introduction and investigations to respiratory system

1. INTRODUCTION & INVESTIGATIONS
TO RESPIRATORY DISEASES
Dr. Firoz A Hakkim. MBBS , MD
Dept. Of Pulmonary Medicine
K S Hegde Medical Academy

2. Human respiratory system--
That organ of body which participate in respiration
known as respiratory organ and that system which
participate known as respiratory system.
The human respiratory system can be divided into two
group stracturally.As --
* The upper respiratory tract– Nose, nasal
cavity,sinuses,pharynx.
* The lower respiratory tract-- Larynx, trachea,
bronchial tree,lungs.

3. .
And the organs of the respiratory tract can be divided
into two groups functionally.
* The conducting portion--
system of interconnecting cavities and tubes that
conduct air into the lungs. nose, pharynx, trachea,
bronchi.
* The respiratory portion—
system where the exchange of respiratory gasses
occurs.
respiratory bronchioles,alveolary duct,alveoli.

4. .

5. Summary of function-
Nose/nesal cavity– warms,moistens and fiters air it is
inhaled.

6. Pharynx(Throat)-
Passage way for air,leads to trachea.

7. Larynx-
The voice box,where vocal chords are located.

8. Trachea(windpipe)-
Tube from pharynx to bronchi rings of cartilage provide
stracture,keep the windpipe open. trachea lined with fine
hairs called cilia which filter air before it reaches the
lungs.

9. Bronchi-
Two branches at the end of the trachea,each lead to a
lungs.

10. Bronchioles-
A network of smaller branches leading from the bronchi
into the lungs tissue and ultimetly to lungs sacs

11. alveoli
The functional respiratory units in the lungs where
gases(o2 and co2) are exchanged(enter and exit the
blood stream)

12. The Bronchopulmonary segments are the
anatomic structural and functional unit of lung
parenchyma, each ventilated by a
segmental/tertiary bronchus
Bronchopulmonary segments

14. RIGHT LUNG BRONCHOPULMONARY
SEGMENTS
Upper lobe Apical
anterior
posterior
Middle lobe medial
lateral
Lower lobe superior
Medial basal
Anterior basal
Lateral basal
Posterior basal

15. LEFT LUNG BRONCHOPULMONARY
SEGMENTS
Upper lobe apical
anterior
posterior
Superior lingular
Inferior lingular
Lower lobe superior
Medial basal
Anterior basal
Lateral basal
Posterior basal

17. Gaseous exchange--
a) In between blood vessels and lungs.

18. .
b) In between blood vessels and body tissue –

19. Gaseous transport-
Main function of blood is to transport the gases in
diffirent form.
Transport of o2 -Most o2 is transported by Hb(red
pigment protein in erythrocytes),(97%)
o2 combine with hemoglobin to form
oxyhemoglobin.As—
Hb + o2 Hbo2
A small amount of o2 is transported in solution in the
blood plasma(3%) and other body fluid.

21. Transport of co2 --
Most co2 is transported as bicarbonate ions.

First co2 bind with water to form carbonic acid.
As- CO2 + H2O H2CO3
Then carbolic acid dissosiates to form hydrogen and
bicarbonate ions.
As-- H2CO3 H+ + HCO3
−
A small amount of co2 is transported by the hemoglobin
molecules in the form of carbaminohemoglobin(HbCO3).
Co2 +Hb HbCO3 (23%)

22. .

23. •Removal of inhaled foreign particles and infectious organisms
•Olfaction (sensation of smell)
•Warming and humidification of air (losing excessive heat)
•Phonation
•Filtration of blood at the pulmonary capillaries
•Acting as a volume reservoir of blood
•Metabolic functions of the pulmonary tissue
NON RESPIRATORY FUNCTIONS OF LUNG

25. Investigations of Respiratory
System

26. A- Imaging
- Plain CXR
A PA film provides information on the lung fields ,
heart ,mediastinum , vascular structures and the
thorathic cage. additional information can be
obtained from a lateral film.

28. • CT scan
It is superior to CXR in determining the position and
size of a pulmonary lesion and whether calcification
or cavitations is present.
It is now routinely used in the assessment of patients
with suspected lung cancer and facilitate guided
percutaneous needle biopsy.
HRCT (high resolution), that uses thin section to
provide a detail assessment of pulmonary
parenchymal diseases
( interstitial lung disease , bronchiectasis)

31. • Ultra sound of chest cavity;
is sensitive to detect plural effusion , may also be used
to improve the diagnostic field of plural biopsy.

33. •Ventilation – perfusion scan;
the main value of this technique is to detect
pulmonary thrombi or embolism, a filling defect in
the perfusion scan accompanied by preserved
ventilation is highly suggestive of recent PE.

35. • Positron Emission Tomography PET scan;
In new technology to investigate pulmonary nodules ,
staging of mediastinal lymph nodes and distal
metastasis.

37. • CT- pulmonary angiography
Is widely available and gold standard to diagnose
PE.

39. B- Endoscopic Examinations;
• Laryngoscopy; larynx may be inspected directly with
a mirror or indirectly with a laryngoscope.

41. • Bronchoscopy;
The trachea , large bronchi and lung segments
can all be inspected by either flexible or rigid
bronchoscope.
Diagnostic indication of flexible bronchoscopy;
- Suspected cases of Lung ca,
- slowly resolving pneumonia,
- pneumonia in the immunocompramised
patients,
- interstitial lung disease, and
- collecting lavage for AFB and culture in
suspected cases of TB , with –ve sputum.

43. • Mediastinoscopy;
Through a small incision at the supra sternal notch
under GA, to get an access to the mediastinum.

45. - Other investigations
• Plural aspiration and biopsy.
• Sputum examination , for microbiological ( AFB,
Culture, Gram stain ) and cytological
examinations
• Pulse oximetry
Allow a non invasive assessment of peripheral O2
saturation, it provides a useful tool for
monitoring those who are acutely ill or at risk of
deterioration.

49. • Peak expiratory flow rate (PEF).
Is measured by a maximum forced expiration through a
peak flow meter , it should be monitored regularly in
asthmatic patients monitor response to therapy and
disease control.

51. • Arterial blood gas analysis
It is heparinized blood taken from , the radial ,
brachial and femoral arteries to check, PH,
PaO2, PaCO2 and HCO3.
Type I respiratory failure; PaO2 < 8Kpa , PaCO2
either Normal or reduced.( hypoxia only), PH is
normal.
Type II respiratory failure ; PaO2 < 8Kpa , PaCO2
>6Kpa
( hypoxia and hypercapnia), PH could be normal ,
high or low.

53. • Pulmonary Function Tests.
Are used to aid diagnosis, assess functional impairments
and monitor treatment or progression of diseases.
Abbreviations used in RFT
FEV1 forced expiratory volume in 1 second
FVC forced vital capacity
VC vital capacity
TLC total lung capacity
FRC function residual capacity
RV residual volume
TLco Gas transfer factor for carbon monoxide
Kco Gas transfer per unit lung volume.

55. • FEV1 is disproportionately reduced in obstructive lung
disease ( asthma, COPD, bronchial obstruction) and the
ratio of FEV1/ VC will be <70%. When there is an airflow
obstruction the test should be repeated following
administration of inhaled or nebulised B2 agonist
( salbutamol) to see the reversibility to normal or >15%
that would give the diagnosis of asthma .
FEV1 and VC will both reduce in restrictive lung disease
(Pulmonary Fibrosis) that will make the FEV1/VC ratio ,
>80%.

58. Interesting facts about respiratory system--
About half a liter of water /day is lost through breathing.
Yawning bring more O2 to the lungs .
Our right lungs is larger then left lungs.
We breathe 13 pints of air every minute.
People under 30 take in double the amount of O2 in
comparison to someone who’s 80 years old.