Respiratory SystemCHAPTER 11

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Respiratory System OverviewResponsibilities of respiratory systemRespiration = exchange of gases between body and airProvides oxygen to body cells for energyRemoves carbon dioxide from body cellsProduction of sound Assisting in bodys defense against foreign materials

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External respirationOxygen is inhaled into lungsPasses through capillaries of the lungs into the pulmonary bloodstreamCarbon dioxide passes from blood through the same capillaries into the lungs and is exhaledRespiratory System Overview

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Internal respirationInhaled oxygen circulates from pulmonary bloodstream in the lungs, back through the heart, to systemic bloodstream, to the body cellsAt cellular level, oxygen passes through capillaries into tissue cells where it is used for energyCarbon dioxide passes from tissue cells into capillaries and travels through bloodstream for removal from body via lungsRespiratory System Overview

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Respiratory System StructuresNoseExternal portion composed of cartilage and bone covered with skinEntrance to nose = nostrils or naresAir enters body through the nose and mouthNasal cavityDivided into left and right chambers by dividing wall called the septumAs air enters through nose, it passes into the nasal cavity

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Paranasal sinusesHollow areas or cavities within the skull that communicate with the nasal cavityLighten the skull and enhance the sound of the voiceLined with mucous membranesHelp to warm and filter the air as it enters the respiratory systemCilia (hairlike projections on mucous membranes) sweep dirt and foreign material toward throat for eliminationRespiratory System Structures

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PharynxAirway that connects the mouth and nose to the larynxAlso known as the throatServes as a common passageway for both air and foodRespiratory System Structures

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PharynxCommonly divided into three sectionsNasopharynxContains the adenoidsOropharynxContains the tonsils (palatine tonsils)LaryngopharynxRespiratory System Structures

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LarynxConnects pharynx with tracheaAlso known as the voice boxMost prominent of supporting cartilages is the thyroid cartilage at the frontForms the Adams appleContains structures that make vocal sounds possible the vocal cordsVocal cords vibrate as air passes through the space between them, producing soundRespiratory System Structures

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TracheaExtends into the chest and serves as a passageway for air to the bronchiCommonly known as the windpipeBronchiTrachea branches into two tubes called the bronchiEach bronchus leads to a separate lungDivides and subdivides into progressively smaller tubes called bronchiolesRespiratory System Structures

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BronchiolesSmallest branches of bronchiTerminal ends known as alveoliAir sacsHave thin walls that allow for exchange of gases between the lungs and the bloodAlveoli = pulmonary parenchymaRespiratory System Structures

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LungsTwo cone-shaped, spongy organs consisting of alveoli, blood vessels, elastic tissue, and nervesLeft lung has two lobes and right lung has three lobesApex = uppermost part of lungBase = lower part of lungHilum = portion in midline region where blood vessels, nerves, and bronchial tubes enter and exit the lungsRespiratory System Structures

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PleuraDouble-folded membrane that surrounds the lungsParietal pleuraOuter layer of the pleura which lines the thoracic cavityVisceral pleuraInner layer of the pleura which covers the lungsRespiratory System Structures

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PleuraPleural spaceSmall space between the pleural membranesFilled with lubricating fluid that prevents friction when the two membranes slide against each other during respiration

Respiratory System Structures

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Breathing ProcessInhalation = inspirationDiaphragm is stimulated by phrenic nerveDiaphragm contracts and flattens (descends)Chest cavity enlargesDecrease in pressure within the thoraxAir is drawn into the lungs

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Breathing ProcessExhalation = expirationDiaphragm relaxes and rises back into thoracic cavityChest cavity decreases in sizeIncrease in pressure with the thoraxAir is forced out of lungs

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Physical Exam TechniquesInspectionVisual examination of the external surface of the body as well as of its movements and posturePalpationProcess of examining by application of the hands or fingers to the external surface of the body to detect evidence of disease or abnormalities in the various organs

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Physical Exam Techniques AuscultationProcess of listening for sounds within the body, usually to sounds of thoracic or abdominal viscera, to detect some abnormal condition, or to detect fetal heart soundsPerformed with a stethoscope

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Physical Exam TechniquesPercussionUse of the fingertips to tap the body lightly but sharply to determine position, size, and consistency of an underlying structure and the presence of fluid or pus in a cavityTapping over solid organ = dull flat soundTapping over air-filled structure = clear, hollow sound

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Common Signs and Symptoms ApneaTemporary cessation of breathing Without breathingBradypneaAbnormally slow breathingEvidenced by respiratory rate slower than 12 respirations per minute

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CoughForceful and sometimes violent expiratory effort preceded by a preliminary inspirationGlottis is partially closed, accessory muscles of expiration brought into action, air is noisily expelledDue to irritation of the airways or infectionIrritants = dust, smoke, mucusCommon Signs and Symptoms

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CoughNonproductive = unproductiveNot effective in bringing up sputumDry coughProductiveEffective in bringing up sputumWet coughCommon Signs and Symptoms

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CyanosisSlightly bluish, grayish, slatelike, or dark purple discoloration of the skin due to presence of abnormal amounts of reduced hemoglobin in the bloodDysphoniaDifficulty in speakingHoarseness Common Signs and Symptoms

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DyspneaAir hunger resulting in labored or difficult breathing, sometimes accompanied by painEpistaxisHemorrhage from the nose; nosebleedCommon Signs and Symptoms

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ExpectorationAct of spitting out saliva or coughing up materials from the air passageways leading to the lungsHemoptysisExpectoration of blood arising from the oral cavity, larynx, trachea, bronchi, or lungs

Common Signs and Symptoms

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HypercapniaIncreased amount of carbon dioxide in the bloodHypoxemiaInsufficient oxygenation of the bloodHypoxiaDeficiency of oxygenCommon Signs and Symptoms

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Kussmaul respirationsVery deep, gasping type of respiration associated with severe diabetic acidosisOrthopneaRespiratory condition in which there is discomfort in breathing in any but erect, sitting, or standing positionCommon Signs and Symptoms

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Pleural rubFriction rub caused by inflammation of the pleural spaceRalesAbnormal sound heard on auscultation of the chest, produced by passage of air through bronchi that contain secretion or exudate or that are constricted by spasm or a thickening of their wallsCommon Signs and Symptoms

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RhinorrheaThin, watery discharge from the noseRhonchiRales or rattlings in the throat, especially when it resembles snoringCommon Signs and Symptoms

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SneezeTo expel air forcibly through the nose and mouth by spasmodic contraction of muscles of expiration due to irritation of nasal mucosaStridorHarsh sound during respirationHigh pitched and resembling the blowing of wind, due to obstruction of air passagesCommon Signs and Symptoms

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TachypneaAbnormal rapidity of breathingWheezeWhistling sound or sighing sound resulting from narrowing of the lumen of a respiratory passagewayCommon Signs and Symptoms

PATHOLOGICAL CONDITIONSUpper Respiratory System

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CoryzaPronounced(kor-RYE-zuh)DefinedInflammation of the respiratory mucous membranes known as the common coldCommon cold usually refers to symptoms of an upper respiratory tract infection

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CroupPronounced(KROOP)DefinedChildhood disease characterized by a barking cough, suffocative and difficult breathing, stridor, and laryngeal spasm

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DiphtheriaPronounced(diff-THEER-ree-uh)DefinedSerious infectious disease affecting the nose, pharynx, or larynx, usually resulting in sore throat, dysphonia, and fever Caused by bacterium Corynebacterium diphtheriae which forms a white coating over the affected airways as it multiplies

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LaryngitisPronounced(lair-in-JYE-tis)DefinedInflammation of the larynx, usually resulting in hoarseness, cough, and difficulty swallowingCauses: abuse of the voice, upper respiratory tract infection, chronic bronchitis, chronic sinusitis

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PertussisPronounced(per-TUH-sis)DefinedAcute upper respiratory infectious disease, caused by the bacterium Bordetello pertussisAlso known as whooping cough

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PharyngitisPronounced(fair-in-JYE-tis)DefinedInflammation of the pharynx, usually resulting in sore throatUsually caused by a virus

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RhinitisPronounced(rye-NYE-tis)DefinedInflammation of the mucous membranes of the noseUsually resulting in obstruction of the nasal passages, rhinorrhea, sneezing, and facial pressure or pain

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SinusitisPronounced(sigh-nus-EYE-tis)DefinedInflammation of a sinus, especially a paranasal sinusUsually results in pain and a feeling of pressure in the affected sinuses

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TonsillitisPronounced(ton-sill-EYE-tis)DefinedInflammation of the palatine tonsils: tonsils appear enlarged and red with yellowish exudateSymptoms:Sore throat, fever, snoring, difficulty swallowing

PATHOLOGICAL CONDITIONSLower Respiratory System

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AsthmaPronounced(AZ-mah)DefinedParoxysmal dyspnea accompanied by wheezing caused by a spasm of the bronchial tubes or by swelling of their mucous membraneOccurs most frequently in childhood or early adulthood

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BronchiectasisPronounced(brong-key-EK-tah-sis)DefinedChronic dilatation of a bronchus or bronchi, with secondary infection that usually involves the lower portion of the lung

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Pronounced(brong-KIGH-tis)DefinedInflammation of the mucous membrane of the bronchial tubesInfection is often preceded by the common coldPatient may experience productive cough, accompanied by wheezing, dyspnea, and chest painBronchitis

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Acute BronchitisCauses are viral infection, bacterial infection, and airborne irritants Chronic BronchitisPrimarily associated with cigarette smoking or exposure to pollutionSmoke irritates airways, resulting in inflammation and hypersecretion of mucusProductive cough is present for at least three months of two consecutive yearsBronchitis

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Bronchogenic CarcinomaPronounced(brong-koh-JEN-ic car-sin-OH-mah)DefinedMalignant lung tumor that originates in the bronchiLung cancer

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EmphysemaPronounced(em-fih-SEE-mah)DefinedChronic pulmonary disease characterized by increase beyond the normal in the size of air spaces distal to the terminal bronchiole, either from dilation of the alveoli or from destruction of their walls

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EmpyemaPronounced(em-pye-EE-mah)DefinedPus in a body cavity, especially in the pleural cavityUsually the result of a primary infection in the lungs

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Hyaline Membrane DiseasePronounced(HIGH-ah-lighn membrane dih-ZEEZ)DefinedSevere impairment of respiration in premature newbornAlso known as respiratory distress syndrome (RSD)

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InfluenzaPronounced(in-floo-IN-zah)DefinedHighly contagious viral infection of the respiratory tract transmitted by airborne droplet infectionAlso known as the fluSymptoms include sore throat, cough, fever, muscular pains, and generalized weakness

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Lung AbscessPronounced(lung AB-sess)DefinedLocalized collection of pus formed by the destruction of lung tissue and microorganisms by white blood cells that have migrated to the area to fight infection

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Pleural EffusionPronounced(PLOO-ral eh-FYOO-zhun)DefinedAccumulation of fluid in the pleural space, resulting in compression of the underlying portion of the lung, with resultant dyspneaUsually secondary to some other disease

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Pleuritis (Pleurisy)Pronounced(ploor-EYE-tis)(PLOOR-ih-see)DefinedInflammation of both the visceral and parietal pleura

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PneumoniaPronounced(new-MOH-nee-ah)DefinedInflammation of the lungs caused primarily by bacteria, viruses, and chemical irritants

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PneumothoraxPronounced(new-moh-THOH-racks)DefinedCollection of air or gas in the pleural cavityAir enters as the result of a perforation through the chest wall or the pleura covering the lung

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Pulmonary EdemaPronounced(PULL-mon-air-ree eh-DEE-mah)DefinedSwelling of the lungs caused by an abnormal accumulation of fluid in the lungs, either in the alveoli or the interstitial spaces

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Pronounced(PULL-mon-air-ree heart dih-ZEEZ)(cor pull-mon-ALL-ee)DefinedHypertrophy of the right ventricle of the heart (with or without failure) resulting from disorders of the lungs, pulmonary vessels, or chest wall

Pulmonary Heart Disease(Cor Pulmonale)

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Sudden Infant Death SyndromePronounced(sudden infant death SIN-drohm)DefinedUnexpected and unexplained death of an apparently well, or virtually well infantAlso known as crib death or SIDS

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Pronounced(too-ber-kyoo-LOH-sis)DefinedInfectious disease caused by the tubercle bacillus, Mycobacterium tuberculosisInflammatory infiltrations, formation of tubercles, and caseous (cheeselike) necrosis in the tissues of the lungsTuberculosis

PATHOLOGICAL CONDITIONSWork-Related

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AnthracosisPronounced(an-thrah-KOH-sis)DefinedAccumulation of carbon deposits in the lungs due to breathing smoke or coal dustAlso known as black lung disease or coal workers pneumonoconiosis

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AsbestosisPronounced(as-beh-STOH-sis)DefinedLung disease resulting from inhalation of asbestos particles

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ByssinosisPronounced(bis-ih-NOH-sis)DefinedLung disease resulting from inhalation of cotton, flax, and hempAlso known as brown lung disease

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SilicosisPronounced(sill-ih-KOH-sis)DefinedLung disease resulting from inhalation of silica (quartz) dust, characterized by formation of small nodules

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURESRespiratory System

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BronchoscopyExamination of interior of bronchi using a lighted, flexible bronchoscope (or endoscope)Chest X-rayHigh-energy electromagnetic waves passing through the body onto a photographic filmProduces a picture of the internal structures of the body for diagnosis and therapyDiagnostic Techniques, Treatments, and Procedures

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LaryngoscopyExamination of interior of the larynx using a lighted, flexible tube known as a laryngoscope (or endoscope)Lung scanVisual imaging of the distribution or ventilation or blood flow in the lungs by scanning the lungs after the patient has been injected with or has inhaled radioactive materialDiagnostic Techniques, Treatments, and Procedures

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Pulmonary function testsVariety of tests performed to assess respiratory functionSputum specimenSpecimen of material expectorated from the mouthIf produced after a cough, it may contain, in addition to saliva, material from the throat and bronchiDiagnostic Techniques, Treatments, and Procedures

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ThoracentesisProcedure that involves the use of a needle to collect pleural fluid for laboratory analysis, or to remove excess pleural fluid or air from the pleural spaceDiagnostic Techniques, Treatments, and Procedures

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Diagnostic Techniques, Treatments, and ProceduresTonsillectomySurgical removal of the palatine tonsilsUsually combined with an adenoidectomy (surgical removal of adenoids)Tuberculin skin test (TST)Determines past or present tuberculosis infection present in the bodyBased on positive skin reaction to the introduction of a purified protein derivative (PPS) of the tubercula bacilli into the skin