001 slide respirasi
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Transcript of 001 slide respirasi
Sugeng Hadisaputra, M.Kep, Sp.Kep.An
The Student ObjectiveAfter attending the discussion of respiratory physiology, students will be able to explain the normal function of
respiratory system, rightly
THE SUBTOPICS
1. Structure of the Respiratory System
2. The Pulmonary Ventilation
3. Lung Volume and Capacity
4. The O2 – CO2 Exchange
5. The Transport of O2 and CO2
6. The Control of Respiration
7. Exercise and The Respiratory System
8. Aging and Respiratory System
Structures of The Respiratory System
Upper Respiratory System•Nose•Pharynx•Associated structures
Lower Respiratory System•Larynx•Trachea•Bronchi•Lung
The respiratory Tract
Alveolus
The Muscles of Breathing
Inspiratory muscles• Diaphragm• External
Intercostalis• Sternocleido-
mastodeus• Scalenus
Expiratory muscles• Internal
Intercostalis• Abdominal
Muscles
PULMONAL VENTILATION(BREATHING)
1. Inspiration
2. Expiration
* The movement of air into and out of the lung depends on pressure change (Boyle’s law)
INSPIRATION
Active
Boyle law
EXPIRATION
Passive•Muscle relaxation
•Elastic recoil
Active•Labor
BREATHING PATTERN
Eupnea = Normal quiet breathing
Apnea = A temporary cessation of breathing
Dyspnea = A painful or labored breathing + tachypnea
Costal breathing = Shallow (chest) breathing
Diaphragmatic breathing = Deep (abdominal) breathing
ALVEOLAR SURFACE TENSION
•Alveolar fluid surrounds air in alveoli exerts tension (surface tension)
•Lowered by Surfactant
•Great surface tension tend to collapse the lung
COMPLIANCE
•The ease of lung + thoracic wall to expand
•The higher the compliance the easer to expand
•The higher the surface tension the lower the compliance
•The lesser the elasticity the lower the compliance
•The Compliance decrease in:
Scar lung
Pulmonary edema
Surfactant deficiency
Muscle paralysis , emphysema
AIRWAY RESISTANCE
•The narrower the airway diameter the higher the resistance
•The broader the airway diameter the lower the resistance
MODIFIED RESPIRATORY MOVEMENT
•Laughing, Sighing, Sobbing
•Sneezing, Coughing
•Talking, Singing
LUNG VOLUME AND CAPACITY
6000 ml
5000 ml
4000 ml
3000 ml
2000 ml
1000 ml
LUNG VOLUMES LUNG CAPACITIES
O2 – CO2 EXCHANGE
Changes In Partial Pressure During External and Internal
Respiration
(Dalton & Henry’s laws)
TRANSPORT OF O2 AND CO2
IN THE BLOOD
O2:
1. 1.5% Dissolved in plasma
2. 98.5% as Oxyhemoglobin
CO2:
1. 7% Dissolved in plasma
2. 23% as Carbaminohemoglobin
3. 70% as Bicarbonate ions
O2 – Hb dissociation curve at normal body temperature
As pO2 increase, more O2 combines with hemoglobin
HEMOGLOBIN AND OXYGEN PARTIAL PRESSURE
HEMOGLOBIN AND OTHER FACTORS
The effect pH on affinity of hemoglobin for oxygen
As pH decrease , the affinity of hemoglobin for O2 is less, so less O2 combines with hemoglobin and
more is available to tissue
The effect pCO2 on affinity of hemoglobin
for oxygen
As pCO2 increase , the affinity of hemoglobin for O2 decreases
The effect body temperature on affinity of hemoglobin
for oxygen
As temperature increase , the affinity of hemoglobin for O2 decreases
FETAL HEMOGLOBIN
Oxygen – hemoglobin dissociation curve
comparing fetal and maternal hemoglobin
Fetal Hb has a higher affinity for O2 than does adult Hb
HYPOXIA
1. Hypoxic hypoxia Low pO2 in arterial blood: high altitude, airways obstruction,
fluid in lung
2. Anemic hypoxia Low Hb: hemorrhage, anemia, CO poisoning
3. Stagnant (ischemic) hypoxia Low tissue blood flow
4. Histotoxic hypoxia Tissue unable uses O2 properly
CARBON DIOXIDE TRANSPORT
1. Dissolved CO2: 7 % dissolved in plasma
2. Carbaminohemoglobin
Hb + CO2 Hb.CO2
3. Bicarbonate ions
CO2 + H2O H2CO3 H+ + HCO3-
Summary of Gas Exchange and Transport in Lung and Tissue
CONTROL OF RESPIRATION
Respiratory center
1. Medullary Rhythmicity Area
2. Pneumotaxic Area
3. Apneustic Area
REGULATION OF THE RESPIRAORY CENTER
1. Cortical influences Voluntary, protective
2. Chemical regulation Central Chemoreceptors: located in Medulla Oblongata
Peripheral Chemoreceptors: Aortic & carotid bodies
3. Neural changes due to movement
4. Inflation reflex Baroreceptors = Stretch receptors
5. Other influences Blood pressure, Limbic system, Temperature, Pain, Stretching the anal
sphincter muscle, Irritation of airways
Proposed role of the medullary rhythmicity area in controlling the basic rhythm of respiration
Return to homeostasis
Stimulus (stress)
Increase arterial blood pCO2
Central & peripheral chemo-receptor
Inspiratory area control center (in MO)
Respiratory muscle: hyperventilation
Decrease arterial blood pCO2; increase pO2
NEGATIVE FEEDBACK
Positive feedback further lowers pO2 so hypoxia
worsens
Stimulus (stress)
Decrease arterial blood pO2 (severe hypoxia)
Central chemo-receptor suffer hypoxia
Inspiratory area suffer hypoxia (in MO)
Respiratory muscle: hypoventilation
Decrease arterial blood pO2
POSITIVE FEEDBACK
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1. Voluntary hyperventilation controlled by cerebral cortex
2. Anticipation of activity via stimulation of the limbic system
VENTILATION RATE AND DEPTH INCREASE WITH:
5. Decrease in blood pressure detected by baroreceptors
7. Prolonged pain
4. Increase in sensory impulses from proprioceptors in muscles and joints and increase in motor impulses from the motor cortex
6. Increase in body temperature
8. Stretching anal sphincter
3. Increase in arterial blood H+ level or pCO2 above 40 mm Hg and decrease in arterial blood pO2 from 100 to 50 mm Hg, detected by central and peripheral chemoreceptor
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1
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56
78 9
1011
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15VENTILATION RATE
AND DEPTH DECREASE WITH:
9. Irritation of pharynx or larynx by touch or chemicals causes apnea followed by coughing or sneezing
10. Severe pain causes apnea
11. Decrease in body temperature (sudden cold stimulus) causes apnea
14. Decrease in arterial blood H+ level or pCO2
below 40 mm Hg and decrease in arterial blood pO2 below 50 mm Hg, detected by central and peripheral chereceptors
15. Voluntary hypoventilation controlled by cerebral cortex (limited by buildup of CO2 and H+)
12. Increase in blood pressure detected by baroreceptors
13. Decrease in sensory impulses from proprioceptors in muscles and joints and decrease in motor impulses from the motor cortex
EXERCISE AND THE RESPIRATORY SYSTEM
Exercise
Raises pulmonary perfusion
Raises the O2 diffusion capacity
Pulmonary ventilation
1. Anticipation of the activity, which stimulates the limbic system
2. Sensory impulses from proprioceptors in muscles and joints
3. Motor impulses from the primary motor cortex (precentral gyrus)
a. Decreased pO2, due to increased O2 consumption
b. Increased pCO2, due to increased CO2 production by contracting muscle fibersc. Increased temperature due to liberation of more heat as more O2 utilized
AGING AND THE RESPIRATORY SYSTEM
Aging
The airways and tissue become more rigid
Decreases1. Vital capacity, as much as 35%2. Blood level of O2
3. Alveolar macrophage activity4. Ciliary action
More susceptible to: pneumonia, bronchitis, emphysema, and other pulmonary disorders