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 info 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 Basic Lung Sounds – Bronchial Basic Lung Sounds – Bronchial  Auscultating The Lungs - Reference Guide Auscultating The Lungs - Reference Guide 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

36. Nonrespiratory Air Maneuvers Reaction or reflex response CoughCough Sneeze –travels up to 40 miles per hourSneeze –travels up to 40 miles per hour Hiccup – phrenic nerve irritation causes diaphragm to spasmHiccup – phrenic nerve irritation causes diaphragm to spasm Yawn – saturates alveoli with fresh airYawn – saturates alveoli with fresh air Need for increased oxygen

37. Control of Breathing Neural Medulla oblongata sets rate of breathing Pons fine-tunes rate and transition

38. Hering-Breuer Reflexes Stimulation is sent Inflation reflex- prevents overexpansion via receptors around bronchioles Deflation reflex – inhibits expiratory centers and stimulates inspiratory centers. Receptors in alveolar walls Usually during forced activity

39. Control of Breathing Chemical Factors Central chemoceptors monitor pH levels in cerebrospinal fluid. High levels of CO2 increase hydrogen level in blood – therefore pH decreases. Peripheral chemoreceptors located in aorta and carotid arteries monitor blood oxygen level. Mechanoreceptors located in muscles and joints detect muscle contraction and force increased ventilation.

40. Lung Volume Static Lung Volume Instructed to perform following breathing maneuvers Tidal volume – amount inhaled during normal breathing Vital capacity – breath in maximum, followed by maximum expiration

41. Lung Volume Residual volume – volume of air that never leaves the lungs Important for continual gas exchange

42. Lung Volume Dynamic Lung Volume

43. End of Quiz #2 Material