Pulmonology: The Study of the Human Respiratory System By Daniel J. Yakubov & Mariel Pullman, 3 rd Year Medical Student

Anatomy What information are you familiar with that relates to the Respiratory Tract?

Upper Respiratory Tract Nose  Larynx Lower Respiratory Tract Trachea  downwards Conducting Portion = Air Transport Nose, Nasal Cavity, Pharynx, Larynx, trachea, primary bronchi  terminal bronchi Respiratory Portion = Gas Exchange Bronchioles, Alveolar Ducts, Air Sacs or the Alveoli

How many Lobes does the Left Lobe have? –2 lobes Inferior Lobe Superior Lobe How many Lobes does the Right Lobe have? –3 Lobes Inferior Lobe Middle Lobe Superior Lobe Where are your Right and Left Lobes? –Thorax and Back. Where??

Why does the Left Lobe only have 2 Lobes? Which Lung has the greater capacity or size? Which Lung has the greater weight? Which Lung has the enough capacity to support higher air intake? Which lung contains the biggest Bronchus?

The human respiratory system allows one to obtain oxygen, eliminate carbon dioxide. Breathing consists of two phases! Anyone Know what the phases are called? Inspiration- the process of taking in air Expiration- the process of blowing out air

Basic Anatomy of the Respiratory System

STRUCTUREFUNCTION nose / nasal cavity warms, moistens, & filters air as it is inhaled pharynx (throat) passageway for air, leads to trachea larynx the voice box, where vocal chords are located trachea (windpipe) keeps the windpipe "open" trachea is lined with fine hairs called cilia which filter air before it reaches the lungs bronchi two branches at the end of the trachea, each lead to a lung bronchioles a network of smaller branches leading from the bronchi into the lung tissue & ultimately to air sacs alveoli the functional respiratory units in the lung where gases are exchanged

Any Questions, thus far?

Physiology How does it work?

Gas Exchange in the Alveoli

Who loves Physics? Part of Medicine heavily relies on physics concepts such as Equilibrium and Boyle’s Law are used in everyday medicine.

▶ Boyle's Law explains why our lung pressure decreases when we increase the volume of our lungs by expanding the rib cage and contracting the diaphragm to inhale. ▶ When we exhale, the rib cage contracts and the diaphragm relaxes into its more curved position, thus decreasing the lung volume and causing pressure to rise. ▶ This pressure then causes air to rush out of the lungs.

▶ Ideal Gas law –The pressure and volume of a container of gas is directly related to the temperature of the gas and the number of molecules in the container –PV = nRT n = moles of gas T = absolute temp R = universal gas J/K·mol

Surfactants are compounds that lower surface tension between 2 liquids Surfactant is produced by the septal cells – Disrupts the surface tension & cohesion of water molecules – Impact? prevents alveoli from sticking together during expiration

Simplification ▶ Inhale = Pressure decreases, volume increases, by contracting our intercostal muscles and diaphragm. ▶ Exhale = Pressure increases, Volume decreases, by retracting our intercostal muscles and diaphragm.

Balloon Demonstration

Phases of Air Flow PhaseMuscles involved InspirationDiaphragm and/or external intercostals Expiration 1 Elastic recoil, diaphragm used to prevent excess pressure from recoil Expiration 2 Elastic recoil, internal intercostals, continuing until no more recoil remains Expiration 3Internal intercostals, abdominals

How do we test inhalation and exhalation? –Spirometry using a Spirometer

Pathophysiology What Happened? What went wrong?

“Patho-” means disease or when something went bad So, What are we about to talk about?

Examples of COPD – What is COPD? Malfunctions & Diseases of the Respiratory System asthma severe allergic reaction characterized by the constriction of bronchioles bronchitis inflammation of the lining of the bronchioles emphysema condition in which the alveoli deteriorate, causing the lungs to lose their elasticity pneumonia condition in which the alveoli become filled with fluid, preventing the exchange of gases lung cancer irregular & uncontrolled growth of tumors in the lung tissue

Abnormal Lung Sounds ▶ Pneumonia can result in Rhonchi ▶ Crackles or Rales (sounds like Poprocks or like rice crispies): Rales or Crackles is caused by fluid in the small airways ▶ Rhonchi (sounds like someone sucking in the last bit of soda at the bottom of the can using a straw): Rhonchi occurs when the lungs contain excess fluid; the fluid usually accumulates within the Alveoli ▶ Wheezing:

Abnormal Lung Sounds-Audio Make sure to listen carefully! 1. The first patient has what type of condition? 2. The second patient has what type of condition? 3. The third patient has what type of condition?

Peak Flow is associated with Asthma! ▶ In order for us to understand how Asthma feels like, we are going to do a little demonstration. –Take the straw –Inhale and exhale for 30 seconds continually, non-stop. –That is what Asthma feels like!

Peak Flow is used to measure how air flows from your lungs in one “fast blow”. One should use the peak flow meter to see if your asthma is getting worse.

Peak flow Chart

Emphysema

Lung Cancer

Coughed-Up Bronchioles

Clinical Skills How do we apply what we learned within Clinical Examinations and Skills?

Pulmonary Examination – PIPPA ▶ Position of the patient and the environment. ▶ Inspection of the patient and respiratory effort. ▶ Palpation of the patient's anterior and posterior chest. ▶ Percussion of the patient's anterior and posterior chest walls. ▶ Auscultation of the patient's anterior and posterior chest walls.