Curriculum Vitae

Name
Place/ birth day
Religion
Status
Education

: dr Herman Mulijadi, MS, Sp KP

: Jakarta, July 10, 1954
: Catholic
: Married
: Medical Physician from Medical faculty of Trisakti University,1983,
:Flight Surgeon Course of Indonesian Air force in, 1987,
:Magister in physiology from Physiological Biomedics program of Post Graduate Indonesia
University in 1993,
:Aviation medical physician certificate from Medical Faculty of Indonesia University in 2005,
:Human factor course, NTSB - Australian Transportation Safety Board, 2007,
:Basic investigation course, National Transportation Safety Board ( NTSB) Australian Transportation Safety Board, 2008,
:Advanced Human Factor Instructors course, NTSB ATSB 2009.

Assignment

: Military Officer at Kendari Air Base 1984 -1986,

: Military Officer at Tasikmalaya Air Base 1986 -1988,
:Flight Surgeon at 2 nd Airlift Squadron 1988 -1993,
:Aeromedical operation officer at United Nation mission Air Force. 1994 1998,
:Medical officer at Headquarter of Indonesian Air Force. 1998 2000,
:Joint Task Force Commander in Sambas Kalbar 1999
:Expert group then Secretary at the Institute of aerospace medicine of Indonesian Air Force.
2000 2012/ retired,
:Human Factor Specialist Investigator (ad hoc) at Indonesian NTSB 2007 now.

Lecture
Experience

: Instructor at Flight Surgeon Course of Indonesian Air force 1993 now,

: Lecturer in Medical Education of Postgraduate Occupation Health Faculty,
Indonesia University, 1995 2007,
:Lecturer in Aviation Medical Specialist of Postgraduate Indonesia University, 2010 now,
: Instructor at Human Factor course, NTSB - Australian Transportation Safety Board, 2011- now.

THE FUNCTION
OF
THE RESPIRATORY SYSTEM
dr Herman Mulijadi MS, SpKP

Introduction
FUNCTIONS OF THE RESPIRATORY SYSTEM
Provide oxygen
Eliminates carbon dioxide
Regulates hydrogen ion concentration (pH) in
coordination with the kidneys
Forms speech sounds (phonation)
Defends against microbes
Influences arterial concentrations of chemical messengers
by removing some from pulmonary capillary blood and
producing and adding others to this blood
Traps and dissolves blood clots from systemic (usually
legs) veins

The process of respiration

Some authors divide the process of

respiration into five steps:
- Ventilation, the exchange of the alveolar
air
and the atmospheric air
- The diffusion of O2 from the alveolar air to
the
blood and CO2 from the blood to the
alveolar air
- The transport of O2 and CO2 by the blood
- The diffusion of O2 from the blood to the
cell
and CO2 from the cell to the blood
- The utilization 0f O2 by the cell and the
production
of CO2 by the cell

RESPIRATORY SYSTEM

LECTURE 6: THE FUNCTIONS OF THE

RESPIRATORY SYSTEM
Duration
: 50 minutes
Instructor
Herman,dr, Physiologist, Department of
Physiology
Objectives
1.Describe the central nervous system
initiation of breathing and the innervation
2.Describe the transport of gas through
the conducting airways to and from the
alveoli.
3.Describe the exchange of oxygen and
carbon dioxide with the atmosphere and
relates gas exchange to the metabolism
of the tissues of the body
4.Define the role of the respiratory system
in acid-base balance.
5.Define and describes the site of gas
exchange in the lungs.

Describe the central nervous system initiation of breathing and the innervation
A Pneumotaxis center: in the upper third of pons
that along with the dorminant vagal
impuls,restrain the apneustic center periodically
An apneustic center in the
middle and upper ponst hat if uncontrolled may
produced prolonged, uninterrupted inspiratory
spasm or apneustic breathing
A medullary center capable
of initiating and maintaining sequences of
inspiration, expiration and inspiration, though
these are nor normal in character

The inspiratory muscles

C3-C5
ventral horn
phrenic nerve

diaphragm

T1-T12
ventral horn
external
intercostal
muscles

The expiratory muscles

L1-L5
spinal column
rectus
abdominus

T1-T12
spinal coloum
internal
intercostal
muscles

Generation of the Respiratory Rhythm

The DRG is located in the ventrolateral subnucleus
of the NTS (located in the dosomedial portion of the
medulla) and consists mostly of inspiratory neurons.
Afferents from the IX (glossopharyngeal) and X
(vagus) cranial nerves terminate here.
The VRG is a much longer column of neurons:
(a)the nucleus retroambigualis is comprised
predominantly of expiratory neurons with axons that
travel to motor neurons in the spinal cord that
innervate expiratory muscles
(b) nucleus paraambigualis is comprised mainly of
inspiratory neurons which synapse onto motor
neurons in the spinal cord which innervate
inspiratory muscle of respiration.
(c) nucleus ambiguus is comprised of neurons which
innervate the muscles of the larynx, pharynx and
tongue.
(d)Nucleus retrofacialis includes the Botzinger
complex. Neurons found in this location inhibit spinal
motor neurons which innervate the inspiratory
muscles.
The VRG remain inactive during normal quiet
breathing. This region acts as an override
mechanism during high demands of VE.3

Describe the central nervous system initiation of breathing and the innervation

The peripheral chemoreceptors are

fast-responding monitors of the
arterial blood comprised of:
(a) The carotid bodies (5mm long)
located bilaterally in the neck at the
bifurcation of the common carotid
artery into its internal and external
branches.
(b) The aortic bodies are located on
the superior wall of the aortic arch.
The carotid bodies in humans are
exclusively responsible for the
ventilatory response to hypoxia.

Describe the central nervous system initiation of breathing and the innervation

Irritant Receptors
These receptors are found throughout the airway from the nose to the alveoli and as
their name implies respond mainly to irritating stimuli. Their stimulation initiates various
protective reflexes, which have stereotyped patterns depending on the location of the
irritant receptors stimulated. A typical classification is listed below:
Receptor
nasal
epipharyngeal
laryngeal
tracheal

Reflex
sneeze
aspiration
cough
cough

Nerve
trigeminal nerve
glossopharyngeal
vagus
vagus

There are also irritant receptors scattered throughout the airway from the trachea to the
bronchioles, and special juxtapulmonary capillary receptors (J-receptors), both
communicating to the medulla via the vagus. The latter receptors may be responsible
for triggering sighs that inflate the lungs more than usual to help overcome ventilationperfusion mismatches..

The irritant receptors all share the ability to stimulate breathing and
produce bronchoconstriction. The bronchoconstriction is produced when
bronchiolar smooth muscle is activated from the nucleusambiguus via the
vagus nerve. You can see that the cough, for example, consists of a deep
breath and explosive expiration with the bronchoconstriction increasing
the velocity of airflow and therefore acting to expel foreign particles from
the airway. However, these reflexes can work against us.
In asthma,bronchoconstriction is produced by the release of active
agents, but these agents also stimulate irritant receptors and thereby
exacerbate the bronchoconstriction via the reflex.

Respiratory Muscle Activity during

Inspiration and Expiration
Mechanically, pulmonary VE is accomplished by altering
intrapulmonary pressure which occurs in response to
contraction of the inspiratory muscles (inspiration), and the
passive recoil of the lungs (expiration).
(a) During inspiration the
diaphragm pulls downward, the
external intercostals pull the ribs
upward and outward, and the
accessory muscles in the neck
stabilize the ribs.
(b) During passive expiration, the
inspiratory
muscles relax and the compliance
of the chest wall returns the ribs
to their relaxed position expelling
air.
(c) During forced expiration the
internal intercostals can pull the
ribs downward and inward and the
rectus abdominis and the external
oblique muscles pull the chest
wall down, compressing the chest
gas volume.

 Review anatomy of the respiratory

system.

Describe the central nervous system initiation of breathing and the innervation

Describe the transport of gas through the conducting airways to and from the alveoli.

Sistem
saraf
parasimpat
ik

Sistem
saraf
simpatik

Muskulus
bronkus

Kontraksi

2:
relaksasi

Kelenjar
bronkus

Stimulasi

1:
inhibisi

Paru

2:
stimulasi
Arteriola

Dilatasi

1:
konstriks
i
2:
dilatasi

Ventilation and Mechanics of Breathing - Functional Anatomy of Respiratory System

First 16 airway generations lack alveoli.

First 16 generations form the anatomical
deadspace.
Portion of the lung supplied by primary
respiratory bronchiole is referred to as the acinus.

All the airways of an acinus participate in gas

exchange
Numerous branching of airways increase total
cross-sectional area of the distal tracheobronchial
tree.

A diagram showing the conducting and respiratory zones of the tracheobronchial tree.

Ventilation and Mechanics of Breathing - Functional Anatomy of Respiratory System

Describe the exchange of oxygen and carbon dioxide with the atmosphere and relates gas exchange to
the metabolism of the tissues of the body

ATMOSPHERE
COMPOSITION :
VAST MIXTURE GAS,
NITROGEN 78,09%(593.48mmhg),
OXYGEN 20,95% (159,22
mmhg),
ARGON
0,92%,
CO2
0,03% (0.22 mmhg),
(Ne,He,Kr,H2,Xe,Rn) 0.01%

Gas Law
The behavior of all gases is affected by three factors:
- the temperature,
- the pressure, and
- the volume of the gas.
The relationships among these three factors have been defined
in what are called the Five Gas Laws.
Dalton's Law,
Boyle's Law,
Charles' Law,
Henry's Law,
General Gas Law, are of special importance to the diver.
1 Torr = 1/760 atm
1 atm = 76 cmHg

Dalton's Law
PTotal= Ppl+ Pp2+ ... + Ppn
In a gas mixture, the portion of the total pressure contributed by a single gas is called the partial
pressure of that gas.

Charles' Law

Boyle's Law
P1V1 = P2V2 = constant at constant T

At constant volume: P1/P2 = T1/T2

At constant pressure: V1/V2 =T1/T2

Vg volume of the gas dissolved at STP (standard T and P)

VL volume of the liquid
Bunson solubility coefficient at specified temperatures
P1 partial pressure in atmospheres of the gas above the liquid

Henry's Law
_Vg_
VL = P1

The General Gas Law

(Boyle's and Charles' laws/Gay-Lussac) can be conveniently combined into what is known as the
General Gas Law, expressed mathematically as follows:
P2 X V2
P1 X V1
=
T1
T2

Tekanan gas berbanding langsung dengan suhu dan jumlah molekulnya per
satuan volume:
P = tekanan
P=

nRT
V
absolute

n = jumlah mol
R = konstan gas
T = suhu
V = volume

Describe the exchange of oxygen and carbon dioxide with the atmosphere and relates gas exchange to
the metabolism of the tissues of the body

Ventilation and Mechanics of Breathing Determinants of Lung

Compliance

Elastic Forces caused by lung

structure and anatomy

Composition of structural components

Arrangement of components

Interdependence of alveoli

Elastic Forces Caused by Surface

tension
The function units of the respiration
system are the alveoli.
Each alveolus is polyhedral in shape and
clustered like units of honeycomb.
~ 300 million air sacs. Total area
contact= ~70m2
Surrounded by capillary beds.
One cell layer thick; simple squamous
epithelium.
Total air barrier is 2 cells across
(~0,5 m).
There are two types of cells:
Alveolar type I - structural cells and
carry out gas exchange.
Alveolar type II - secrete surfactant
that reduces surface tension..

Ventilation and Mechanics of Breathing Determinants of Lung Compliance

- Surfactant
Comprised of dipalmitoyl phosphatidylcholine, Ca++, proteins (surface
apoproteins)
Secreted by Type II epithelial cells
Decreases surface tension of the water layer at the alveolar surface, which
increases lung compliance (decreases work of breathing)
Decreasing surface tension leads to a reduction in hysteresis
Surfactant promotes alveolar stability
Surfactant dries alveoli
A deep breath increases the secretion of surfactant by stretching type II cells.
Surfactants concentration decreases when the breaths are small.

Paru juga mempunyai :

Pulmonary alveolar macrophages (PAM),
Limfosit,
Sel plasma,
Sel mast berisi heparin,
Sel APUD (amine precursor uptake and decarboxylase) yang
mensekresi hormone (sel neuroendokrin).
Berbagai macam lipid,
Histamine,
Berbagai protease yang berperan dalam reaksi alergi

Gas Exchange - Oxygen Transport

Oxygen transport: Oxygen is carried in two forms:
1)dissolved in plasma and
2)combined with hemoglobin.
Henrys law states that the amount of dissolved gas is proportional to the partial pressure of that
gas:
Dissolved in plasma - For each mmHg of PO2, there will be 0.003 ml of O2/100 ml dissolved in
blood transferred to the tissue. The normal oxygen content of blood is 20 ml/100 ml of blood.
Therefore, another method of transporting oxygen to the blood must be present.
Combined with hemoglobin - Each hemoglobin (Hb) molecule is capable of binding 4 molecules of
oxygen. is said to be fully saturated. When fully saturated, each gram of Hb can bind 1.34 ml of
oxygen.
Example: Hb content in women is 14 grams. In men it is 16 grams.
O2 content = 16 g/100 ml * 1.34 ml O2/g * 1.0 = 21.44 mlO2/100 ml of blood

Oxyhemoglobin Dissociation Curve

Effect of pH on Oxygemoglobin Dissociation

Define the role of the respiratory system in acid-base balance.

A diagram showing the normal pH

and the changes in pH associated
with the accumulation and loss
of acids and bases

Carbonic acid
Lactic acid
Ketone bodies
Phosphoric acid

The concept of pH

bicarbonate ions

(from Powers S.K. and Howley E.T. Chapter 10 in Exercise Physiology,Chicago: Brown and Benchmark, 1997, p. 206).

Gas Exchange - Carbon Dioxide Transport

Carbon dioxide is carried in the blood in three forms:
Dissolved CO2 represents only about 6% of the total.
CO2 content = 0.072 * PCO2 (24 times more soluble
than O2).

Carbamino compounds represent another 4%.

CO2 binds reversibly to the amino terminus of alpha
and beta chains.

The remainder is carried as bicarbonate.

CO2 + H2O <=> H2CO3 <=> H+ + HCO3-.
In a normal individual, arterial and alveolar PCO2 are virtually
identical. Arterial PCO2 is a balance between CO2 production and
elimination.
Mixed venous CO2 content is a balance between CO2
production, CO2
delivery and the CO2 equilibrium curve.

Thanks for your attention

Any Question?