1. health and fitness
2. disease
3. asthma

CHAPTER 11
Respiratory System
Respiratory System Overview
• Responsibilities of respiratory system
– Respiration = exchange of gases between
body and air
• Provides oxygen to body cells for energy
• Removes carbon dioxide from body cells
– Production of sound
– Assisting in body’s defense against foreign
materials
2
Respiratory System Overview
• External respiration
– Oxygen is inhaled into lungs
– Passes through capillaries of the lungs into
the pulmonary bloodstream
– Carbon dioxide passes from blood through
the same capillaries into the lungs and is
exhaled
3
Respiratory System Overview
• Internal respiration
– Inhaled oxygen circulates from pulmonary
bloodstream in the lungs, back through the
heart, to systemic bloodstream, to the body
cells
• At cellular level, oxygen passes through capillaries
into tissue cells where it is used for energy
• Carbon dioxide passes from tissue cells into
capillaries and travels through bloodstream for
removal from body via lungs
4
Respiratory System Structures
• Nose
– External portion composed of cartilage and
bone covered with skin
• Entrance to nose = nostrils or nares
• Air enters body through the nose and mouth
• Nasal cavity
– Divided into left and right chambers by
dividing wall called the septum
• As air enters through nose, it passes into the nasal
cavity
5
Respiratory System Structures
• Paranasal sinuses
– Hollow areas or cavities within the skull
that communicate with the nasal cavity
– Lighten the skull and enhance the sound of
the voice
– Lined with mucous membranes
• Help to warm and filter the air as it enters the
respiratory system
• Cilia (hairlike projections on mucous
membranes) sweep dirt and foreign material
toward throat for elimination
6
Respiratory System Structures
• Pharynx
– Airway that connects the mouth and nose
to the larynx
• Also known as the throat
• Serves as a common passageway for both air
and food
7
Respiratory System Structures
• Pharynx
– Commonly divided into three sections
• Nasopharynx
– Contains the adenoids
• Oropharynx
– Contains the tonsils (palatine tonsils)
• Laryngopharynx
8
Respiratory System Structures
• Larynx
– Connects pharynx with trachea
– Also known as the voice box
– Most prominent of supporting cartilages is
the thyroid cartilage at the front
• Forms the Adam’s apple
– Contains structures that make vocal sounds
possible – the vocal cords
• Vocal cords vibrate as air passes through the
space between them, producing sound
9
Respiratory System Structures
• Trachea
– Extends into the chest and serves as a
passageway for air to the bronchi
– Commonly known as the windpipe
• Bronchi
– Trachea branches into two tubes called the
bronchi
– Each bronchus leads to a separate lung
• Divides and subdivides into progressively smaller
tubes called bronchioles
10
Respiratory System Structures
• Bronchioles
– Smallest branches of bronchi
– Terminal ends known as alveoli
• Air sacs
• Have thin walls that allow for exchange of gases
between the lungs and the blood
• Alveoli = pulmonary parenchyma
11
Respiratory System Structures
• Lungs
– Two cone-shaped, spongy organs consisting
of alveoli, blood vessels, elastic tissue, and
nerves
– Left lung has two lobes and right lung has
three lobes
– Apex = uppermost part of lung
– Base = lower part of lung
– Hilum = portion in midline region where blood
vessels, nerves, and bronchial tubes enter and
exit the lungs
12
Respiratory System Structures
• Pleura
– Double-folded membrane that surrounds the
lungs
– Parietal pleura
• Outer layer of the pleura which lines the thoracic
cavity
– Visceral pleura
• Inner layer of the pleura which covers the lungs
13
Respiratory System Structures
• Pleura
– Pleural space
• Small space between the pleural membranes
• Filled with lubricating fluid that prevents friction
when the two membranes slide against each other
during respiration
14
Breathing Process
• Inhalation = inspiration
– Diaphragm is stimulated by phrenic nerve
– Diaphragm contracts and flattens (descends)
– Chest cavity enlarges
– Decrease in pressure within the thorax
– Air is drawn into the lungs
15
Breathing Process
• Exhalation = expiration
– Diaphragm relaxes and rises back into
thoracic cavity
– Chest cavity decreases in size
– Increase in pressure with the thorax
– Air is forced out of lungs
16
Physical Exam Techniques
• Inspection
– Visual examination of the external surface of
the body as well as of its movements and
posture
• Palpation
– Process 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
17
Physical Exam Techniques
• Auscultation
– Process 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 sounds
• Performed with a stethoscope
18
Physical Exam Techniques
• Percussion
– Use 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 cavity
• Tapping over solid organ = dull flat sound
• Tapping over air-filled structure = clear, hollow
sound
19
Common Signs and Symptoms
• Apnea
– Temporary cessation of breathing
• “Without breathing”
• Bradypnea
– Abnormally slow breathing
– Evidenced by respiratory rate slower than 12
respirations per minute
20
Common Signs and Symptoms
• Cough
– Forceful and sometimes violent expiratory
effort preceded by a preliminary inspiration
• Glottis is partially closed, accessory muscles of
expiration brought into action, air is noisily
expelled
– Due to irritation of the airways or infection
• Irritants = dust, smoke, mucus
21
Common Signs and Symptoms
• Cough
– Nonproductive = unproductive
• Not effective in bringing up sputum
• “Dry cough”
– Productive
• Effective in bringing up sputum
• “Wet cough”
22
Common Signs and Symptoms
• Cyanosis
– Slightly bluish, grayish, slatelike, or dark
purple discoloration of the skin due to
presence of abnormal amounts of reduced
hemoglobin in the blood
• Dysphonia
– Difficulty in speaking
– Hoarseness
23
Common Signs and Symptoms
• Dyspnea
– Air hunger resulting in labored or difficult
breathing, sometimes accompanied by pain
• Epistaxis
– Hemorrhage from the nose; nosebleed
24
Common Signs and Symptoms
• Expectoration
– Act of spitting out saliva or coughing up
materials from the air passageways
leading to the lungs
• Hemoptysis
– Expectoration of blood arising from the oral
cavity, larynx, trachea, bronchi, or lungs
25
Common Signs and Symptoms
• Hypercapnia
– Increased amount of carbon dioxide in the
blood
• Hypoxemia
– Insufficient oxygenation of the blood
• Hypoxia
– Deficiency of oxygen
26
Common Signs and Symptoms
• Kussmaul respirations
– Very deep, gasping type of respiration
associated with severe diabetic acidosis
• Orthopnea
– Respiratory condition in which there is
discomfort in breathing in any but erect,
sitting, or standing position
27
Common Signs and Symptoms
• Pleural rub
– Friction rub caused by inflammation of the
pleural space
• Rales
– Abnormal 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 walls
28
Common Signs and Symptoms
• Rhinorrhea
– Thin, watery discharge from the nose
• Rhonchi
– Rales or rattlings in the throat, especially
when it resembles snoring
29
Common Signs and Symptoms
• Sneeze
– To expel air forcibly through the nose and
mouth by spasmodic contraction of muscles
of expiration due to irritation of nasal mucosa
• Stridor
– Harsh sound during respiration
– High pitched and resembling the blowing of
wind, due to obstruction of air passages
30
Common Signs and Symptoms
• Tachypnea
– Abnormal rapidity of breathing
• Wheeze
– Whistling sound or sighing sound resulting
from narrowing of the lumen of a respiratory
passageway
31
PATHOLOGICAL CONDITIONS
Upper
Respiratory System
Coryza
• Pronounced
– (kor-RYE-zuh)
• Defined
– Inflammation of the respiratory mucous
membranes known as the common cold
• “Common cold” usually refers to symptoms of an
upper respiratory tract infection
33
Croup
• Pronounced
– (KROOP)
• Defined
– Childhood disease characterized by a barking
cough, suffocative and difficult breathing,
stridor, and laryngeal spasm
34
Diphtheria
• Pronounced
– (diff-THEER-ree-uh)
• Defined
– Serious 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
35
Laryngitis
• Pronounced
– (lair-in-JYE-tis)
• Defined
– Inflammation of the larynx, usually resulting in
hoarseness, cough, and difficulty swallowing
• Causes: abuse of the voice, upper respiratory tract
infection, chronic bronchitis, chronic sinusitis
36
Pertussis
• Pronounced
– (per-TUH-sis)
• Defined
– Acute upper respiratory infectious disease,
caused by the bacterium Bordetello pertussis
– Also known as “whooping cough”
37
Pharyngitis
• Pronounced
– (fair-in-JYE-tis)
• Defined
– Inflammation of the pharynx, usually resulting
in sore throat
• Usually caused by a virus
38
Rhinitis
• Pronounced
– (rye-NYE-tis)
• Defined
– Inflammation of the mucous membranes of
the nose
• Usually resulting in obstruction of the nasal
passages, rhinorrhea, sneezing, and facial
pressure or pain
39
Sinusitis
• Pronounced
– (sigh-nus-EYE-tis)
• Defined
– Inflammation of a sinus, especially a
paranasal sinus
• Usually results in pain and a feeling of pressure in
the affected sinuses
40
Tonsillitis
• Pronounced
– (ton-sill-EYE-tis)
• Defined
– Inflammation of the palatine tonsils: tonsils
appear enlarged and red with yellowish
exudate
• Symptoms:
• Sore throat, fever, snoring, difficulty swallowing
41
PATHOLOGICAL CONDITIONS
Lower
Respiratory System
Asthma
• Pronounced
– (AZ-mah)
• Defined
– Paroxysmal dyspnea accompanied by
wheezing caused by a spasm of the bronchial
tubes or by swelling of their mucous
membrane
• Occurs most frequently in childhood or early
adulthood
43
Bronchiectasis
• Pronounced
– (brong-key-EK-tah-sis)
• Defined
– Chronic dilatation of a bronchus or bronchi,
with secondary infection that usually involves
the lower portion of the lung
44
Bronchitis
• Pronounced
– (brong-KIGH-tis)
• Defined
– Inflammation of the mucous membrane of the
bronchial tubes
• Infection is often preceded by the common cold
• Patient may experience productive cough,
accompanied by wheezing, dyspnea, and chest
pain
45
Bronchitis
• Acute Bronchitis
– Causes are viral infection, bacterial infection,
and airborne irritants
• Chronic Bronchitis
– Primarily associated with cigarette smoking or
exposure to pollution
• Smoke irritates airways, resulting in inflammation
and hypersecretion of mucus
• Productive cough is present for at least three
months of two consecutive years
46
Bronchogenic Carcinoma
• Pronounced
– (brong-koh-JEN-ic car-sin-OH-mah)
• Defined
– Malignant lung tumor that originates in the
bronchi
– Lung cancer
47
Emphysema
• Pronounced
– (em-fih-SEE-mah)
• Defined
– Chronic 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
48
Empyema
• Pronounced
– (em-pye-EE-mah)
• Defined
– Pus in a body cavity, especially in the pleural
cavity
• Usually the result of a primary infection in the lungs
49
Hyaline Membrane Disease
• Pronounced
– (HIGH-ah-lighn membrane dih-ZEEZ)
• Defined
– Severe impairment of respiration in
premature newborn
– Also known as respiratory distress syndrome
(RSD)
50
Influenza
• Pronounced
– (in-floo-IN-zah)
• Defined
– Highly contagious viral infection of the
respiratory tract transmitted by airborne
droplet infection
– Also known as the flu
• Symptoms include sore throat, cough, fever,
muscular pains, and generalized weakness
51
Lung Abscess
• Pronounced
– (lung AB-sess)
• Defined
– Localized 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
52
Pleural Effusion
• Pronounced
– (PLOO-ral eh-FYOO-zhun)
• Defined
– Accumulation of fluid in the pleural space,
resulting in compression of the underlying
portion of the lung, with resultant dyspnea
• Usually secondary to some other disease
53
Pleuritis (Pleurisy)
• Pronounced
– (ploor-EYE-tis)
– (PLOOR-ih-see)
• Defined
– Inflammation of both the visceral and parietal
pleura
54
Pneumonia
• Pronounced
– (new-MOH-nee-ah)
• Defined
– Inflammation of the lungs caused primarily by
bacteria, viruses, and chemical irritants
55
Pneumothorax
• Pronounced
– (new-moh-THOH-racks)
• Defined
– Collection of air or gas in the pleural cavity
• Air enters as the result of a perforation through the
chest wall or the pleura covering the lung
56
Pulmonary Edema
• Pronounced
– (PULL-mon-air-ree eh-DEE-mah)
• Defined
– Swelling of the lungs caused by an abnormal
accumulation of fluid in the lungs, either in the
alveoli or the interstitial spaces
57
Pulmonary Heart Disease
(Cor Pulmonale)
• Pronounced
– (PULL-mon-air-ree heart dih-ZEEZ)
– (cor pull-mon-ALL-ee)
• Defined
– Hypertrophy of the right ventricle of the heart
(with or without failure) resulting from
disorders of the lungs, pulmonary vessels, or
chest wall
58
Sudden Infant Death Syndrome
• Pronounced
– (sudden infant death SIN-drohm)
• Defined
– Unexpected and unexplained death of an
apparently well, or virtually well infant
– Also known as crib death or SIDS
59
Tuberculosis
• Pronounced
– (too-ber-kyoo-LOH-sis)
• Defined
– Infectious disease caused by the tubercle
bacillus, Mycobacterium tuberculosis
– Inflammatory infiltrations, formation of
tubercles, and caseous (cheeselike) necrosis
in the tissues of the lungs
60
PATHOLOGICAL CONDITIONS
Work-Related
Anthracosis
• Pronounced
– (an-thrah-KOH-sis)
• Defined
– Accumulation of carbon deposits in the lungs
due to breathing smoke or coal dust
– Also known as black lung disease or coal
worker’s pneumonoconiosis
62
Asbestosis
• Pronounced
– (as-beh-STOH-sis)
• Defined
– Lung disease resulting from inhalation of
asbestos particles
63
Byssinosis
• Pronounced
– (bis-ih-NOH-sis)
• Defined
– Lung disease resulting from inhalation of
cotton, flax, and hemp
– Also known as brown lung disease
64
Silicosis
• Pronounced
– (sill-ih-KOH-sis)
• Defined
– Lung disease resulting from inhalation of silica
(quartz) dust, characterized by formation of
small nodules
65
DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES
Respiratory System
Diagnostic Techniques,
Treatments, and Procedures
• Bronchoscopy
– Examination of interior of bronchi using a
lighted, flexible bronchoscope (or endoscope)
• Chest X-ray
– High-energy electromagnetic waves passing
through the body onto a photographic film
– Produces a picture of the internal structures of
the body for diagnosis and therapy
67
Diagnostic Techniques,
Treatments, and Procedures
• Laryngoscopy
– Examination of interior of the larynx using a
lighted, flexible tube known as a laryngoscope
(or endoscope)
• Lung scan
– Visual 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 material
68
Diagnostic Techniques,
Treatments, and Procedures
• Pulmonary function tests
– Variety of tests performed to assess
respiratory function
• Sputum specimen
– Specimen of material expectorated from the
mouth
• If produced after a cough, it may contain, in
addition to saliva, material from the throat and
bronchi
69
Diagnostic Techniques,
Treatments, and Procedures
• Thoracentesis
– Procedure 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 space
70
Diagnostic Techniques,
Treatments, and Procedures
• Tonsillectomy
– Surgical removal of the palatine tonsils
• Usually combined with an adenoidectomy (surgical
removal of adenoids)
• Tuberculin skin test (TST)
– Determines past or present tuberculosis
infection present in the body
• Based on positive skin reaction to the introduction
of a purified protein derivative (PPS) of the
tubercula bacilli into the skin
71