kuliah anatomi respirasi
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Transcript of kuliah anatomi respirasi
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dr. Ety Sari, M.Kes
Sistem Respirasi:Susunan dan Cara Kerja Otot
Pernafasan
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5 Functions of the Respiratory System
1. Provides extensive gas exchange surface area between air and circulating blood
2. Moves air to and from exchange surfaces of lungs
3. Protects respiratory surfaces from outside environment
4. Produces sounds5. Participates in olfactory sense
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Organization of the Respiratory System
• The respiratory system is divided into the upper respiratory system, above the larynx, and the lower respiratory system, from the larynx down
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Components of the Respiratory System
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The Respiratory Tract
• Consists of a conducting portion:– from nasal cavity to terminal bronchioles
• Consists of a respiratory portion:– the respiratory bronchioles and alveoli
Alveoli• Are air-filled pockets within the lungs
– where all gas exchange takes place
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The Upper Respiratory System
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The Nose
• Air enters the respiratory system:– through nostrils or external nares– into nasal vestibule
• Nasal hairs:– are in nasal vestibule – are the first particle filtration system
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The Nasal Cavity
• The nasal septum:– divides nasal cavity into left and right
• Mucous secretions from paranasal sinus and tears:– clean and moisten the nasal cavity
• Superior portion of nasal cavity is the olfactory region:– provides sense of smell
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Air Flow
• From vestibule to internal nares:– through superior, middle, and inferior
meatuses
Meatuses• Constricted passageways that produce
air turbulence:– warm and humidify incoming air– trap particles
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The Palates
• Hard palate:– forms floor of nasal cavity– separates nasal and oral cavities
• Soft palate:– extends posterior to hard palate– divides superior nasopharynx from lower
pharynx
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Air Flow• Nasal cavity opens into nasopharynx
through internal nares
The Nasal Mucosa• Warm and humidify inhaled air for
arrival at lower respiratory organs
• Breathing through mouth bypasses this important step
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The Pharynx and Divisions
• A chamber shared by digestive and respiratory systems
• Extends from internal nares to entrances to larynx and esophagus
• Nasopharynx
• Oropharynx
• Laryngopharynx
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The Nasopharynx • Superior portion of the pharynx• Contains pharyngeal tonsils and openings to
left and right auditory tubesThe Oropharynx
• Middle portion of the pharynx• Communicates with oral cavity
The Laryngopharynx• Inferior portion of the pharynx• Extends from hyoid bone to entrance to
larynx and esophagus
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What is the structure of the larynx and its
role in normal breathing and production of sound?
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Anatomy of the Larynx
Figure 23–4
Air Flow-From the pharynx enters the larynx:
a cartilaginous structure that surrounds the glottis
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Cartilages of the Larynx
• 3 large, unpaired cartilages form the larynx:– the thyroid cartilage – the cricoid cartilage– the epiglottis
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The Thyroid Cartilage
• Also called the Adam’s apple
• Is a hyaline cartilage
• Forms anterior and lateral walls of larynx
• Ligaments attach to hyoid bone, epiglottis, and laryngeal cartilages
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The Cricoid Cartilage• Is a hyaline cartilage• Form posterior portion of larynx• Ligaments attach to first tracheal cartilage• Articulates with arytenoid cartilages
The Epiglottis• Composed of elastic cartilage• Ligaments attach to thyroid cartilage and
hyoid bone
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The Glottis
Figure 23–5
3 pairs of Small Hyaline Cartilages of the Larynxarytenoid cartilages, corniculate cartilages
cuneiform cartilages
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Cartilage Functions
• Thyroid and cricoid cartilages support and protect:– the glottis – the entrance to trachea
• During swallowing:– the larynx is elevated– the epiglottis folds back over glottis
• Prevents entry of food and liquids into respiratory tract
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Cartilage Functions
• Corniculate and arytenoid cartilages function in:– opening and closing of glottis– production of sound
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Ligaments of the Larynx
• Vestibular ligaments and vocal ligaments:– extend between thyroid cartilage and arytenoid
cartilages– are covered by folds of laryngeal epithelium that
project into glottis
1) The Vestibular Ligaments
• Lie within vestibular folds:– which protect delicate vocal folds
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Sound Production
• Air passing through glottis:– vibrates vocal folds– produces sound waves
Sound Variation• Sound is varied by:
– tension on vocal folds: slender and short =high pitched, thicker and longer = low pitched
– voluntary muscles (position arytenoid cartilage relative to thyroid cartilage)
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Speech
• Is produced by:– phonation:
• sound production at the larynx
– articulation:• modification of sound by other structures
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The Laryngeal Musculature
• The larynx is associated with:– muscles of neck and pharynx– intrinsic muscles that:
• control vocal folds• open and close glottis
•Coughing reflex: food or liquids went “down the wrong pipe”
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Anatomy of the Trachea
Figure 23–6
What is the structure of airways outside the lungs?
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The Trachea
• Also called the windpipe
• Extends from the cricoid cartilage into mediastinum– where it branches into right and left
pulmonary bronchi
The SubmucosaBeneath mucosa of trachea
Contains mucous glands
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The Tracheal Cartilages
• 15–20 tracheal cartilages:– strengthen and protect airway– discontinuous where trachea contacts
esophagus
• Ends of each tracheal cartilage are connected by:– an elastic ligament and trachealis muscle
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The Primary Bronchi
• Right and left primary bronchi:– separated by an internal ridge (the carina)
1) The Right Primary Bronchus
• Is larger in diameter than the left
• Descends at a steeper angle
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Structure of Primary Bronchi
• Each primary bronchus:– travels to a groove (hilus) along medial
surface of the lung
Hilus-• Where pulmonary nerves, blood
vessels, and lymphatics enter lung• Anchored in meshwork of connective
tissue
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The Root of the Lung
• Complex of connective tissues, nerves, and vessels in hilus:– anchored to the mediastinum
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Figure 23–7
Gross Anatomy of the Lungs
Left and right lungs:are in left and right pleural cavities
The base:inferior portion of each lung rests on superior surface of diaphragm
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Lobes of the Lungs
• Lungs have lobes separated by deep fissures
1) The Right Lung- Has 3 lobes: – superior, middle, and inferior– separated by horizontal and oblique fissures
2) The Left Lung- Has 2 lobes: – superior and inferior– are separated by an oblique fissure
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Relationship between Lungs and Heart
Figure 23–8
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The Bronchial Tree
• Is formed by the primary bronchi and their branches
• Extrapulmonary Bronchi
• The left and right bronchi branches outside the lungs
• Intrapulmonary Bronchi
• Branches within the lungs
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Bronchi and Lobules
Figure 23–9
A Primary Bronchus
Branches to form secondary bronchi (lobar bronchi)1 secondary bronchus goes to each lobe
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Secondary Bronchi
• Branch to form tertiary bronchi, also called the segmental bronchi
• Each segmental bronchus:– supplies air to a single
bronchopulmonary segment-– The right lung has 10– The left lung has 8 or 9
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Bronchial Structure
• The walls of primary, secondary, and tertiary bronchi:– contain progressively less cartilage and
more smooth muscle– increasing muscular effects on airway
constriction and resistance
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Figure 23–10
The Bronchioles
Bronchitis:
Inflammation of bronchial walls: causes constriction and breathing difficulty
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The Bronchioles
• Each tertiary bronchus branches into multiple bronchioles
• Bronchioles branch into terminal bronchioles: – 1 tertiary bronchus forms about 6500
terminal bronchioles
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Bronchiole Structure
• Bronchioles:– have no cartilage– are dominated by smooth muscle
Autonomic Control• Regulates smooth muscle:
– controls diameter of bronchioles– controls airflow and resistance in lungs
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Bronchodilation
• Dilation of bronchial airways
• Caused by sympathetic ANS activation
• Reduces resistance
Bronchoconstriction• Constricts bronchi
• Caused by: – parasympathetic ANS activation– histamine release (allergic reactions)
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Pulmonary Lobules• Are the smallest compartments of the lung
• Are divided by the smallest trabecular partitions (interlobular septa)
• Each terminal bronchiole delivers air to a single pulmonary lobule
• Each pulmonary lobule is supplied by pulmonary arteries and veins
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Exchange Surfaces
• Within the lobule:– each terminal bronchiole branches to form
several respiratory bronchioles, where gas exchange takes place
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Figure 23–11
Alveolar Organization Respiratory bronchioles are connected to alveoli along alveolar ductsAlveolar ducts end at alveolar sacs:
common chambers connected to many individual alveoli
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Blood Supply to Respiratory Surfaces
• Each lobule receives an arteriole and a venule
1. respiratory exchange surfaces receive blood:• from arteries of pulmonary circuit
2. a capillary network surrounds each alveolus:• as part of the respiratory membrane
3. blood from alveolar capillaries:• passes through pulmonary venules and veins• returns to left atrium
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Blood Supply to the Lungs
• Capillaries supplied by bronchial arteries:– provide oxygen and nutrients to tissues of
conducting passageways of lung
• Venous blood bypasses the systemic circuit and flows into pulmonary veins
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Pleural Cavities and Pleural Membranes
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Location of Lungs in Thoracic Cavity
Figure 21.12a, b
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Pleural Cavities and Pleural Membranes
• 2 pleural cavities:– are separated by the mediastinum
• Each pleural cavity:– holds a lung – is lined with a serous membrane (the pleura)
• Pleura consist of 2 layers: – parietal pleura – visceral pleura
• Pleural fluid:– lubricates space between 2 layers
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Diagram of the Pleurae and Pleural Cavities
Figure 21.11
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The Mechanisms of Ventilation
Two phases of pulmonary ventilation Inspiration – inhalation Expiration – exhalation
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Inspiration
Volume of thoracic cavity increases Decreases internal gas pressure Action of the diaphragm
Diaphragm flattens
Action of intercostal musclesContraction raises the ribs
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Inspiration
Deep inspiration requires Scalenes Sternocleidomastoid Pectoralis minor Erector spinae – extends the back
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Changes in Thoracic Volume
Figure 21.16a–c
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Changes in Thoracic Volume
Figure 21.16d
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What are the origins and actions of the respiratory muscles responsible for respiratory movements?
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The Respiratory Muscles
Figure 23–16c, d
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Figure 23–16a, b
The Respiratory Muscles
Most important are:the diaphragm external intracostal muscles of the ribsaccessory respiratory muscles:
activated when respiration increases significantly
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The Mechanics of Breathing
• Inhalation:– always active
• Exhalation:– active or passive
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3 Muscle Groups of Inhalation 1. Diaphragm:
– contraction draws air into lungs– 75% of normal air movement
2. External intracostal muscles:– assist inhalation– 25% of normal air movement
3. Accessory muscles assist in elevating ribs:– sternocleidomastoid– serratus anterior– pectoralis minor– scalene muscles
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Muscles of Active Exhalation
1. Internal intercostal and transversus thoracis muscles:
– depress the ribs
2. Abdominal muscles:– compress the abdomen– force diaphragm upward
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Modes of Breathing
• Respiratory movements are classified:– by pattern of muscle activity– into quiet breathing and forced breathing
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Quiet Breathing (Eupnea) • Involves active inhalation and passive
exhalation
• Diaphragmatic breathing or deep breathing:– is dominated by diaphragm
• Costal breathing or shallow breathing:– is dominated by ribcage movements
Elastic Rebound
• When inhalation muscles relax:– elastic components of muscles and lungs recoil– returning lungs and alveoli to original position
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Forced Breathing
• Also called hyperpnea
• Involves active inhalation and exhalation
• Assisted by accessory muscles
• Maximum levels occur in exhaustion
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Neural Control of Ventilation
Most important respiratory center VRG – ventral respiratory group
Located in reticular formation in the medulla oblongata
Neurons generate respiratory rhythm
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Respiratory Centers in the Brain Stem
Figure 21.17
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Respiratory Centers of the Brain• When oxygen demand rises:
– cardiac output and respiratory rates increase under neural control
• Have both voluntary and involuntary components
Involuntary Centers• Regulate respiratory muscles
• In response to sensory information
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Voluntary Centers• In cerebral cortex affect:
– respiratory centers of pons and medulla oblongata
– motor neurons that control respiratory muscles
–The Respiratory Centers• 3 pairs of nuclei in the reticular formation
of medulla oblongata and pons
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Respiratory Rhythmicity Centers of the Medulla Oblongata
• Set the pace of respiration
• Can be divided into 2 groups:
Dorsal respiratory group (DRG)-• Inspiratory center
• Functions in quiet and forced breathing
• Inspiratory and expiratory center
• Functions only in forced breathing
Ventral respiratory group (VRG)
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Figure 23–25a
Quiet BreathingBrief activity in the DRG:
stimulates inspiratory muscles
DRG neurons become inactive:
allowing passive exhalation
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Figure 23–25b
Forced BreathingIncreased activity in DRG:
stimulates VRGwhich activates accessory inspiratory muscles
After inhalation:expiratory center neurons stimulate active exhalation
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Respiratory Centers and Reflex Controls
Figure 23–26
Interactions between VRG and DRG:
establish basic pace and depth of respiration
The pneumotaxic center:
modifies the pace
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The Apneustic and Pneumotaxic Centers of the Pons
• Paired nuclei that adjust output of respiratory rhythmicity centers:– regulating respiratory rate and depth of
respiration
An Apneustic Center• Provides continuous stimulation to its DRG
center• Pneumotaxic Centers• Inhibit the apneustic centers• Promote passive or active exhalation
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5 Sensory Modifiers of Respiratory Center Activities
• Chemoreceptors are sensitive to:– PCO
2, PO
2, or pH
– of blood or cerebrospinal fluid
• Baroreceptors in aortic or carotic sinuses:– sensitive to changes in blood pressure
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5 Sensory Modifiers of Respiratory Center Activities
• Stretch receptors:– respond to changes in lung volume
• Irritating physical or chemical stimuli:– in nasal cavity, larynx, or bronchial tree
• Other sensations including:– pain– changes in body temperature– abnormal visceral sensations
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Chemoreceptor Reflexes• Respiratory centers are strongly influenced by
chemoreceptor input from:* cranial nerve IX -The glossopharyngeal nerve:– from carotid bodies
– stimulated by changes in blood pH or PO2
* cranial nerve X -The vagus nerve:– from aortic bodies
– stimulated by changes in blood pH or PO2
* receptors that monitor cerebrospinal fluid-• Are on ventrolateral surface of medulla oblongata
• Respond to PCO2 and pH of CSF
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Chemoreceptor Responses to PCO2
Figure 23–27
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Location of Peripheral Chemoreceptors
Figure 21.18
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Respiratory Performance and Age
Figure 23–28
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3 Effects of Aging on the Respiratory System
1. Elastic tissues deteriorate:– reducing lung compliance– lowering vital capacity
2. Arthritic changes:– restrict chest movements– limit respiratory minute volume
3. Emphysema:– affects individuals over age 50– depending on exposure to respiratory irritants
(e.g., cigarette smoke)