III.

ANATOMY AND PHYSIOLOGY

The system which brings about inspiration, expiration, exchange of gases in lungs and transport of gases between the lungs and tissues is known as Respiratory system.

Alveoli

Upper respiratory tract Nose The nose, whether pug or ski-jump in shape, is the only externally visible part of the respiratory system. During breathing, air enters the nose by passing through the external nares, or nostrils. The interior of the nose consists of the nasal cavity, divided by a midline nasal mucoseptum. The olfactory receptors for the sense of smell are located in the mucosa in the slit like superior part of the nasal cavity, just beneath the ethmoid bone.

Pharynx The pharynx is a muscular passageway about 13 cm long that vaguely resembles a short length of red garden hose. Commonly called the throat, the pharynx serves as a common passageway for food and air. Air enters the superior potion, the nasopharynx, from the nasal cavity and then descends through the oropharynx and laryngopharynx to enter the larynx-below.

Lower Respiratory Tract Larynx The larynx, routes air and food into the proper channels and plays a role in speech. The largest of the hyaline cartilages is the shield shape thyroid cartilage, which protrudes anteriorly and is commonly called the Adamss apple.

Trachea Air entering the trachea or windpipe from the larynx travels down its length (10-12 cm, or about 4 inches) to the level of the fifth thoracic vertebra, which is approximately midchest. The trachea is lined with a ciliated mucosa.

Primary Bronchi The division of the trachea forms the right and left primary bronchi. The right primary bronchus is wider, shorter, and straighter than the left. By the time incoming air reaches the bronchi, it is warm, cleansed of most impurities, and well humidified.

Lungs The paired lungs are fairly large organs. They occupy the entire thoracic cavity except for the most central area, the mediastinum, which houses the heart, the great blood vessels, bronchi, esophagus, and other organs. The surface of each lung is covered with a visceral serosa called the pulmonary,or visceral, pleura, and the walls of the thoracic cavity is lined by the parietal pleura.

Alveoli (site of gas exchange) An alveolus (plural: alveoli, from Latin alveus, "little cavity"), is an anatomical structure that has the form of a hollow cavity. In the lung, the pulmonary alveoli are spherical outcroppings of the respiratory bronchioles and are the primary sites of gas exchange with the blood. The lungs contain about 300 million alveoli, representing a total surface area of 70-90 square metres, each wrapped in a fine mesh of capillaries. It has a radii of about 0.1 mm and wall thicknesses of about 0.2 m. It consists of an epithelial layer and extracellular matrix surrounded by

capillaries. In some alveolar walls there are pores between alveoli. There are three major alveolar cell types in the alveolar wall (pneumocytes): Type I cells that form the structure of an alveolar wall. Type II cells that secrete surfactant to lower the surface tension of water and allows the membrane to separate thereby increasing the capability to exchange gases. Type III cells that destroy foreign material, such as bacteria. The alveoli have an innate tendency to collapse (atelectasis) because of their spherical shape, small size, and surface tension due to water vapor. Phospholipids, which are called surfactants, and pores help to equalize pressures and prevent collapse.

Pulmonary gas exchange Pulmonary gas exchange is driven by passive diffusion and thus does not require energy for exchange. Substances move down a concentration gradient. Oxygen moves from the alveoli (high oxygen concentration) to the blood (lower oxygen concentration, due to the continuous consumption of oxygen in the body). Conversely, carbon dioxide is produced by metabolism and has a higher concentration in the blood than in the air. Oxygen in the lungs first diffuses through the alveolar wall and dissolves in the fluid phase of blood. The amount of oxygen dissolved in the fluid phase is governed by Henry's Law. Oxygen dissolved in the blood may diffuse into red blood cells and bind to hemoglobin. Binding of oxygen to hemoglobin allows a greater amount of oxygen to be transported in the blood. Although carbon dioxide and oxygen are the most important molecules exchanged, other gases are also transported between the alveoli and blood. The amount of a gas that is exchanged depends on the water solubility of the gas the affinity of the gas for hemoglobin. Water vapor is also excreted through the lungs, due to humidification of inspired air by the lung tissues. Red blood cells transit the alveolar capillaries in about 3/4 of a second. Most gases (including carbon dioxide and nitrous oxide) reach equilibrium with the blood before the red blood cells leave the alveolar capillaries. Gases that reach equilibrium before the blood leaves the alveolar capillaries are perfusion limited, since the amount of the gas exchanged depends solely on the volumetric flow rate of blood past the alveoli. However, carbon monoxide is stored in such high

concentrations in the blood, due to its strong binding to hemoglobin that equilibrium is not reached before the blood leaves the alveolar capillary. Thus, the concentration of carbon monoxide in the arterial system can be used to assess the resistance of the alveolar walls to gas diffusion. Transport of carbon monoxide is thus termed diffusion limited. Oxygen is normally perfusion limited, but in disease conditions it can be diffusion limited.