Sistem Pernafasan

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

ANATOMI DAN FISIOLOGI PERNAFASAN

Dr. Aidi Nasrul AKBID SUMBAR LUBUK ALUNG 2008

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Introduction to Pulmonary Physiology • The pulmonary system, in tandem with the cardiovascular system, works to carry out three functions: – Ventilation – Perfusion – Diffusion

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Anatomy

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Upper Airways • Structures – Nasopharynx – Oropharynx – Tongue – Epiglottis – Larynx • Function – Protection – Humidification – Filtration

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Lower Airways • Structures – – – –

Trachea Mainstem bronchi Bronchioles Terminal bronchioles

• Function – Filtration – Transmission of air

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Structural Considerations

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Structural Considerations • Cilia: beat 100 times/second • MAST cells secrete sticky substance filled with WBCs

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Alveolus • 100 million alveoli in each lung • Single cell thick wall • Immediately adjacent to pulmonary capillary • Gas exchanges via diffusion

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

1. Ventilation • Definition: movement of air from the external environment to the alveoli • Components: • • • • •

Brain Innervation Chest wall Upper airways Lower airways

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Inspiration • Increased intrathoracic space • Negative pressure • Bronchioles dilate • Air enters airways/alveoli (unless a hole is present in the chest wall)

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Expiration • Diaphragm & intercostals relax • Thoracic space gets smaller • Increased intrathoracic pressure • Air passively exits via airways

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

What Happens to the Airways? • Smooth-muscle lined airways (bronchioles) naturally change diameter with inspiration and expiration • (This will be important when we discuss obstructive lung disease)

Inspiration

Expiration

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

2. Perfusion • Definition of perfusion: adequate blood flow through the pulmonary capillary bed • Components: – Intact pulmonary capillary bed – Adequate cardiac function – Adequate blood volume

R Heart

L Heart

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Pulmonary Capillary Bed May be damaged by: • Clots (pulmonary emboli) • Crushing injuries (pulmonary contusion)

R Heart

L Heart

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Cardiac Function • The pulmonary capillary bed is part of the cardiopulmonary circuit • Impairment of flow through any chamber or valve will impact pressures and flow

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Blood Volume • Adequate perfusion requires adequate blood volumes AND composition • Reduction of volume, or decreased/ inadequate RBCs will diminish perfusion

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

3. Diffusion – Definition of diffusion: movement of gases between the alveoli and the pulmonary capillary bed – Components: • Alveolus • Basement membrane (interstitial space) • Capillary wall

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Diffusion? • The passive exchange of gases along a concentration gradient (high to low) • Exchange continues until the concentrations are equal

Before diffusion CO2

O2 CO2 O2

After diffusion O2 CO2

O2 CO2

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Diffusion?

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Basement Membrane • Includes the walls of the alveolus and capillary • Most importantly, includes the interstitial space between the walls of the capillary and alveoli • Drainage via lymphatics

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Capillary Wall • If capillary wall is thickened, diffusion will be impaired • If capillary wall is damaged, diffusion will be impaired

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

w.

A B B Y Y.c

om

Y

F T ra n sf o

A B B Y Y.c

bu to re he C

lic

k

he k lic C w.

om

w

w

w

w

rm

y

ABB

PD

re

to

Y

2.0

2.0

bu

y

rm

er

Y

F T ra n sf o

ABB

PD

er

Y

Terima Kasih

w.

A B B Y Y.c

om