1. Part II - Respiratory Physiology

2. 4 distinct events
Pulmonary ventilation: air is moved in and out of the lungs
External respiration: gas exchange between blood and alveoli
Respiratory gas transport: CV system transports oxygen and carbon dioxide between lungs & tissues (discussed in Blood chapter)
Internal respiration: gas exchange between blood & tissue cells
Definition: Cellular respiration: actual use of oxygen & production of carbon dioxide in the cells
(this is why we have to breathe!!)

3. Pulmonary Ventilation

4. External Respiration

5. Resp. Gas Transport

6. Internal Respiration

7. Cellular Respiration

8. Mechanics of Breathing

9. Pulmonary Ventilation: Event #1
Pulmonary ventilation: - Moving air into and out of the lungs
Depends on pressure changes
Breathing
Inspiration = moving air into the lungs
Expiration = moving air out of lungs

10. Pressure Relationships
Intrapulmonary pressure
Pressure within the alveoli (lungs)
Changes with phases of breathing
Always equalizes itself with atmospheric pressure
Intrapleural pressure
Pressure within intrapleural space (between the pleural membranes )
Always 4 mmHg less than intrapulmonary pressure

12. Atalectasis
Any conditions that causes intrapulmonary pressure to equal intrapleural pressure will cause the lungs to collapse
This means they lose the ability to move air since there is NO more pressure difference

13. Atelectasis
term for lung collapse

14. Pneumothorax
Air in the intrapleural space due to trauma – causes lung collapse

15. Pulmonary ventilation
Question: Why does breathing happen?
ONLY acceptable answer: The RULE: Volume changes lead to pressure changes which lead to the flow of gases to equalize the pressure

16. Diaphragm Structure Boyle’s Law =
Pressure & Volume have an INVERSE relationship.

17. Pressure differences cause gas to flow from high to low

18. When the diaphragm contracts, the muscle fibers shorten – so muscle comes down

19. Inspiration Main inspiratory muscles
Diaphragm & external intercostals
Thoracic dimensions change to increase volume of thoracic cavity by 0.5 liters
Intrapulmonary pressure drops 1-3 mmHg and air rushes in for normal quiet inspiration
A deep forced (active) inspiration requires activation of accessory muscles – see diagram in notes

20. Expiration A passive process dependent on natural lung elasticity
lungs recoil when inspiration stops – so alveoli compress –which leads to a volume
decreases -causing intrapulmonary pressure to rise - gas outflows to equalize the pressure with atmospheric pressure
Forced (active) expiration requires contraction of abdominals, etc – see diagram

22. What doctors listen for
Bronchial sounds: produced by air rushing through trachea & bronchi
Vesicular sounds: produced by air filling alveoli

23. Respiratory Sounds
Wheezing : whistling sound
Rales: rasping sound

24. Hear the sounds Basic Lung Sounds – Bronchial
Auscultating The Lungs - Reference Guide

25. Physical factors influencing
Pulmonary ventilation can be influenced by 4 physical factors
Respiratory passage resistance
Lung compliance
Lung elasticity
Alveolar surface tension forces

26. Respiratory passage resistance
Resistance due to increased friction as air moves through passages
Smooth muscle bronchoconstriction Disorders such as asthma – when bronchi constrict
Local accumulations of mucus, infectious material, and tumors – also block air passage

27. Asthma

28. Lung compliance The ease with which lungs can readily expand
Affected by the elasticity of the lungs and the thoracic cage which can be diminished by 2 main factors:
Fibrosis of the lung tissue
Ossification and/or muscle paralysis impairs flexibility of the thoracic cage

29. Lung fibrosis

30. Lung Elasticity
Essential for normal expiration
Emphysema: tissue becomes less elastic and more fibrous
loss of elasticity & increase in fibrous tissue causes enormous effort to exhale – at end stages, alveolar walls break down and surface area is lost for gas exchange

32. Alveolar Surface Tension forces
Surface tension is caused by the tendency of polar molecules such as water to stick to each other with hydrogen bonds
this can cause the walls of the alveoli to stick together like plastic wrap every time you exhale.
Large amounts of energy /effort will be required to simply re-expand the lungs and allow you to inhale (IRDS)

33. Alveolar Surface Tension Forces
Surfactant – interferes with cohesion of water molecules so less energy needed to expand lungs – this is one of the things that keeps our lungs partially expanded at all times. (the other thing is the pressure difference previously discussed)
Secreted by Type II cells in lungs

34. Alveoli & Surface Tension

35. IRDS – Infant Respiratory Distress Syndrome
AKA: Hyaline Membrane Disease Caused by lack of surfactant due to prematurity 28 weeks of gestation is considered