1 Sistem Respirasi Anatomi
Transcript of 1 Sistem Respirasi Anatomi
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Chapter 22
Lecture
Outline
See PowerPoint Image Slides
for all figures and tables pre-inserted intoPowerPoint without notes.
Copyright (c) The McGraw-Hill Companies, Inc. Permission require !or reprouction or isplay.
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Respiratory System
" natomy of the Respiratory System
" Pulmonary !entilation
" "as #$change and %ransport
" Respiratory &isorders
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Organs of Respiratory System
" 'ose( pharyn$( laryn$( trachea( bronchi( lungs
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"eneral spects
" irflow in lungs # bronchi
→
bronchioles→
al)eoli
" Conducting di)ision
# passages for airflow( nostrils to bronchioles
" Respiratory di)ision
# distal gas-e$change regions( al)eoli
" *pper respiratory tract # organs in head and nec+( nose through laryn$
" Lower respiratory tract
# organs of thora$( trachea through lungs
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'ose
" ,unctions # warms( cleanses( humidifies inhaled air
# detects odors
# resonating chamber that amplifies the )oice
" ony and cartilaginous supports
# superior half nasal bones medially and
ma$illae laterally # inferior half lateral and alar cartilages
# ala nasi flared portion shaped by dense C%(
forms lateral wall of each nostril
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natomy of 'asal Region
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natomy of 'asal Region
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'asal Ca)ity
" #$tends from nostrils to posterior nares
" !estibule dilated chamber inside ala nasi
# stratified s/uamous epithelium( )ibrissae
0guard hairs1
" 'asal septum di)ides ca)ity into right and
left chambers called nasal fossae
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*pper Respiratory %ract
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*pper Respiratory %ract
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'asal Ca)ity - Conchae and eatuses
" Superior( middle and inferior nasalconchae
# 3 folds of tissue on lateral wall of nasal fossa
# mucous membranes supported by thin scroll-li+e turbinate bones
" eatuses
# narrow air passage beneath each conchae # narrowness and turbulence ensures air
contacts mucous membranes
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'asal Ca)ity - ucosa
" Olfactory mucosa # lines roof of nasal fossa
" Respiratory mucosa
# lines rest of nasal ca)ity with ciliatedpseudostratified epithelium
" &efensi)e role of mucosa
# mucus 0from goblet cells1 traps inhaledparticles
" bacteria destroyed by lyso4yme
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'asal Ca)ity - Cilia and #rectile %issue
" ,unction of cilia of respiratory epithelium # sweep debris-laden mucus into pharyn$ to be
swallowed
" #rectile tissue of inferior concha # )enous ple$us that rhythmically engorges with
blood and shifts flow of air from one side of
fossa to the other once or twice an hour to
pre)ent drying
" Spontaneous epista$is 0nosebleed1
# most common site is inferior concha
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Regions of Pharyn$
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Pharyn$
" 'asopharyn$ (pseudostratified epithelium) # posterior to choanae( dorsal to soft palate
# recei)es auditory tubes and contains
pharyngeal tonsil
# 56° downward turn traps large particles 0786 m1
" Oropharyn$ (stratified squamous epithelium)
# space between soft palate and root of tongue(
inferiorly as far as hyoid bone( contains
palatine and lingual tonsils
" Laryngopharyn$ (stratified squamous)
# hyoid bone to le)el of cricoid cartilage
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Laryn$
" "lottis 9 )ocal cords and opening between" #piglottis
# flap of tissue that guards glottis( directs food
and drin+ to esophagus
" Infant laryn$
# higher in throat( forms a continuous airway
from nasal ca)ity that allows breathing whileswallowing
# by age 2( more muscular tongue( forces laryn$
down
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!iews of Laryn$
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'ine Cartilages of Laryn$
" #piglottic cartilage - most superior
" %hyroid cartilage 9 largest: laryngealprominence
" Cricoid cartilage - connects laryn$ to trachea" rytenoid cartilages 021 - posterior to thyroid
cartilage
" Corniculate cartilages 021 - attached toarytenoid cartilages li+e a pair of little horns
" Cuneiform cartilages 021 - support soft tissue
between arytenoids and epiglottis
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;alls of Laryn$
" Interior wall has 2 folds on each side( fromthyroid to arytenoid cartilages
# )estibular folds superior pair( close glottis during
swallowing # )ocal cords produce sound
" Intrinsic muscles - rotate corniculate andarytenoid cartilages
# adducts 0tightens high pitch sound1 or abducts 0loosens low
pitch sound1 )ocal cords
" #$trinsic muscles - connect laryn$ to hyoid
bone( ele)ate laryn$ during swallowing
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ction of !ocal Cords
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%rachea" Rigid tube
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Lower Respiratory %ract
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Lungs - Surface natomy
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%hora$ - Cross Section
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ronchial %ree
" Primary bronchi 0C-shaped rings1 # from trachea: after 2-3 cm enter hilum of lungs
# right bronchus slightly wider and more )ertical0aspiration1
" Secondary 0lobar1 bronchi 0o)erlapping plates1
# one secondary bronchus for each lobe of lung
" %ertiary 0segmental1 bronchi 0o)erlappingplates1
# 86 right( @ left
# bronchopulmonary segment portion of lung
supplied by each
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ronchial %ree
" ronchioles 0lac+ cartilage1 # layer of smooth muscle
# pulmonary lobule
" portion )entilated by one bronchiole
# di)ides into =6 - @6 terminal bronchioles
" ciliated: end of conducting di)ision
# respiratory bronchioles
" di)ide into 2-86 al)eolar ducts: end in al)eolar sacs
" l)eoli - bud from respiratory bronchioles(al)eolar ducts and al)eolar sacs
# main site for gas e$change
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Lung %issue
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l)eolar lood Supply
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l)eolus
,ig. 22.88
b and c
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Pleurae and Pleural ,luid
" !isceral 0on lungs1 and parietal 0lines ribcage1 pleurae
" Pleural ca)ity - space between pleurae(
lubricated with fluid" ,unctions
# reduce friction
# create pressure gradient" lower pressure assists lung inflation
# compartmentali4ation
" pre)ents spread of infection
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Pulmonary !entilation
" reathing 0pulmonary )entilation1 9 onecycle of inspiration and e$piration
# /uiet respiration 9 at rest
# forced respiration 9 during e$ercise" ,low of air in and out of lung re/uires a
pressure difference between air pressure
within lungs and outside body
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Respiratory uscles
"&iaphragm 0dome shaped1 # contraction flattens diaphragm
" Scalenes - hold first pair of ribs stationary
" #$ternal and internal intercostals # stiffen thoracic cage: increases diameter
" Pectoralis minor( sternocleidomastoid and
erector spinae muscles # used in forced inspiration
" bdominals and latissimus dorsi
# forced e$piration 0to sing( cough( snee4e1
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Respiratory uscles
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'eural Control of reathing
" reathing depends on repetiti)e stimuli frombrain
" 'eurons in medulla oblongata and pons control
unconscious breathing
" !oluntary control pro)ided by motor corte$
" Inspiratory neurons fire during inspiration
" #$piratory neurons fire during forced e$piration
" ,ibers of phrenic ner)e go to diaphragm:
intercostal ner)es to intercostal muscles
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Respiratory Control Centers
" Respiratory nuclei in medulla # inspiratory center 0dorsal respiratory group1" fre/uent signals( you inhale deeply
" signals of longer duration( breath is prolonged
# e$piratory center 0)entral respiratory group1" in)ol)ed in forced e$piration
" Pons
# pneumota$ic center
" sends continual inhibitory impulses to inspiratory center( asimpulse fre/uency rises( breathe faster and shallower
# apneustic center
" prolongs inspiration( breathe slower and deeper
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Respiratory Control Centers
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Input to Respiratory Centers
" ,rom limbic system and hypothalamus # respiratory effects of pain and emotion
" ,rom airways and lungs
# irritant receptors in respiratory mucosa" stimulate )agal afferents to medulla( results in
bronchoconstriction or coughing
# stretch receptors in airways - inflation refle$" e$cessi)e inflation triggers refle$
" stops inspiration
" ,rom chemoreceptors
# monitor blood pA( CO2 and O2 le)els
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Chemoreceptors
" Peripheral chemoreceptors # found in ma?or blood )essels
" aortic bodies
# signals medulla by )agus ner)es
" carotid bodies
# signals medulla by glossopharyngeal ner)es
" Central chemoreceptors
# in medulla" primarily monitor pA of CS,
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Peripheral Chemoreceptor Paths
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!oluntary Control
" 'eural pathways # motor corte$ of frontal lobe of cerebrum sends
impulses down corticospinal tracts to
respiratory neurons in spinal cord( bypassing
brainstem
" Limitations on )oluntary control
# blood CO2 and O2 limits cause automatic
respiration
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Pressure and ,low
" tmospheric pressure dri)es respiration # 8 atmosphere 0atm1 B >6 mmAg
" Intrapulmonary pressure and lung )olume
# pressure is in)ersely proportional to )olume" for a gi)en amount of gas( as )olume ↑( pressure ↓
and as )olume ↓( pressure ↑
" Pressure gradients # difference between atmospheric and
intrapulmonary pressure
# created by changes in )olume thoracic ca)ity
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Inspiration - Pressure Changes
∀↓ intrapleural pressure
# as )olume of thoracic ca)ity ↑(
)isceral pleura clings to parietal pleura
∀↓ intrapulmonary pressure
# lungs e$pand with )isceral pleura
" %ranspulmonary pressure
# intrapleural minus intrapulmonary pressure 0notall pressure change in the pleural ca)ity is transferredto the lungs1
" Inflation aided by warming of inhaled air
" =66 ml of air flows with a /uiet breath
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Respiratory Cycle
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Passi)e #$piration
" &uring /uiet breathing( e$piration achie)edby elasticity of lungs and thoracic cage
" s )olume of thoracic ca)ity ↓(
intrapulmonary pressure↑
and air ise$pelled
" fter inspiration( phrenic ner)es continue
to stimulate diaphragm to produce abra+ing action to elastic recoil
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,orced #$piration
" Internal intercostal muscles # depress the ribs
" Contract abdominal muscles
↑
intra-abdominal pressure forcesdiaphragm upward
↑ pressure on thoracic ca)ity
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Pneumothora$
" Presence of air in pleural ca)ity # loss of negati)e intrapleural pressure allows
lungs to recoil and collapse
" Collapse of lung 0or part of lung1 is calledatelectasis
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Resistance to irflow
" Pulmonary compliance # distensibility of lungs: change in lung )olume
relati)e to a change in transpulmonary pressure
" ronchiolar diameter # primary control o)er resistance to airflow
# bronchoconstriction
" triggered by airborne irritants( cold air(
parasympathetic stimulation( histamine
# bronchodilation
" sympathetic ner)es( epinephrine
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l)eolar Surface %ension
" %hin film of water needed for gas e$change # creates surface tension that acts to collapse
al)eoli and distal bronchioles
" Pulmonary surfactant 0great al)eolar cells1 # decreases surface tension
" Premature infants that lac+ surfactant
suffer from respiratory distress syndrome
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l)eolar !entilation
" &ead air
# fills conducting di)ision of airway( cannot
e$change gases
" natomic dead space
# conducting di)ision of airway
" Physiologic dead space
# sum of anatomic dead space and any
pathological al)eolar dead space
" l)eolar )entilation rate
# air that )entilates al)eoli D respiratory rate
# directly rele)ant to ability to e$change gases
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easurements of !entilation
" Spirometer - measures )entilation" Respiratory )olumes
# tidal )olume )olume of air in one /uiet breath
# inspiratory reser)e )olume" air in e$cess of tidal inspiration that can be inhaled
with ma$imum effort
# e$piratory reser)e )olume
" air in e$cess of tidal e$piration that can be e$haled
with ma$imum effort
# residual )olume 0+eeps al)eoli inflated1
" air remaining in lungs after ma$imum e$piration
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Lung !olumes and Capacities
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" !ital capacity # total amount of air that can be e$haled with
effort after ma$imum inspiration
" assesses strength of thoracic muscles and
pulmonary function
" Inspiratory capacity
# ma$imum amount of air that can be inhaled
after a normal tidal e$piration
" ,unctional residual capacity
# amount of air in lungs after a normal tidal
e$piration
Respiratory Capacities
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Respiratory Capacities
" %otal lung capacity # ma$imum amount of air lungs can hold
" ,orced e$piratory )olume 0,#!1
# E of )ital capacity e$haledF time # healthy adult - = to @=E in 8 sec
" Pea+ flow # ma$imum speed of e$halation
" inute respiratory )olume 0R!1 # %! $ respiratory rate( at rest =66 $ 82 B > LFmin
# ma$imum 82= to 86 LFmin
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Respiratory !olumes and Capacities
" ge -↓
lung compliance( respiratory muscleswea+en
" #$ercise - maintains strength of respiratory
muscles " ody si4e - proportional( big bodyFlarge lungs
" Restricti)e disorders
↓
compliance and )ital capacity" Obstructi)e disorders
# interfere with airflow( e$piration re/uires more
effort or less complete
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Composition of ir
" i$ture of gases: each contributes itspartial pressure # at sea le)el 8 atm. of pressure B >6 mmAg
# nitrogen constitutes @.>E of the atmosphere so
" P'2 B @.>E $ >6 mmAg B =5 mmAg
" PO2 B 8=5
" PA2O B 3.
" PCO2 B G 6.3
" P'2 G PO
2 G PA2O G PCO2 B >6 mmAg
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Composition of ir
" Partial pressures 0as well as solubility of gas1 # determine rate of diffusion of each gas and gas
e$change between blood and al)eolus
" l)eolar air # humidified( e$changes gases with blood( mi$es with
residual air
# contains
" P'2B =>5
" PO2 B 86<
" PA2O B
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ir-;ater Interface
" Important for gas e$change between airin lungs and blood in capillaries
" "ases diffuse down their concentration
gradients" AenryHs law
# amount of gas that dissol)es in water is
determined by its solubility in water and its partial pressure in air
l l " # h
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l)eolar "as #$change
l l " # h
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l)eolar "as #$change
" %ime re/uired for gases to e/uilibrate B6.2= sec
" RC transit time at rest B 6.= sec to pass
through al)eolar capillary" RC transit time with )igorous e$ercise B
6.3 sec
, t ff ti " # h
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,actors ffecting "as #$change
" Concentration gradients of gases # PO
2 B 86< in al)eolar air )ersus
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,actors ffecting "as #$change
" embrane thic+ness - only 6.= m thic+" embrane surface area - 866 ml blood in
al)eolar capillaries( spread o)er 6 m2
"!entilation-perfusion coupling - areas ofgood )entilation need good perfusion0)asodilation1
Concentration "radients of "ases
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Concentration "radients of "ases
mbient Pressure and Concentration
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mbient Pressure and Concentration"radients
L &i ff t " # h
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Lung &isease ffects "as #$change
P f i d? t t
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Perfusion d?ustments
! til ti d? t t
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!entilation d?ustments
O % t
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O$ygen %ransport
" Concentration in arterial blood # 26 mlFdl
" 5@.=E bound to hemoglobin
" 8.=E dissol)ed
" inding to hemoglobin
# each heme group of < globin chains may
bind O2
# o$yhemoglobin 0AbO2 1
# deo$yhemoglobin 0AAb1
O % t
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O$ygen %ransport
" O$yhemoglobin dissociation cur)e # relationship between hemoglobin saturation
and PO2 is not a simple linear one
# after binding with O2( hemoglobin changesshape to facilitate further upta+e 0positi)e
feedbac+ cycle1
O h l bi &i i ti C
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O$yhemoglobin &issociation Cur)e
Carbon &io ide %ransport
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Carbon &io$ide %ransport
" s carbonic acid - 56E # CO2 G A2O → A2CO3→ ACO3- G AG
" s carbaminohemoglobin 0AbCO21- =E binds to
amino groups of Ab 0and plasma proteins1
" s dissol)ed gas - =E
" l)eolar e$change of CO2 # carbonic acid - 6E
# carbaminohemoglobin - 23E
# dissol)ed gas - E
Systemic "as #$change
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Systemic "as #$change
" CO2 loading
# carbonic anhydrase in RC cataly4es" CO2 G A2O → A2CO3→ ACO3- G AG
# chloride shift
" +eeps reaction proceeding( e$changes ACO3- for Cl- 0AG binds to hemoglobin1
" O2 unloading
# AG binding to AbO2 ↓ its affinity for O
2" Ab arri)es 5E saturated( lea)es =E
saturated - )enous reser)e
# utili4ation coefficient
" amount of o$ygen Ab has released 22E
Systemic "as #$change
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Systemic "as #$change
l)eolar "as #$change Re)isited
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l)eolar "as #$change Re)isited
" Reactions are re)erse of systemic gase$change
" CO2 unloading
# as Ab loads O2 its affinity for AG decreases( AG dissociates from Ab and bind with ACO3-
" CO2 G A2O A2CO3 ACO3- G AG
# re)erse chloride shift" ACO3- diffuses bac+ into RC in e$change
for Cl-( free CO2 generated diffuses into
al)eolus to be e$haled
l)eolar "as #$change
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l)eolar "as #$change
,actors ffect O *nloading
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,actors ffect O2 *nloading
" cti)e tissues need o$ygen # ambient PO
2 acti)e tissue has ↓ PO
2: O2 is released
# temperature acti)e tissue has ↑ temp: O2 is released
# ohr effect acti)e tissue has↑
CO2( which lowers pA
0muscle burn1: O2 is released
# bisphosphoglycerate 0P"1 RCHs produce P"
which binds to Ab: O2 is released
∀↑ body temp 0fe)er1( %A( "A( testosterone( and
epinephrine all raise P" and cause O2 unloading
0↑ metabolic rate re/uires ↑ o$ygen1
O$ygen &issociation and %emperature
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O$ygen &issociation and %emperature
O$ygen &issociation and pA
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O$ygen &issociation and pA
ohr effect release of O2 in response to low pA
,actors ffecting CO Loading
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" Aaldane effect # low le)el of AbO2 0as in acti)e tissue1 enables
blood to transport more CO2
# AbO2 does not bind CO2 as well asdeo$yhemoglobin 0AAb1
# AAb binds more AG than AbO2" as AG is remo)ed this shifts the
CO2 G A2O → ACO3- G AG
reaction to the right
,actors ffecting CO2 Loading
lood Chemistry
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lood Chemistry
and Respiratory Rhythm
" Rate and depth of breathing ad?usted to
maintain le)els of
# pA # PCO
2
# PO2
" LetHs loo+ at their effects on respiration
#ffects of Aydrogen Ions
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#ffects of Aydrogen Ions
" pA of CS, 0most powerful respiratory stimulus1" Respiratory acidosis 0pA J .3=1 caused by
failure of pulmonary )entilation
# hypercapnia PCO2 7
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#ffects of Aydrogen Ions
" Respiratory al+alosis 0pA 7 .
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#ffects of Carbon &io$ide
" Indirect effects on respiration # through pA as seen pre)iously
" &irect effects
↑
CO2 may directly stimulate peripheralchemoreceptors and trigger ↑ )entilation more
/uic+ly than central chemoreceptors
#ffects of O$ygen
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#ffects of O$ygen
" *sually little effect" Chronic hypo$emia( PO
2 J >6 mmAg(
can significantly stimulate )entilation
# emphysema( pneumonia # high altitudes after se)eral days
Aypo$ia
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Aypo$ia
" Causes # hypo$emic hypo$ia - usually due to inade/uate
pulmonary gas e$change
" high altitudes( drowning( aspiration( respiratory
arrest( degenerati)e lung diseases( CO poisoning
# ischemic hypo$ia - inade/uate circulation
# anemic hypo$ia - anemia
# histoto$ic hypo$ia - metabolic poison 0cyanide1
" Signs cyanosis - blueness of s+in
" Primary effect tissue necrosis( organs with
high metabolic demands affected first
O$ygen #$cess
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O$ygen #$cess
" O$ygen to$icity pure O2 breathed at 2.=atm or greater
# generates free radicals and A2O2
# destroys en4ymes # damages ner)ous tissue
# leads to sei4ures( coma( death
" Ayperbaric o$ygen # formerly used to treat premature infants(
caused retinal damage( discontinued
Chronic Obstructi)e Pulmonary &isease
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Chronic Obstructi)e Pulmonary &isease
" sthma
# allergen triggers histamine release
# intense bronchoconstriction 0bloc+s air flow1
" Other COP&Hs usually associated with smo+ing
# chronic bronchitis
# emphysema
Chronic Obstructi)e Pulmonary &isease
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Chronic Obstructi)e Pulmonary &isease
" Chronic bronchitis
# cilia immobili4ed and ↓ in number
# goblet cells enlarge and produce e$cess
mucus # sputum formed 0mucus and cellular debris1
" ideal growth media for bacteria
# leads to chronic infection and bronchialinflammation
Chronic Obstructi)e Pulmonary &isease
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Chronic Obstructi)e Pulmonary &isease
" #mphysema
# al)eolar walls brea+ down
" much less respiratory membrane for gas e$change
# healthy lungs are li+e a sponge: in emphysema( lungs aremore li+e a rigid balloon
# lungs fibrotic and less elastic
# air passages collapse
" obstruct outflow of air
" air trapped in lungs
#ffects of COP&
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#ffects of COP&
∀↓
pulmonary compliance and )ital capacity" Aypo$emia( hypercapnia( respiratory
acidosis
# hypo$emia stimulates erythropoietin releaseand leads to polycythemia
" cor pulmonale
# hypertrophy and potential failure of right heartdue to obstruction of pulmonary circulation
Smo+ing and Lung Cancer
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Smo+ing and Lung Cancer
" Lung cancer accounts for more deathsthan any other form of cancer
# most important cause is smo+ing 08=
carcinogens1
" S/uamous-cell carcinoma 0most common1
# begins with transformation of bronchial
epithelium into stratified s/uamous
# di)iding cells in)ade bronchial wall( cause
bleeding lesions
# dense swirls of +eratin replace functional
respiratory tissue
Lung Cancer
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Lung Cancer
" denocarcinoma # originates in mucous glands of lamina propria
" Small-cell 0oat cell1 carcinoma
# least common( most dangerous # originates in primary bronchi( in)ades
mediastinum( metastasi4es /uic+ly
Progression of Lung Cancer
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Progression of Lung Cancer
" 56E originate in primary bronchi" %umor in)ades bronchial wall( compresses
airway: may cause atelectasis
" Often first sign is coughing up blood" etastasis is rapid: usually occurs by time
of diagnosis
# common sites pericardium( heart( bones( li)er(lymph nodes and brain
" Prognosis poor after diagnosis
# only E of patients sur)i)e = years
Aealthy LungFSmo+ers Lung- Carcinoma
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y g g