Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structure and Function of the Pulmonary System Chapter 25

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System   Airways  Pulmonary circulation  Chest wall  Lungs  Lobes (three on right, two on left)  Segments  Lobules

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System  Conducting airways  Upper airways Nasopharynx Nasopharynx Oropharynx Oropharynx  Larynx Connects upper and lower airways Connects upper and lower airways  Lower airways Trachea Trachea Bronchi Bronchi Terminal bronchioles Terminal bronchioles

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bronchioles-”respiratory tree”

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System  Gas-exchange airways  Respiratory bronchioles  Alveolar ducts  Alveoli Epithelial cells Epithelial cells  Type I alveolar cells –Alveolar structure  Type II alveolar cells –Surfactant production

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. CO2 & O2 – alveolar exchange

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Pulmonary System

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary and Bronchial Circulation  Pulmonary circulation has a lower pressure than the systemic circulation  One third of pulmonary vessels are filled with blood at any given time  Pulmonary artery divides and enters the lung at the hilus  Each bronchus and bronchiole has an accompanying artery or arteriole

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary and Bronchial Circulation  Alveolocapillary membrane  Formed by the shared alveolar and capillary walls  Gas exchange occurs across this membrane

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonary and Bronchial Circulation

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Chest Wall and Pleura  Chest wall  Skin, ribs, and intercostal muscles  Thoracic cavity  Pleura  Serous membrane  Parietal and visceral layers  Pleural space (cavity)  Pleural fluid

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Thoracic Cavity

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Function of the Pulmonary System  Ventilate the alveoli  Diffuse gases into and out of the blood  Perfuse the lungs so the body receives oxygen

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Function of the Pulmonary System  Ventilation  Mechanical movement of gas or air into and out of the lungs  Minute volume Ventilatory rate multiplied by the volume of air per breath Ventilatory rate multiplied by the volume of air per breath  Alveolar ventilation

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Ventilation  Neurochemical control  Respiratory center Dorsal respiratory group Dorsal respiratory group Ventral respiratory group Ventral respiratory group Pneumotaxic center Pneumotaxic center Apneustic center Apneustic center

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Ventilation  Neurochemical control  Lung receptors Irritant receptors Irritant receptors Stretch receptors Stretch receptors J receptors J receptors  Chemoreceptors Central chemoreceptors Central chemoreceptors Peripheral chemoreceptors Peripheral chemoreceptors

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Neurochemical Respiratory Control

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mechanics of Breathing  Major and accessory muscles  Major muscles of inspiration Diaphragm Diaphragm External intercostals External intercostals  Accessory muscles of inspiration Sternocleidomastoid and scalene muscles Sternocleidomastoid and scalene muscles  Accessory muscles of expiration Abdominal and internal intercostal muscles Abdominal and internal intercostal muscles

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Muscles of Ventilation

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mechanics of Breathing  Alveolar surface tension and ventilation  Function of surfactant  Elastic properties of the lung and chest wall  Elastic recoil  Compliance  Airway resistance  Work of breathing

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mechanics of Breathing

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Gas Transport  Four steps  Ventilation of the lungs  Diffusion of oxygen from the alveoli into the capillary blood  Perfusion of systemic capillaries with oxygenated blood  Diffusion of oxygen from systemic capillaries into the cells  Diffusion of CO 2 occurs in reverse order

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Gulfstream G650

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Louie’s Backyard Restaurant Key West Florida

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Measurement of Gas Pressure  Barometric pressure  Partial pressure  Partial pressure of water vapor

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Measurement of Gas Pressure

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Gas Transport  Distribution of ventilation and perfusion  Gravity and alveolar pressure  Ventilation-perfusion ratio(0.8)

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Gas Transport  Oxygen transport  Diffusion across the alveolocapillary membrane  Determinants of arterial oxygenation Hemoglobin binding, oxygen saturation Hemoglobin binding, oxygen saturation  Oxyhemoglobin association and dissociation Oxyhemoglobin dissociation curve Oxyhemoglobin dissociation curve Bohr effect Bohr effect

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Measurement of Gas Pressure

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Gas Transport  Carbon dioxide transport  Dissolved in plasma  Bicarbonate(HCO 3 )  Carbamino compounds (hemaglobin)  Haldane effect

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Carbon Dioxide Transport  Dissolved in plasma-Pco 2  Arterial -5%  Venous-10%  Bicarbonate-HCO 3  Arterial-90%  Venous-60%  Carbamino compounds-Hb  Arterial-5%  Venous-30%

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Control of Pulmonary Circulation  Hypoxic pulmonary vasoconstriction  Caused by low alveolar PO 2  Blood is shunted to other, well-ventilated portions of the lungs Provides better ventilation and perfusion matching Provides better ventilation and perfusion matching If hypoxia affects all segments of the lungs, the vasoconstriction can result in pulmonary hypertension If hypoxia affects all segments of the lungs, the vasoconstriction can result in pulmonary hypertension

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Control of Pulmonary Circulation  Acidemia also causes pulmonary artery constriction

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tests of Pulmonary Function  Spirometry  Diffusion capacity  Residual volume  Functional reserve capacity (FRC)  Total lung capacity  Arterial blood gas analysis  Chest radiographs

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aging and the Pulmonary System  Loss of elastic recoil  Stiffening of the chest wall  Alterations in gas exchange  Increases in flow resistance  Decreased exercise tolerance

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aging and the Pulmonary System