HAP 5 SEMESTER 2 BPHARMACY PCI SYLLABUSS

1. HAP
Respiratory system
Anatomy of respiratory system with special reference to anatomy of lungs,
mechanism of respiration, regulation of respiration Lung Volumes and
capacities transport of respiratory gases, artificial respiration, and resuscitation
methods.

3. • The Upper Respiratory System: nose, pharynx, and associated
structures.
• Nose : (external nose) ,(internal nose).
• The external nose is the portion of the nose visible on the face
and consists of a supporting framework of bone and hyaline
cartilage covered with muscle and skin and lined by a mucous
membrane.
• The components of the cartilaginous framework are the septal
nasal cartilage, lateral nasal cartilage, alar cartilages
• On the under surface of the external nose are two openings
called the external nares or nostrils, which lead into cavities
called the nasal vestibules.

5. • Pharynx: pharynx (FAR-inks), or throat, is a funnel-shaped tube about
13 cm (5 in.) long that starts at the internal nares and extends to the
level of the cricoid cartilage, the most inferior cartilage of the larynx
(voice box)
• The pharynx can be divided into three anatomical regions:
• (1) nasopharynx(superior portion), (2) oropharynx(intermediate
portion), and (3) laryngopharynx(inferior portion).

6. • Nasopharynx: arch-shaped muscular partition between the
nasopharynx and oropharynx that is lined by mucous membrane.
There are five openings in its wall: two internal nares, two openings
that lead into the auditory (pharyngotympanic) tubes (commonly
known as the eustachian tubes), and the opening into the oropharynx
• Oropharynx: It has only one opening into it, the fauces (throat)the
opening from the mouth. This portion of the pharynx has both
respiratory and digestive functions, serving as a common passageway
for air, food, and drink.
• Laryngopharynx: Inferior end opens into the esophagus (food tube)
posteriorly and the larynx (voice box) anteriorly.

8. • The Lower Respiratory System:
Larynx : or voice box, is a short passageway that connects the
laryngopharynx with the trachea.
The wall of the larynx is composed of nine pieces of cartilage
Three occur singly (thyroid cartilage, epiglottis, and cricoid cartilage), and
three occur in pairs (arytenoid, cuneiform,and corniculate cartilages).
The portion of the cavity of the larynx above the vestibular folds (false
vocal cords) is called the laryngeal vestibule.
The portion of the cavity of the larynx below the vocal folds is called the
infraglottic cavity
The thyroid cartilage (Adam’s apple) consists of two fused plates of hyaline
cartilage that form the anterior wall of the larynx and give it a triangular
shape.
The epiglottis (epi- = over; -glottis = tongue) is a large, leaf shaped piece of
elastic cartilage that is covered with epithelium

9. Trachea:

10. The trachea or windpipe, is a tubular passageway for air that is about 12 cm (5
in.) long and 2.5 cm (1 in.) in diameter.
• The layers of the tracheal wall, from deep to superficial, are the
(1) mucosa, (2) submucosa, (3) hyaline cartilage, and (4) adventitia
(composed of areolar connective tissue).
Bronchi: At the superior border of the fifth thoracic vertebra, the trachea divides
into a right main (primary) bronchus (wind pipe), which goes into the right lung,
and a left main (primary) bronchus, which goes into the left lung
• At the point where the trachea divides into right and left main bronchi an internal
ridge called the carina
• On entering the lungs, the main bronchi divide to form smaller bronchi—the
lobar (secondary) bronchi, one for each lobe of thelung.
• The lobar bronchi continue to branch, forming still smaller bronchi, called seg-
mental (tertiary) bronchi then divide into bronchioles.

11. • Lungs:
• The lungs are paired cone-shaped organs in the thoracic
cavity
• Pleural membrane: double-layered serous
membrane(enclosure)
• Parietal pleura: S Layer, deep layer-the visceral pleura,
• Between the visceral and parietal pleurae is a small space,
the pleural cavity.

12. • The broad inferior portion of the lung, the base, is concave and fits
over the convex area of the diaphragm.
• The narrow superior portion of the lung is the apex.
• The mediastinal (medial) surface of each lung contains a region, the
hilum, through which bronchi, pulmonary blood vessels, lymphatic
vessels, and nerves enter and exit
• These structures are held together by the pleura and connective
tissue and constitute the root of the lung.
• Lobes, Fissures, and Lobules
• Alveolar Sacs and Alveoli
• Pulmonary circulation

13. • 1. A layer of type I and type II alveolar cells and associated alveolar
macrophages that constitutes the alveolar wall
2. An epithelial basement membrane underlying the alveolar wall
3. A capillary basement membrane that is oft en fused to the epithe-
lial basement membrane
4. The capillary endothelium

14. • Mechanism of Breathing:
• 1. Breathing (Pulmonary ventilation):
• The mechanism of breathing involves the inspiration and
expiration of air with the movement of the diaphragm and
intercostal muscles.
• During inhalation, external intercostal muscles contract.
• At the same time, the diaphragm contracts and flattens.
• These actions increase the volume of the thoracic (chest)
cavity, and the air (oxygen) is forced into the lungs.
• On the contrary, exhalation occurs when the thoracic cavity is
reduced, and the air (carbon dioxide) is expelled out

16. • 2. External Respiration:
• It involves the diffusion of oxygen and carbon dioxide between
the alveoli and the pulmonary capillaries due to the partial
pressure difference.
• The solubility of oxygen in the blood is not high, hence there is
a big difference in the partial pressure of oxygen in the alveoli
versus in the blood of the pulmonary capillaries.
• The partial pressure of oxygen in the alveoli is about
104mmHg, and it is about 40mmHg in the capillary blood.
• The difference is about 64mmHg
• This strong pressure gradient forces oxygen from the alveoli
into the blood across the respiratory membrane.

17. • 3. Internal Respiration:
• The gaseous exchange process that takes place in the tissues
is called internal respiration.
• The oxygen after dissociating from the haemoglobin reaches
the tissues or cells.
• The oxygen causes the complete breakdown of the glucose
molecules (food) into carbon, water, and energy.
• The energy remains stored in the form of ATP (Adenosine
Triphosphate) and is further utilized to perform several living
activities.
• This mechanism of internal respiration is also named Cellular
Respiration.

18. • 4. Transport of Oxygen: Oxygen is carried through the blood
from the respiratory organs to the different tissues.
• Oxygen can be carried in two forms:
• 1. Through plasma
• 2. Through Red Blood Cells (RBCs)

19. • 5. Transport of Carbon Dioxide: Carbon dioxide is transported
in the blood in the below-mentioned three ways:
• 1. In dissolved state: About 5−7per cent of carbon dioxide is
transported, being dissolved in the plasma of blood.
• 2. In the form of bicarbonate: Carbon dioxide produced by the
tissues diffuses passively into the blood and passes into the red
blood corpuscles, where it reacts with water to form carbonic
acid (H2CO3)
• 3. In combination with the amine group of protein:
(carbaminohemoglobin)

20. • Respiration is regulated by two mechanisms:
• Nervous or neural mechanism
• Chemical mechanism.

22. NERVOUS MECHANISM
• Respiratory centers, Afferent nerves and Efferent nerves
• RESPIRATORY CENTERS: Respiratory centers are group of
neurons, which control the rate, rhythm and force of respiration.
• These centers are bilaterally situated in reticular formation of
the brainstem.
• Depending upon the situation in the brainstem, the respiratory
centers are classified into two groups:
• Medullary centers
• Pontine centers

23. • Medullary centers, which are made up of:
oDorsal respiratory group of neurons: basic rhythm of respiration.
• Pontine centres which are:
oPneumotaxic center:. Pneumotaxic center influences the
switching between inspiration and expiration.
oApneustic center: The apneustic center increases the depth of
inspiration by acting directly on the dorsal group neurons.
oApneusis is an abnormal pattern of respiration or breathing
irregularity characterized by prolonged inspiration followed by
short, inefficient expiration.

24. • Afferent Pathway:
• Impulses from peripheral chemoreceptors and baroreceptors
are carried to the respiratory centers by the branches of
glossopharyngeal and vagus nerves.
• Respiratory centers receive afferent impulses from different
parts of the body and, modulate the movements of thoracic
cage and lungs accordingly through efferent nerve fibers.

25. • Efferent Pathway:
• The nerve fibers from the respiratory centers leave brainstem,
descend in spinal cord, and terminate on the motor neurons in
the anterior horn cells of cervical and thoracic segments of
spinal cord.
• From the motor neurons of spinal cord, two sets of nerve fibers
arise:
• Phrenic nerve fibers (C3 – C5) which supply the diaphragm
• The intercostal nerve fibers (T1 – T11) which supply the
external intercostal muscles

26. • Chemical control :
• The chemical regulatory mechanism adjusts ventilation in such a way that
the alveolar PCO2 is normally held constant.
• The receptors in the carotid and aortic bodies are stimulated by a rise in
the PCO2 of the arterial blood.

27. Lung Volumes and Capacities
• Lung volumes, which can be measured directly by use of a spirometer
• Lungs capacities, which are combinations of different lung volumes.
• The apparatus used to measure volumes and capacities is called a
spirometer or respirometer
• The record is called a spirogram.

28. Lung Volumes:
While at rest, a healthy adult averages 12 breaths a minute, with each inhalation
and exhalation moving about 500 mL of air into and out of the lungs. The volume
of one breath is called the tidal volume (VT).
Collectively, the conducting airways with air that does not undergo respiratory
exchange are known as the anatomic (respiratory)dead space.
By taking a very deep breath, you can inhale a good deal more than 500 mL. This
additional inhaled air, called the inspiratory reserve volume (IRV), is about
3100 mL in an average adult male and 1900 mL in an average adult
female

30. • If you inhale normally and then exhale as forcibly as possible, you
should be able to push out considerably more air in addition to the
500 mL of tidal volume. The extra 1200 mL in males and 700 mL
in females is called the expiratory reserve volume (ERV).
• The forced expiratory volume in 1 second, (FEV1) is the
volume of air that can be exhaled from the lungs in 1 second with
maximal effort following a maximal inhalation.

31. • Even aft er the expiratory reserve volume is exhaled, considerable air
remains in the lungs because the sub atmospheric intrapleural
pressure keeps the alveoli slightly inflated, and some air remains in
the noncollapsible airways. This volume, which cannot be measured
by spirometry, is called the residual volume (re-ZID-u-al) (RV) and
amounts to about 1200 mL in males and 1100 mL in females.
• If the thoracic cavity is opened, the intrapleural pressure rises to equal
the atmospheric pressure and forces out some of the residual volume.
The air remaining is called the minimal volume.

32. Lung Capacities:
• Inspiratory capacity (IC) is the sum of tidal volume and inspiratory reserve volume
(500 mL + 3100 mL = 3600 mL in males and 500mL + 1900 mL = 2400 mL in
females).
• Functional residual capacity (FRC) is the sum of residual volume and expiratory
reserve volume(1200 mL + 1200 mL = 2400 mL in males and 1100 mL + 700 mL
=1800 mL in females).
• Vital capacity (VC) is the sum of inspiratory reserve volume, tidal volume, and
expiratory reserve volume (4800 mL in males and 3100 mL in females).
• Total lung capacity (TLC) is the sum of vital capacity and residual volume (4800 mL
+ 1200 mL =6000 mL in males and 3100 mL + 1100 mL = 4200 mL in females).

33. • The minute ventilation (V)—the total volume of air inspired and
expired each minute—is tidal volume multiplied by respiratory rate. In
a typical adult at rest, minute ventilation is about 6000 mL/min (V= 12
breaths per minute × 500 mL = 6000 mL/min).
• The alveolar ventilation (VA) is the volume of air per minute that
actually reaches the respiratory zone (350 mL). Alveolar ventilation is
typically about 4200 mL/min (VA = 12 breaths per minute × 350 mL =
4200 mL/min).

34. • Transport of Oxygen and Carbon Dioxide:

35. Oxygen transport
The heme portion of haemoglobin
• 4 atoms of iron
• Each is capable of binding to a molecule of oxygen
Oxygen and Haemoglobin
• Forms oxyhaemoglobin (Hb + O2 = HbO2)
Oxygen and haemoglobin dissociation and binding factors
• The partial pressure of oxygen Po2
• Higher pressure, more binding
• Saturation
Fully oxidised – fully saturated
A mixture of Hb and HbO2 – partially saturated
Percent saturation of haemoglobin – average saturation of a molecule with oxygen
High partial pressure = more binding until full saturation

36. • Factors affecting oxygen’s affinity for hemoglobin:
1. Acidity
 Decrease in pH affinity of hemoglobin for oxygen decreases
• Dissociation curve shifts to right
• Oxygen dissociates from haemoglobin
• Bohr Shift effect
 Elevated pH affinity-Dissociation curve shifts to the left
2. Partial pressure of carbon dioxide
• Co2 can bind to Hb
• Decreased partial pressure of carbon dioxide shifts dissociation curve to the left
3. Temperature
• High temp= more dissociation of O2 from Hb
4. 2,3-Bisphosphoglycerate (BPG)
• Previously called DPG
• Decreases affinity of haemoglobin for oxygen and helps unload oxygen from haemoglobin
When combined with haemoglobin, the haemoglobin binds less tightly to oxygen

38. Carbon dioxide transport
• In a resting person, metabolism generates about 200 ml of CO2 per
minute.
• This CO2 is transported to the lungs from the tissues by the blood in
three ways-
a) As dissolved gas – about 10% of CO2 entering the blood remains
physically dissolved in plasma and carried as such.
b) As carbamino Hb- about 30% of CO2 reacts with Hb to form
carbamino Hb and is transported to the lungs

42. Manual methods : Mouth to mouth breathing

44. CARDIOPULMONARY RESUSCITATION (CPR)
• Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions
and artificial ventilation to maintain circulatory flow and oxygenation during
cardiac arrest .
7 STEPS OF CARDIOPULMONARY RESUSCITATION:
• 1. Checking the scene and the person
• 2. Call for help /assistance
• 3. Opening the airway
• 4. Checking for breathing.
• 5. Chest compressions
• 6. Delivering rescue breaths
• 7. Repeating CPR steps
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