uscles

"&iaphragm 0dome shaped1 # contraction flattens diaphragm

" Scalenes - hold first pair of ribs stationary

" #$ternal and internal intercostals # stiffen thoracic cage: increases diameter

" Pectoralis minor( sternocleidomastoid and

erector spinae muscles # used in forced inspiration

" bdominals and latissimus dorsi

# forced e$piration 0to sing( cough( snee4e1


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Respiratory uscles


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'eural Control of reathing

" reathing depends on repetiti)e stimuli frombrain

" 'eurons in medulla oblongata and pons control

unconscious breathing

" !oluntary control pro)ided by motor corte$

" Inspiratory neurons fire during inspiration

" #$piratory neurons fire during forced e$piration

" ,ibers of phrenic ner)e go to diaphragm:

intercostal ner)es to intercostal muscles


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Respiratory Control Centers

" Respiratory nuclei in medulla # inspiratory center 0dorsal respiratory group1" fre/uent signals( you inhale deeply

" signals of longer duration( breath is prolonged

# e$piratory center 0)entral respiratory group1" in)ol)ed in forced e$piration

" Pons

# pneumota$ic center

" sends continual inhibitory impulses to inspiratory center( asimpulse fre/uency rises( breathe faster and shallower

# apneustic center

" prolongs inspiration( breathe slower and deeper


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Respiratory Control Centers


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Input to Respiratory Centers

" ,rom limbic system and hypothalamus # respiratory effects of pain and emotion

" ,rom airways and lungs

# irritant receptors in respiratory mucosa" stimulate )agal afferents to medulla( results in

bronchoconstriction or coughing

# stretch receptors in airways - inflation refle$" e$cessi)e inflation triggers refle$

" stops inspiration

" ,rom chemoreceptors

# monitor blood pA( CO2 and O2 le)els


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Chemoreceptors

" Peripheral chemoreceptors # found in ma?or blood )essels

" aortic bodies

# signals medulla by )agus ner)es

" carotid bodies

# signals medulla by glossopharyngeal ner)es

" Central chemoreceptors

# in medulla" primarily monitor pA of CS,


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Peripheral Chemoreceptor Paths


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!oluntary Control

" 'eural pathways # motor corte$ of frontal lobe of cerebrum sends

impulses down corticospinal tracts to

respiratory neurons in spinal cord( bypassing

brainstem

" Limitations on )oluntary control

# blood CO2 and O2 limits cause automatic

respiration


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Pressure and ,low

" tmospheric pressure dri)es respiration # 8 atmosphere 0atm1 B >6 mmAg

" Intrapulmonary pressure and lung )olume

# pressure is in)ersely proportional to )olume" for a gi)en amount of gas( as )olume ↑( pressure ↓

and as )olume ↓( pressure ↑

" Pressure gradients # difference between atmospheric and

intrapulmonary pressure

# created by changes in )olume thoracic ca)ity


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Inspiration - Pressure Changes

∀↓ intrapleural pressure

# as )olume of thoracic ca)ity ↑(

)isceral pleura clings to parietal pleura

∀↓ intrapulmonary pressure

# lungs e$pand with )isceral pleura

" %ranspulmonary pressure

# intrapleural minus intrapulmonary pressure 0notall pressure change in the pleural ca)ity is transferredto the lungs1

" Inflation aided by warming of inhaled air

" =66 ml of air flows with a /uiet breath


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Respiratory Cycle


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Passi)e #$piration

" &uring /uiet breathing( e$piration achie)edby elasticity of lungs and thoracic cage

" s )olume of thoracic ca)ity ↓(

intrapulmonary pressure↑

and air ise$pelled

" fter inspiration( phrenic ner)es continue

to stimulate diaphragm to produce abra+ing action to elastic recoil


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,orced #$piration

" Internal intercostal muscles # depress the ribs

" Contract abdominal muscles

↑

intra-abdominal pressure forcesdiaphragm upward

↑ pressure on thoracic ca)ity


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Pneumothora$

" Presence of air in pleural ca)ity # loss of negati)e intrapleural pressure allows

lungs to recoil and collapse

" Collapse of lung 0or part of lung1 is calledatelectasis


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Resistance to irflow

" Pulmonary compliance # distensibility of lungs: change in lung )olume

relati)e to a change in transpulmonary pressure

" ronchiolar diameter # primary control o)er resistance to airflow

# bronchoconstriction

" triggered by airborne irritants( cold air(

parasympathetic stimulation( histamine

# bronchodilation

" sympathetic ner)es( epinephrine


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l)eolar Surface %ension

" %hin film of water needed for gas e$change # creates surface tension that acts to collapse

al)eoli and distal bronchioles

" Pulmonary surfactant 0great al)eolar cells1 # decreases surface tension

" Premature infants that lac+ surfactant

suffer from respiratory distress syndrome


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l)eolar !entilation

" &ead air

# fills conducting di)ision of airway( cannot

e$change gases

" natomic dead space

# conducting di)ision of airway

" Physiologic dead space

# sum of anatomic dead space and any

pathological al)eolar dead space

" l)eolar )entilation rate

# air that )entilates al)eoli D respiratory rate

# directly rele)ant to ability to e$change gases


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easurements of !entilation

" Spirometer - measures )entilation" Respiratory )olumes

# tidal )olume )olume of air in one /uiet breath

# inspiratory reser)e )olume" air in e$cess of tidal inspiration that can be inhaled

with ma$imum effort

# e$piratory reser)e )olume

" air in e$cess of tidal e$piration that can be e$haled

with ma$imum effort

# residual )olume 0+eeps al)eoli inflated1

" air remaining in lungs after ma$imum e$piration


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Lung !olumes and Capacities


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" !ital capacity # total amount of air that can be e$haled with

effort after ma$imum inspiration

" assesses strength of thoracic muscles and

pulmonary function

" Inspiratory capacity

# ma$imum amount of air that can be inhaled

after a normal tidal e$piration

" ,unctional residual capacity

# amount of air in lungs after a normal tidal

e$piration

Respiratory Capacities


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Respiratory Capacities

" %otal lung capacity # ma$imum amount of air lungs can hold

" ,orced e$piratory )olume 0,#!1

# E of )ital capacity e$haledF time # healthy adult - = to @=E in 8 sec

" Pea+ flow # ma$imum speed of e$halation

" inute respiratory )olume 0R!1 # %! $ respiratory rate( at rest =66 $ 82 B > LFmin

# ma$imum 82= to 86 LFmin


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Respiratory !olumes and Capacities

" ge -↓

lung compliance( respiratory muscleswea+en

" #$ercise - maintains strength of respiratory

muscles " ody si4e - proportional( big bodyFlarge lungs

" Restricti)e disorders

↓

compliance and )ital capacity" Obstructi)e disorders

# interfere with airflow( e$piration re/uires more

effort or less complete


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Composition of ir

" i$ture of gases: each contributes itspartial pressure # at sea le)el 8 atm. of pressure B >6 mmAg

# nitrogen constitutes @.>E of the atmosphere so

" P'2 B @.>E $ >6 mmAg B =5 mmAg

" PO2 B 8=5

" PA2O B 3.

" PCO2 B G 6.3

" P'2 G PO

2 G PA2O G PCO2 B >6 mmAg


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Composition of ir

" Partial pressures 0as well as solubility of gas1 # determine rate of diffusion of each gas and gas

e$change between blood and al)eolus

" l)eolar air # humidified( e$changes gases with blood( mi$es with

residual air

# contains

" P'2B =>5

" PO2 B 86<

" PA2O B


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ir-;ater Interface

" Important for gas e$change between airin lungs and blood in capillaries

" "ases diffuse down their concentration

gradients" AenryHs law

# amount of gas that dissol)es in water is

determined by its solubility in water and its partial pressure in air

l l " # h


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l)eolar "as #$change

l l " # h


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" %ime re/uired for gases to e/uilibrate B6.2= sec

" RC transit time at rest B 6.= sec to pass

through al)eolar capillary" RC transit time with )igorous e$ercise B

6.3 sec

, t ff ti " # h


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,actors ffecting "as #$change

" Concentration gradients of gases # PO

2 B 86< in al)eolar air )ersus


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,actors ffecting "as #$change

" embrane thic+ness - only 6.= m thic+" embrane surface area - 866 ml blood in

al)eolar capillaries( spread o)er 6 m2

"!entilation-perfusion coupling - areas ofgood )entilation need good perfusion0)asodilation1

Concentration "radients of "ases


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Concentration "radients of "ases

mbient Pressure and Concentration


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mbient Pressure and Concentration"radients

L &i ff t " # h


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Lung &isease ffects "as #$change

P f i d? t t


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Perfusion d?ustments

! til ti d? t t


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!entilation d?ustments

O % t


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O$ygen %ransport

" Concentration in arterial blood # 26 mlFdl

" 5@.=E bound to hemoglobin

" 8.=E dissol)ed

" inding to hemoglobin

# each heme group of < globin chains may

bind O2

# o$yhemoglobin 0AbO2 1

# deo$yhemoglobin 0AAb1

O % t


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O$ygen %ransport

" O$yhemoglobin dissociation cur)e # relationship between hemoglobin saturation

and PO2 is not a simple linear one

# after binding with O2( hemoglobin changesshape to facilitate further upta+e 0positi)e

feedbac+ cycle1

O h l bi &i i ti C


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O$yhemoglobin &issociation Cur)e

Carbon &io ide %ransport


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Carbon &io$ide %ransport

" s carbonic acid - 56E # CO2 G A2O → A2CO3→ ACO3- G AG

" s carbaminohemoglobin 0AbCO21- =E binds to

amino groups of Ab 0and plasma proteins1

" s dissol)ed gas - =E

" l)eolar e$change of CO2 # carbonic acid - 6E

# carbaminohemoglobin - 23E

# dissol)ed gas - E

Systemic "as #$change


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" CO2 loading

# carbonic anhydrase in RC cataly4es" CO2 G A2O → A2CO3→ ACO3- G AG

# chloride shift

" +eeps reaction proceeding( e$changes ACO3- for Cl- 0AG binds to hemoglobin1

" O2 unloading

# AG binding to AbO2 ↓ its affinity for O

2" Ab arri)es 5E saturated( lea)es =E

saturated - )enous reser)e

# utili4ation coefficient

" amount of o$ygen Ab has released 22E



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l)eolar "as #$change Re)isited


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l)eolar "as #$change Re)isited

" Reactions are re)erse of systemic gase$change

" CO2 unloading

# as Ab loads O2 its affinity for AG decreases( AG dissociates from Ab and bind with ACO3-

" CO2 G A2O A2CO3 ACO3- G AG

# re)erse chloride shift" ACO3- diffuses bac+ into RC in e$change

for Cl-( free CO2 generated diffuses into

al)eolus to be e$haled



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,actors ffect O *nloading


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,actors ffect O2 *nloading

" cti)e tissues need o$ygen # ambient PO

2 acti)e tissue has ↓ PO

2: O2 is released

# temperature acti)e tissue has ↑ temp: O2 is released

# ohr effect acti)e tissue has↑

CO2( which lowers pA

0muscle burn1: O2 is released

# bisphosphoglycerate 0P"1 RCHs produce P"

which binds to Ab: O2 is released

∀↑ body temp 0fe)er1( %A( "A( testosterone( and

epinephrine all raise P" and cause O2 unloading

0↑ metabolic rate re/uires ↑ o$ygen1

O$ygen &issociation and %emperature


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O$ygen &issociation and %emperature

O$ygen &issociation and pA


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O$ygen &issociation and pA

ohr effect release of O2 in response to low pA

,actors ffecting CO Loading


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" Aaldane effect # low le)el of AbO2 0as in acti)e tissue1 enables

blood to transport more CO2

# AbO2 does not bind CO2 as well asdeo$yhemoglobin 0AAb1

# AAb binds more AG than AbO2" as AG is remo)ed this shifts the

CO2 G A2O → ACO3- G AG

reaction to the right

,actors ffecting CO2 Loading

lood Chemistry


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lood Chemistry

and Respiratory Rhythm

" Rate and depth of breathing ad?usted to

maintain le)els of

# pA # PCO

2

# PO2

" LetHs loo+ at their effects on respiration

#ffects of Aydrogen Ions


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" pA of CS, 0most powerful respiratory stimulus1" Respiratory acidosis 0pA J .3=1 caused by

failure of pulmonary )entilation

# hypercapnia PCO2 7


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" Respiratory al+alosis 0pA 7 .


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#ffects of Carbon &io$ide

" Indirect effects on respiration # through pA as seen pre)iously

" &irect effects

↑

CO2 may directly stimulate peripheralchemoreceptors and trigger ↑ )entilation more

/uic+ly than central chemoreceptors

#ffects of O$ygen


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#ffects of O$ygen

" *sually little effect" Chronic hypo$emia( PO

2 J >6 mmAg(

can significantly stimulate )entilation

# emphysema( pneumonia # high altitudes after se)eral days

Aypo$ia


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Aypo$ia

" Causes # hypo$emic hypo$ia - usually due to inade/uate

pulmonary gas e$change

" high altitudes( drowning( aspiration( respiratory

arrest( degenerati)e lung diseases( CO poisoning

# ischemic hypo$ia - inade/uate circulation

# anemic hypo$ia - anemia

# histoto$ic hypo$ia - metabolic poison 0cyanide1

" Signs cyanosis - blueness of s+in

" Primary effect tissue necrosis( organs with

high metabolic demands affected first

O$ygen #$cess


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O$ygen #$cess

" O$ygen to$icity pure O2 breathed at 2.=atm or greater

# generates free radicals and A2O2

# destroys en4ymes # damages ner)ous tissue

# leads to sei4ures( coma( death

" Ayperbaric o$ygen # formerly used to treat premature infants(

caused retinal damage( discontinued

Chronic Obstructi)e Pulmonary &isease


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" sthma

# allergen triggers histamine release

# intense bronchoconstriction 0bloc+s air flow1

" Other COP&Hs usually associated with smo+ing

# chronic bronchitis

# emphysema



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" Chronic bronchitis

# cilia immobili4ed and ↓ in number

# goblet cells enlarge and produce e$cess

mucus # sputum formed 0mucus and cellular debris1

" ideal growth media for bacteria

# leads to chronic infection and bronchialinflammation



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" #mphysema

# al)eolar walls brea+ down

" much less respiratory membrane for gas e$change

# healthy lungs are li+e a sponge: in emphysema( lungs aremore li+e a rigid balloon

# lungs fibrotic and less elastic

# air passages collapse

" obstruct outflow of air

" air trapped in lungs

#ffects of COP&


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#ffects of COP&

∀↓

pulmonary compliance and )ital capacity" Aypo$emia( hypercapnia( respiratory

acidosis

# hypo$emia stimulates erythropoietin releaseand leads to polycythemia

" cor pulmonale

# hypertrophy and potential failure of right heartdue to obstruction of pulmonary circulation

Smo+ing and Lung Cancer


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Smo+ing and Lung Cancer

" Lung cancer accounts for more deathsthan any other form of cancer

# most important cause is smo+ing 08=

carcinogens1

" S/uamous-cell carcinoma 0most common1

# begins with transformation of bronchial

epithelium into stratified s/uamous

# di)iding cells in)ade bronchial wall( cause

bleeding lesions

# dense swirls of +eratin replace functional

respiratory tissue

Lung Cancer


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Lung Cancer

" denocarcinoma # originates in mucous glands of lamina propria

" Small-cell 0oat cell1 carcinoma

# least common( most dangerous # originates in primary bronchi( in)ades

mediastinum( metastasi4es /uic+ly

Progression of Lung Cancer


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Progression of Lung Cancer

" 56E originate in primary bronchi" %umor in)ades bronchial wall( compresses

airway: may cause atelectasis

" Often first sign is coughing up blood" etastasis is rapid: usually occurs by time

of diagnosis

# common sites pericardium( heart( bones( li)er(lymph nodes and brain

" Prognosis poor after diagnosis

# only E of patients sur)i)e = years

Aealthy LungFSmo+ers Lung- Carcinoma


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1 sistem respirasi anatomi

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