NATIONAL REVIEW COURSE. Respiratory System

Transcription

1 NATIONAL REVIEW COURSE Respiratory System I. Overview of the Respiratory System A. The respiratory system functions as an air distributor and gas exchanger supplying oxygen and removing carbon dioxide from cells. 1. Alveoli sacs that serve as gas exchangers; all other parts of respiratory system serve as air distributors. 2. The respiratory system also warms, filters, and humidifies air. 3. Respiratory organs influence speech, homeostasis of body ph, and olfaction. B. The respiratory system is divided into two divisions: C. Upper respiratory tract organs are located in the head and neck; consists of nose, nasopharnyx, oropharnyx, laryngopharnyx, and larnyx. D. Lower respiratory tract organs located within the thorax; consists of trachea, bronchial tree, and lungs. E. Accessory structures include oral cavity, rib cage, and diaphragm. II. Upper Respiratory Tract A. Nasal cavities two spaces separated by a bone and cartilage partition called the nasal septum; bound between the eyes, above the oral cavity. 1. Nostrils (nares) the two openings into the nasal cavities. 2. Nasal choana or conchae (turbinates) curved projections along the lateral sides of the nasal cavities; filter out dust particles and warm and humidify the incoming air. 3. Sinuses small cavities in the bones of the skull; lined with mucous membranes; communicate with the nasal cavities; serve to decrease the weight of the skull and act as resonance chambers for vocalization. B. Pharynx (throat) passageway lined with nucous membranes; connects the nasal cavities to the larynx. C. Nasopharynx the uppermost portion of the pharynx; lies directly behind the nasal cavities; contains the pharyngeal tonsils (adenoids). D. Oropharynx the middle portion of the pharynx; lies directly behind the oral cavity; contains the palatine tonsils, on the walls of the oropharynx, and the lingual tonsils, on the posterior aspect of the tongue. E. Laryngopharynx the bottom portion of the pharynx; lies directly above the larynx. F. Larynx a cartilaginous structure; contains the vocal cords and a small protrusion of cartilage commonly called the Adam s apple; also called the voice box. 1. Glottis the opening between the two vocal cords. 2. Epiglottis a cartilaginous structure above the glottis; folds down over the glottis during swallowing to prevent food and water from entering the trachea.

2 III. IV. Lower Respiratory Tract A. Trachea a rigid tube made up of a series of horseshoe-shaped cartilaginous rings and smooth muscle tissue; connects the pharynx to the bronchi of the lungs; also called the windpipe. B. Lungs organs in which gas exchange takes place. 1. Mediastinum anatomical space between the two lungs; where the trachea, heart, major blood vessels, and esophagus are located. 2. Bronchi cartilaginous tubes that extend from the trachea into the lungs at the hilum. a. Bronchioles small bronchi b. Terminal bronchioles the last segments of the bronchioles; connect to the alveoli. C. Alveoli tiny sacs that number about 350 million per lung; where gas exchange takes place. 1. Surfactant a lipid secreted in the alveoli; reduces the surface tension of the water within the lung, thus decreasing the energy required to fill the alveoli with air. D. Pleural membranes serous membranes associated with the lungs; produce a lubricant to reduce friction between the lungs and the walls of the pleural cavity. 1. Parietal pleura serous membrane lining the internal walls of the thoracic cavity. 2. Visceral pleura serous membrane covering the outer surface of the lungs. Respiratory Physiology A. Phases of Breathing: 1. Inhalation active phase of breathing in which energy is used to draw air into the lungs. 2. Exhalation passive phase of breathing in which air is pushed out of the lungs. B. External respiration: 1. Pulmonary ventilation breathing; includes inhalation and exhalation. 2. Pulmonary gas exchange exchange of oxygen and carbon dioxide in the lungs. C. Transport of gases by the blood systemic circulation. D. Internal respiration: 1. Systemic tissue gas exchange exchange of oxygen and carbon dioxide in the tissues. 2. Cellular respiration the use of oxygen by the cells of the body. E. Animation: Breathing * F. Animation: Gas Exchange * V. Muscles of Respiration A. Inhalation: *

3 VI. 1. Diaphragm pulls downward to increase the superior/inferior aspect of the thorax. 2. External intercostals lifts the ribs to increase the anterior/posterior aspect of the thorax. 3. Pectoralis minor lifts the ribs to increase the anterior/posterior aspect of the thorax. 4. Scalenes lifts ribs 1 and 2 5. Sternocleidomastoid lifts the clavicle and sternum. B. Most exhalation is performed passively by relaxing the muscles of inhalation; the following muscles are used for forced exhalation. C. Exhalation: 1. Internal intercostals compresses the thorax. 2. External obliques compresses the thorax. 3. Internal obliques compresses the thorax. 4. Transversus abdominis compresses the thorax. Lung Volumes and Capacities A. Tidal volume the volume of air moved in or out of the lungs in one breath during quiet, relaxed breathing; approximately 0.5 L. B. Inspiratory reserve volume (IRV) the volume of air that can be forcibly inhaled after normal inspiration; approximately 3.3 L. C. Expiratory reserve volume (ERV) the largest volume of additional air that can be forcibly exhaled after normal exhalation; approximately 1.0 to 1.2 L. D. Residual volume the volume of air that remains in the lungs after maximum exhalation; approximately 1.2 L. E. Vital capacity the volume of air that can be exhaled after maximum inhalation; approximately 4.8 L. F. Total lung capacity the total volume of air that can be contained in the lungs; approximately 6 L. Diseases of the Respiratory System VII. General Terminology A. Eupnea [G. eu = well + pnoia = breath] normal, unlabored breathing. B. Tachypnea fast breathing. C. Dyspnea difficult, labored breathing. D. Apnea absence of breathing. VIII. Disorders A. Bronchitis inflammation (acute or chronic) of the mucous membranes in the bronchial tubes of the lung. 1. Causes: infection; inhalation of a chemical irritant. 2. Indications/Contraindications: can be contagious if caused by infection so obain the advice and approval of client s doctor before performing bodywork; massage can reduce thoracic muscular spasms; avoid massage if client has a fever.

4 B. Emphysema destruction and enlargement of the alveoli in the lung; causes labored breathing and air trapping in the lung, leading to barrel chest (rounded chest) and weight loss. 1. Causes: cigarette smoking; occupational exposure. 2. Indications/Contraindications: massage can relax muscles involved in breathing and therefore reduce anxiety; consult with client s doctor. C. Pneumothorax accumulation of air in the pleural space (i.e. the space between the lung and rib cage); results in partial or complete collapse of the lung (the lung is unable to inflate); commonly accompanied by hemothorax (blood in the pleural space). 1. Causes: puncture into the thoracic cavity; fractured or dislocated ribs. 2. Indications/Contraindications: refer to doctor; massage is contraindicated. D. Asthma a disease characterized by episodes of muscle spasm or inflammation of the bronchi and bronchiole tubes. 1. Causes: allergic response to a particular allergen; emotional or physical stress or strenous exercise. 2. Indications/Contraindications: massage can be very effective in reducing stress; all bodywork should be gentle and relaxing. E. Tuberculosis an infectious disease that leads to the development of tubercles (i.e. small masses of bacteria and necrotic tissue surrounded by macrophages) in the alveoli of the lung. 1. Cause: Mycobacterium tuberculosis infection acquired by inhalation of the bacteria. 2. Indications/Contraindications: consult with client s doctor. F. Common cold (rhinovirus) inflammation of the mucous membranes of the upper respiratory tract; signs and symptoms include excessive nasal secretions, tearing, sore throat, hoarse voice, and general malaise; usually lasts about 6 to 7 days. 1. Cause: viral infection of the upper respiratory tract; most commonly spread by touching the eyes and nose with fingers that have come into contact with an infected surface. 2. Indications/Contraindications: avoid direct contact with the client (contagious condition); allow symptoms to clear before performing bodywork. 3. Video: Why Don t We Do It In Our Sleeves? * G. Pneumonia inflammation of the bronchioles and alveoli of the lungs. 1. Causes: bacterial or fungal infection; inhalation or irritating fumes or particles. 2. Indications/Contraindications: consult with client s doctor; massage during acute stages is contraindicated; massage is beneficial for respiratory muscles and shoulders during the *

5 postacute stage; client s doctor may advise tapotement to promote expectoration. H. Pleurisy (pleuritis) inflammation of the pleura; a painful condition made worse by inspiration. 1. Causes: viral infection; tuberculosis; cancer. 2. Indications/Contraindications: refer to doctor; medical care should precede any bodywork. I. Cystic fibrosis an inherited multisystem disease of the exocrine glands; results in the production of excessive, thick mucus that obstructs the gastrointestinal, respiratory, and urinary systems. 1. Cause: genetic (1 in 20 Caucasians carry the cystic fibrosis trait). 2. Indications/Contraindications: avoid the area of the pancreas if inflamed; obtain approval of client s doctor before performing bodywork; tapotement to the chest, light exercise, and bronchodilators increase drainage of the bronchioles. Sample Questions The amount of air moved into or out of the lungs during quiet, relaxed breathing is the: A. tidal volume. B. vital capacity. C. residual volume. D. total lung capacity. The lungs are located in the: A. pericardial cavity. B. mediastinum. C. thoracic cavity. D. dorsal cavity. Which of the following is the cartilaginous structure that contains the vocal cords and a small protrusion of cartilage commonly called the Adam s apple? A. Larynx B. Trachea C. Esophagus D. Pharynx The serous membrane associated with the lungs is the: A. pleural membrane. B. parietal membrane. C. pericardial membrane. D. respiratory membrane. The exchange of gases between the blood supply and the body cells is called: A. external respiration. B. ventilation. C. tapotement. D. internal respiration.

6 Each lung has one tube that branches off from the trachea called the: A. bronchiole tubes. B. trachea. C. bronchial tubes. D. C-rings. What nerve innervates the diaphragm? A. Vagus B. Glossopharyngeal C. Phrenic D. Sciatic When the bronchial tubes become inflamed, constricted, and have an unusual buildup of mucous, this is called: A. adhesions. B. asthma. C. atopic lungitis. D. tracheotomy. For a massage client with cystic fibrosis, which two massage techniques are most beneficial to help loosen phlegm? A. Rocking and vibration B. Tapotement and vibration C. Cupping and rocking D. Petrissage and tapotement Emphysema is: A. when the alveoli sacs begin to die in the lungs, and oxygen is unable to get into the blood for gas exchange. B. reversible. C. also known as CAD. D. Both A and B are correct. All of the following muscle assist in respiration except: A. sternocleidomastoid. B. internal intercostals. C. pectoralis major. D. middle scalenes.