RESPIRATORY SYSTEM

I. FUNCTION
• To supply the body with oxygen and dispose carbon dioxide
• It involves at least 3 distinct process:
1. Pulmonary Ventilation
 Inflow and outflow of air between the atmosphere and alveoli of the
lungs
2. External Respiration
 Diffusion of oxygen and carbon dioxide between the alveoli and
pulmonary capillaries
3. Internal Respiration
 Transport of oxygen and carbon dioxide via the blood to and from
the tissue
II. FUNCTIONAL ANATOMY OF THE RESPIRATORY SYSTEM
A. Conducting Zone
• Also called as “dead space” because there is no gas exchange in
these zones
• Respiratory passages extending from nose to the terminal bronchioles
B. Respiratory Zone
• Actual site of gas exchange
• Composed of the respiratory bronchioles, alveolar ducts, and alveoli
i. Conducting Zone Structures
I. Upper resp tract
A. Filtering of air
B. Warming and moisruring
C. Humidification

A. Nose
 made up of framework of cartilage
 nostril septum

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  Kessel-bach plexus: anastomosis
 capillaries

B. Pharynx
 muscular passageway for both air and food
1. Orophyarynx
2. Nasopharynx
3. Laryngophyarynx

C. Larynx
 voicebox
1. For phonation
2. Coughing reflex
3. Opening of larynx: glottis
 it opens to allow passage of air
 closes to allow food passage
II. Lower resp tract
 For gas exchange
A. Trachea (windpipe)
 consists of cartilaginous rings
 permanent artificial airway
B. Bronchii
Right bronchus Left bronchus
Diameter Wider Narrower
Length Shorter Longer
Direction More vertical Oblique
ii. Respiratory Zone Structures
a. Respiratory Bronchioles
b. Alveolar ducts
c. Alveolar sac
d. Alveoli  actual site of gas exchange

• The respiratory membrane is composed of several cell types

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 A. Type I pneumocytes
• Walls of the alveoli composed of simple squamous epithelium
B. Type II pneumocytes
• Cuboidal secretory cells
• Secrete a fluid containing surfactant that coats the gas exposed
alveolar surfaces
• Surfactant decreases the surface tension on the alveolar walls
• L:S ratio = 1:2
2 types of surfactant:
1. Lecithin: 2
2. Spingomyelin: 1
 indicates lung maturity: LS ratio

 premature infant - 1:2 LS ratio - need brown fats, O2 regulation < 40% to prevent
retrolental fibroplasia, retinopathy, blindness
•
C. Alveolar macrophages
• Dust cells
• Provide primary line of defense against inhaled dust, bacteria, and
other foreign particles
III. LUNGS AND PLEURAL CAVITIES
A. Lungs
Right Lung Left Lung
• Lobes 3 2
• Fissures 1 horizontal 1 oblique
1 oblique
• Cardiac notch (- ) (+)
• Lingula (- ) (+)

B. Pleura
IV. MUSCULAR CONTROL OF BREATHING
A. Inspiration
• Diaphragm contracts  moves inferiorly and flattens out  increase
height of the thoracic cavity

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 • Contraction of the external intercostals muscles  elevates the rib cage
and thrust the sternum forward  expand the diameter of the thorax
B. Expiration
• Inspiratory muscles relax  rib cage descends and lungs recoil
V. AIRWAY RESISTANCE AND COMPLIANCE
A. Airway resistance
• Determined chiefly by radium or size of the airway
• Changes in bronchial diameter  alters the rate of air flow for a given
pressure gradient during respiration
• ↑ resistance – greater than normal respiratory effort is required
B. Compliance
• A measure of the elasticity, expandability, and distensibility of the lungs
and thoracic structures
• Normal compliance  lungs and thorax easily stretch and distend
when pressure is applied
• High or ↑ compliance  lungs have lost elasticity and the thorax is
overdistended  ? (example)
• Low or ↓compliance  lungs and thorax are stiff  ? (example)
VI. GAS EXCHANGE IN THE BODY
VII. CONTROL OF RESPIRATION
A. Medullary Respiratory Centers
a. Dorsal respiratory group or inspiratory center
b. Ventral respiratory group or expiratory center
B. Pons Respiratory Centers
a. . Pneumotaxic Center  rhythm and prevents over inflation of the lungs
b. Apneustic Center  inspiratory drive
C. Chemical Control of Respiration
a. Central chemoreceptor
i. Located bilaterally in the medulla
ii. Sensitive to small changes in blood CO2 and pH

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 iii. Hypercapnia / ↑ CO2  the most powerful respiratory stimulant
iv. Release of H ions in the CSF  reflexive increase in the rate and
depth of breathing
b. Peripheral chemoreceptor
i. Found within vessels of the neck (carotid and aortic bodies)
ii. Sensitive to arterial oxygen levels
iii. ↓ arterial pressure of oxygen (below 60 mmHg)  becomes the
major stimulus for respiration  ↑ ventilation
ASSESSMENT
Major Signs and Symptoms of Respiratory Diseases
a. Dyspnea
 How much exertion triggers SOB?
 Is there an associated cough?
 Is dyspnea related to the symptoms?
 At what time of day or night does the dyspnea occur?
 Is the SOB worse when the patient is flat in bed?
 Does the SOB occur at rest? With exercise? Running? Climbing stairs?
 Is the SOB worse while walking?
 Management: Identify and correcting its cause, rest, positioning, oxygen
administration
b. Sputum production
 Purulent with change in color – bacterial infection
 Profuse, frothy, pink material – pulmonary edema
 Foul smelling associated with bad breath – lung abscess, bronchiectasis
 Management: ↑ OFI, inhalation of aerosolized solutions, chest
physiotherapy
c. Chest Pain
 Sharp, stabbing, and intermittent – pulmonary problem
 Dull, aching, and persistent
 Management: Analgesics

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d. Wheezing
 Bronchoconstriction or airway narrowing
 Management: Bronchodilators
e. Hemoptysis
 Most common causes: pulmonary infection, lung Ca, heart or blood vessel
abnormalities, pulmonary artery or vein abnormalities, pulmonary emboli and
infarction
 Determine the source and treat the underlying cause of bleeding
f. Cyanosis
 A very late indicator of hypoxia
 Nor a reliable sign of hypoxia
g. Clubbing of the Fingers
 Found in patients with chronic hypoxic conditions, chronic lung infections,
lung Ca