respiratory system dr. alex alexander. general overview where it all begins: o2 into the nasal...
TRANSCRIPT
Respiratory System Dr. Alex Alexander
General OverVIEW
where it all begins: O2 into the nasal cavity
through the nasopharynx
into the trachea
the bronchi
bronchioles
alveoli
and CO2 exits in reverse
How the Lungs AndHeart work in conjunction
An important forecast:
the anatomic structures in the region:
Lung lobe anatomy
side view of right lung lobes
Side-view of left lung lobes
Alveolar Gas Exchangewhy is it so important?
Alveoli are tiny air sacs that fill with air on inspiration
(breathing in)these are surrounded by
capillariesthe walls are so thin that
oxygen and carbon dioxide can pass through them
Diaphragm
Remember that the diaphragm pulls down on inspiration (filling the lungs with air)
The diaphragm relaxes up to aid exhalation of carbon dioxide and other toxins
How the Diaphragm works in aiding Breathing
lung percussion
hand position lung percussion
anterior auscultory spaces
posterior auscultory spaces
Interesting...
* At rest, the body takes in and breathes out about 10 liters of air each minute.
* The right lung is slightly larger than the left.
* The highest recorded "sneeze speed" is 165 km per hour.
* The surface area of the lungs is roughly the same size as a tennis court.
* The capillaries in the lungs would extend 1,600 kilometers if placed end to end.
* We lose half a liter of water a day through breathing. This is the water vapor we see when we breathe onto glass.
* A person at rest usually breathes between 12 and 15 times a minute.
* The breathing rate is faster in children and women than in men.
Words to grasp• Respiratory System- The group of organs in your body that are responsible for
taking in Oxygen and breathing out the Carbon Dioxide which is the waste product of cellular respiration.
• Oxygen-The gas that your body needs to work and function.
• Carbon Dioxide- The waste product (gas) that is produced through respiration of people and animals.
• Nose/Nasal Cavity- Where Oxygen first enters your body. Tiny hairs help filter the air and air is moistened and heated by your nose. Your Nose leads into your Nasal Cavity.
• Mouth/Oral Cavity- Oxygen/air can also enter through your Mouth but it is not filtered. Your Mouth opens up into your Oral Cavity.
• Sinus- A cavity in the bones of your skull that helps moisten and heat the air that you breath.
• Pharynx/Throat- Gathers air from your Nasal and Oral Cavities and passes it to your Trachea.
• Trachea/Windpipe- A tube like pathway that connects your throat to your Bronchi Tubes and lungs. Air passes through it when it travels from the Pharynx to the Bronchi Tubes.
More Words to Grasp
• Bronchi Tubes- Each tube (one per lung) splits up into many smaller tubes called Bronchiole, like branches on a tree.
• Bronchiole- Keep splitting up until they reach your Alveoli.
• Respiratory Bronchiole- The air-tubes that are actually connected to the Alveoli.
• Alveolar Duct- The final tube, which is part of the Alveoli, that leads to the air-sacs.
• Alveolar Sac- Where the chemical change takes place and where blood cells pick up oxygen and drop off carbon dioxide.
• Alveoli- Tiny air-sacs at the end of your Alveolar Duct. They fill up with Oxygen and are surrounded by Capillaries.
• Capillaries- Tiny blood streams (around one cell wide) that surround your Alveoli. They take Oxygen out of our Lungs and replace it with Carbon Dioxide, which you later breath out.
• Diaphragm- The muscle membrane that helps you breath in and out by changing the pressure in your chest cavity.
Respiratory distress syndrome
Sudden infant death syndrome
croup
covered in previous slide group
epiglottitis
covered in previous slide group
A change of pace - we’ll review and practice physical exam
let’s look at the YouTube video and discuss/practice physical exam
some websites for lung sounds
http://www.stethographics.com/main/physiology_ls_introduction.html
http://www.cvmbs.colostate.edu/clinsci/callan/breath_sounds.htm
http://www.wilkes.med.ucla.edu/lungintro.htm
http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/pd/b-sounds.htm
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
COPD is a general term for 2 chronic lung diseases that usually occur together:
Chronic bronchitis
Emphysema
COPD almost exclusively occurs in users of cancer sticks (90%), but can occur as a result of pollution (coal miners) and due to genetic predisposition (alpha-1-antitrypsin deficiency).
16 million Americans have COPD, and 110,000 die each year.
CHRONIC BRONCHITIS
Chronic cough
Sputum production
Chronic inflammation, thickening, and scarring of the bronchial passages
EMPHYSEMA
Destruction of the lung parenchyma
Enlargement of the air spaces
Destruction of alveoli “swiss cheese” lung
COPD
Smoking leads to excessive mucus production and bronchial inflammation.
Nicotine paralyzes cleansing cilia.
Mucus, bacteria, irritants are trapped in the airway.
Neutrophils (a WBC) in the bronchioles release enzymes that dissolve elastin and protein, destroying alveoli and their elasticity.
Tiny air passages collapse, worse during exhale, trapping air in lungs
Reduced surface area (destruction) and blockage (mucus) of alveoli reduced gas exchange
Pulmonary arteries then have less oxygen vasoconstriction pulmonary hypertension right heart failure
REMEMBER BOB?
A 54 year old male smoker, Bob, presents with a history of frequent lung infections and a chronic “smoker’s cough” productive of brown/yellow mucus. He has this cough at least 4 months of each year for the past 3-4 years. He feels short of breath and wheezy when he gets sick and when he walks up a flight of stairs, which seems to be getting worse. His albuterol inhaler helps very temporarily with the chest tightness but not with the cough.
You encourage Bob to quit smoking, which he is having a hell of a time trying to do. You follow him over several years, when he comes back with the onset of “waterlogged” legs and worsening shortness of breath
BOB IS A BLUE BLOATER
Chronic Bronchitis>Emphysema
Mucus production causes bronchiolar obstruction nonventilated alveoli shunting of blood away from hypoxic areas pulmonary hypertension right heart failure edema
Patient is cyanotic (blue) due to shunting of deoxygenated blood, and edematous (bloater) due to heart failure.
Less dyspnea at rest but severely dyspneic with any exertion.
Hello, PAPPY. Still Smoking?
A 67 year old man, Pappy, is a longtime smoker. He has over the past 15-20 years felt increasingly short of breath, first with running, then with walking, and now even with getting around his house and moving from his bedroom to the kitchen. He is a very thin man, sitting on the edge of his chair with his lips pursed, breathing quickly, unable to say more than a few words between breaths. He states that he is no worse than usual. He continues to smoke a pack a day but seems very sad about it.
PAPPY=PINK PUFFER
Emphysema>chronic bronchitis
These patients breathe rapidly to get enough air exchange, but are therefore not cyanotic (they’re PINK).
The alveoli lack elasticity and are being destroyed, so pursing the lips and using accessory muscles are common.
Patients tend to be thin, may have a barrel chest, clubbing, and breathing quickly and with more effort. (PUFFING)
COPD
Diagnosis: clinical appearance and history, X-ray, PFTs (obstruction)
Treatment:
Bronchodilators (anticholinergics, sympathomimetics, methylxanthines)
Antibiotics
Steroids
Oxygen
Chest physiotherapy and exercise rehab
Lung surgery/transplant
These medicines help control symptoms, help keep people from being in the hospital as often, increase quality of life, and help people live longer, BUT ONLY QUITTING SMOKING CAN TRULY REVERSE THE DISEASE!!!!
bronchiectasis
It is a condition that results from prolonged injury or inflammation of respiratory airways and bronchioles.
It is characterized by abnormal dilation of the bronchus or bronchi. It is most frequently associated with chronic respiratory disease, infections, cystic fibrosis, tumor growth or exposure to respiratory toxins.
The major manifestations of bronchiectasis are impaired ventilation of the alveoli, chronic inflammation and possible fibrosis of the areas.
idiopathic pulmonary fibrosis
a chronic and fatal interstitial pulmonary disease. Half of the patient’s diagnosed with this die within five years of diagnosis.
the stimulus which begins a cascade of immune, inflammatory and fibrotic lung processes is unknown. Chronic inflammation seems to be the key.
presenting symptoms are dyspnea, dry hacking paroxysmal cough. Early in the disease end respiratory crackles can be heard at the bases of the lungs.
a thorough history to rule out other causes of interstitial lung disease, histology of tissue through biopsy are used for diagnosis.
the alveolar walls swell with the presence of inflammatory cells (mononuclear cells and polymorphonuclear leukocytes) are found early and later collagen and fibroblasts fill the interstitium.
vital capacity and lung capacity are severely restricted as the disease progresses.
idiopathic pulmonary fibrosis
oxygen therapy doesn’t change the course but can help prevent dyspnea and hypoxia. Corticosteroids and cytotoxic drugs are often used.
YET ANOTHER CASE
A 32 year old homeless man comes to you for treatment of a chronic cough. He has been coughing for about 6 months, and in that time has also had night sweats, fevers, chills, anorexia, and weight loss. He has begun coughing up some blood, which is what led him to seek help. He recalls the cough started during a time that he was in jail briefly and staying in shelters. He also relates to you that he is an IV drug user but has not had any blood testing for 5 years.
TUBERCULOSIS
• Mycobacterium tuberculosis
3 million deaths/yr worldwide (85% Asia & Africa)
Primary infection Latent infection Active secondary infection
TUBERCULOSIS
5% of people who convert to positive will get active disease within 2 years. An additional 5% will develop active TB within their lifetime.
90% of people who are exposed to TB will never get active TB.
It is recommended that if you test positive, you should take a prophylactic TB medication daily for 9 months to reduce the risk of reactivation later on in life.
TUBERCULOSIS
Small, aerosolized droplets are essentially the only vehicle for TB transmission.
Ask anyone with symptoms of TB, especially if they may be at risk, to wear a mask.
silicosis
asbestosis
coal worker’s pneumoconiosis
moving on...
As shown near the beginning of the presentation:
the heart and lungs work inseparably to distribute oxygen throughout the body and remove toxins from the body
The circulatory System
blood flow through the heart
• Blood from the body travels into the right atrium, moves into the right ventricle, and is finally pushed into lungs in the pulmonary arteries
• The blood then picks up oxygen and travels back to the heart into the left atrium through the pulmonary veins
• The blood then travels through the to the Left Ventricle and exits to the body through the Aorta…
• Oxygen rich blood leaves the heart and travels through arteries
• In the capillaries the oxygen and food is given to the body’s cells
• The blood finally travels back through veins to the heart to pick up oxygen
• Capillaries carry the blood to…
• Venules that connect to veins and the…
• Veins (wide blood vessels) carries the oxygen-poor blood back to the heart.
Technically the Hemoglobin in the blood (a substance full of iron) attracts oxygen from the lungs. The red blood cell then carries it to the desired tissue. Because this tissue has a high CO2 count the hemoglobin lets go of its oxygen and collects the carbon dioxide. You see the hemoglobin has an affinity for whichever gas has a greater count. Because the tissue has a large amount of built up waste (CO2) the hemoglobin attracts it and then replaces it with oxygen, and vise versa in the lungs.
What are we measuring when we take blood pressure?
As you can see the heart contracts and relaxes
leading to an increase and decrease in pressure.
When a blood pressure cuff is placed and inflated the
measure of pressure exerted is what you find.
Elasticity and contractility are extremely important. A
brittle blood carrier will easily break.
the electric heart
Electrical signals created by the S-A node follow a natural electrical pathway through your heart walls. The movement of the electrical signals causes your heart's chambers to contract and relax. When a signal passes through a chamber wall, the chamber contracts. When the signal has moved out of the wall, the chamber relaxes. In a healthy heart, the chambers contract and relax in a coordinated way, or in rhythm.When your heart beats in rhythm at a normal rate, it's called sinus rhythm. A problem in your heart's electrical system can disrupt your heart's normal rhythm. Any kind of abnormal rhythm or heart rate is called an arrhythmia. It's normal and healthy for your heartbeat to speed up or slow down during the day as your activity level changes. But it's not normal for your heart to beat out of rhythm. When your heart beats out of rhythm, it may not deliver enough blood to your body.Learn more about different types of arrhythmias in the Conditions and Treatments section: tachycardia, bradycardia, and atrial fibrillation.
An ECG (EKG) is a recording of the electrical activity in your heart. Parts of an EKGThe hills and valleys on an EKG recording are called waves. Each wave tells your doctor a story about how your heart is working (Figure 1):The P-wave shows your heart's upper chambers (atria) contractingThe QRS complex shows your heart's lower chambers (ventricles) contractingThe T-wave shows your heart's lower chambers (ventricles) relaxing
Pictures are worth a thousand words
Electrocardiogram Continued
Abnormalities in the EKG can indicate a variety of conditions including an MI (heart attack).