Ch. 4 Pulmonology Study of the anatomy and physiology of the respiratory system.

Ch. 4 PulmonologyStudy of the anatomy and physiology of the respiratory system.

Anatomy

Upper respiratory system: nose, nasal cavity, and pharynx (throat).

Lower respiratory system: larynx (voice box), trachea (windpipe), bronchi, bronchioles, and alveoli (in the lungs).

PhysiologyFunction: exchange oxygen rich air from the environment with oxygen poor air from the body.

-oxygen into the blood stream-carbon dioxide out of the blood stream

1. Nose and Nasal CavityThe nose contains the nasal cavity, which is divided in the center by the nasal septum.

Each side of the nasal septum has three long, bony projections: the superior, middle, and inferior turbinates, or nasal conchae.

Function: slow down air so that it can we warmed.

Additional Structures: mucosa, mucus, and hairs.

2. PharynxPassageway for inhaled air, exhaled air, and food.

Function: Mucous membranes within the pharynx warm and moisten inhaled air and trap particles.

Pharynx splits into the trachea and the esophagus.

3. LarynxThe “voicebox”

Function: air moving through the larynx (vocal cords) produces sound and speech.

While swallowing food or drink:

-muscles in the neck pull the larynx up to meet the epiglottis

-the trachea is sealed off.

-food or drink is kept out of the trachea.

4. TracheaBelow the vocal cords, the larynx merges into the trachea.

Passageway for inhaled and exhaled air.

Rings of cartilage provide support to the trachea.

Unique feature: On the posterior surface, there is no cartilage. The trachea is flexible and can flatten to make room when food passes through the esophagus.

5. Bronchi & Bronchial TreeThe trachea splits into the right and left primary bronchi.

Each primary bronchi enters a lung and branches into smaller bronchioles.

The smallest bronchioles (diameter 1 mm or less) have smooth muscle around them, but no cartilage.

All three structures are lined with cilia that move in coordinated waves to carry mucus and trapped particles toward the throat where they can be expelled.

Figure 4-4 Trachea, lung, bronchi, bronchioles, and alveoli

6. Lungs-Spongy, air-filled structures-Each lung contains lobes, that are visible on the outer surface of the lung.-The rounded top of each lung is the apex. The right lung, which is larger, has three lobes:

right upper lobe (RUL)right middle lobe (RML)right lower lobe (RLL)

The left lung has two lobes:left upper lobe (LUL)

left lower lobe (LLL)

The mediastinum, an irregularly shaped area between the lungs, contains the trachea, heart & esophagus.

Additional Medical Terminology for the Pulmonary System:

One bronchus enters each lung at the hilum. The bronchus then splits into bronchioles. At the tips of the bronchioles are alveoli.

Alveoli secrete surfactant, a protein-fat compound that reduces surface tension and keeps the walls of the alveoli from collapsing with each exhalation.

Each lung is surrounded by the pleura, a double-layered serous membrane that secretes a fluid to reduce friction.

The base of each lung lies along the diaphragm, it is a thin sheet like muscle separating the thoracic and abdominal cavity.

Physiology of RespirationRespiration consists of breathing in (inhalation or inspiration) and breathing out (exhalation or expiration).

The respiratory control centers (medulla oblongata and pons) in the brain regulate the depth and rate of respiration (eupnea).

Receptors in large arteries in the chest and neck send these centers information about the blood level of oxygen; receptors in the brain send information about the blood level of carbon dioxide.

The respiratory control centers send nerve impulses to the phrenic nerve, causing the diaphragm to contract and begin inspiration.

Five Processes to Respiration:1. Ventilation―Movement of air in and out of the lungs. 2. External respiration―Movement of oxygen from the alveoli through capillaries into the pulmonary blood vessels (veins) and movement of carbon dioxide from the pulmonary blood vessels (arteries) through capillaries into the alveoli.3. Gas transport―Blood transports oxygen and carbon dioxide; oxygenated blood travels from lungs to heart, where it is pumped throughout the body.4. Internal respiration―Movement of oxygen from blood into cells and movement of carbon dioxide from cells into blood.5. Cellular respiration―Oxygen is used by the cells to produce energy in the process of metabolism.

End of Test 1 Notes.

Figure 4-7 Gas exchange

Diseases and Conditions Test 2 MaterialNose and Pharynx:

Upper respiratory infection (URI)

Trachea, Bronchi, and Bronchioles:Asthma

Bronchitis

Bronchiectasis

Lungs:Abnormal breath sounds

Adult respiratory distress syndrome (ARDS)

Atelectasis

Chronic obstructive pulmonary disease (COPD)

Figure 4-9 Adult respiratory distress syndrome

Lungs: Cystic fibrosis (CF)

Empyema

Influenza

Legionnaire’s disease

Lungs:Lung cancer

Occupational lung diseases

Lungs:Aspiration pneumonia

Bacterial pneumonia

Bronchopneumonia

Double pneumonia

Lungs:

Lobar pneumonia

Pneumococcal pneumonia

Pneumocystic jiroveci pneumonia

Viral pneumonia

Walking pneumonia

Figure 4-14 Pneumonia(Custom Medical Stock Photo, Inc.)

Lungs:

Pulmonary edema

Pulmonary embolism

Severe acute respiratory syndrome (SARS)

Tuberculosis (TB)

Figure 4-15 Pulmonary embolus

Pleura and Thorax:Hemothorax

Pleural effusion

Pleurisy

Pneumothorax

Respiration:Apnea

Bradypnea

Cough

Dyspnea

Orthopnea

Tachypnea

Oxygen and Carbon Dioxide Levels:Anoxia

Asphyxia

Cyanosis

Hypercapnia

Hypoxemia

Laboratory and Diagnostic Procedures:

Arterial blood gases (ABG)

Carboxyhemoglobin

Oximetry

Laboratory and Diagnostic Procedures:

Pulmonary function test (PFT)

Sputum culture and sensitivity (C&S)

Tuberculosis tests

Radiology and Nuclear Medicine Procedures:Chest radiography

CT scan and MRI scan

Lung scan

Medical Procedures:Auscultation and percussion

Cardiopulmonary resuscitation (CPR)

Endotracheal intubation

Figure 4-19 Endotracheal intubation

Medical Procedures:Heimlich maneuver

Incentive spirometry

Oxygen therapy

Vital signs

Figure 4-20 Nasal cannula(©Ray Kemp/911 Imaging)

Figure 4-21 Endotracheal tube and Ambu bag(Pearson Education/PH College)

Surgical Procedures:Bronchoscopy

Chest tube insertion

Lung resection

Figure 4-22 Lobectomy

Surgical Procedures:Thoracocentesis

Thoracotomy

Tracheostomy

Figure 4-23 Tracheostomy(©Jenny Thomas/Pearson Education)

Abbreviations

Abbreviations (cont’d)