Unit VI

Respiratory System
Chapter 22

Copyright © McGraw-Hill Education. Permission required for reproduction or display. 1

Co 22
Fig. 22.1 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Nasal
cavity
Hard Posterior
palate nasal
aperture
Soft palate
Nostril
Epiglottis
Pharynx

Larynx Esophagus

Trachea Left lung

Left main
bronchus
Lobar
Right lung bronchus
Segmental
bronchus
Pleural
cavity

Pleura
(cut)

Diaphragm
Fig. 22.2 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Root

Bridge

Dorsum nasi

Nasofacial angle

Apex

Ala nasi
Naris (nostril)

Nasal septum
Philtrum
Alar nasal sulcus

(a)

Nasal bone

Lateral cartilage

Septal nasal
cartilage

Minor alar
cartilages

Major alar
cartilages
Dense connective
tissue

(b)
© McGraw-Hill Education/Joe DeGrandis, photographer
Fig. 22.3 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Frontal sinus
Cribriform plate
Nasal conchae: Auditory tube
Superior
Middle Sites of respiratory control nuclei:
Inferior Pons
Medulla oblongata
Meatuses
Nasopharynx
Hard palate Uvula
Oropharynx
Tongue

Laryngopharynx
Larynx:
Epiglottis
Vestibular fold
Vocal cord

Vertebral column
Trachea
Esophagus

(a)

Meatuses:
Frontal Superior
sinus Middle
Nasal conchae: Inferior
Superior Sphenoid sinus
Middle Posterior nasal
aperture
Inferior Pharyngeal
Vestibule tonsil
Guard hairs Auditory
Nasal septum:
tube
Naris (nostril) Perpendicular plate
Hard palate Soft palate
Upper lip Septal cartilage
Uvula
Palatine tonsil Vomer
Tongue
Lower lip Lingual tonsil
Pharynx:
Mandible Epiglottis Nasopharynx

Oropharynx

Laryngopharynx
Vestibular fold
Vocal cord
Larynx
Trachea
Esophagus
(b) (c)
a: © McGraw-Hill Education/Rebecca Gray, photographer/Don Kincaid, dissections
Fig. 22.4

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Epiglottic Epiglottis
cartilage Hyoid bone
Hyoid bone Epiglottic cartilage

Thyrohyoid ligament
Fat pad

Thyroid cartilage
Thyroid cartilage
Laryngeal prominence
Cuneiform cartilage

Arytenoid cartilage Corniculate cartilage

Vestibular fold
Cricoid cartilage Vocal cord

Cricotracheal Arytenoid cartilage

ligament
Arytenoid muscle

Cricoid cartilage
Trachea
Tracheal cartilage

(a) Anterior (b) Posterior (c) Median

Fig. 22.5
Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Anterior
Epiglottis
Glottis

Vestibular fold

Vocal cord
Trachea

Corniculate
cartilage

(a) Posterior

Main
bronchi

Carina

Tracheal
mucosa

(b)
a: © CNRI/Phototake; b: © BSIP/Newscom
Fig. 22.6
Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Adduction of vocal cords Abduction of vocal cords

Thyroid cartilage

Cricoid cartilage
Anterior
Vocal cord

Lateral
cricoarytenoid muscle

Arytenoid cartilage Posterior

Corniculate cartilage

Posterior
cricoarytenoid muscle
(a) (c)

Base of tongue

Epiglottis

Vestibular fold
Vocal cord

Glottis
Corniculate
cartilage
(b) (d)
Fig. 22.7
Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Mucus
Thyroid Mucociliary
cartilage escalator
Larynx
Cricoid Particles
cartilage of debris
Epithelium:
Goblet cell
Ciliated cell

Mucous gland

Trachea Cartilage

Chondrocytes

(b)

Carina Trachealis
muscle

Lobar Hyaline
bronchi Main cartilage ring
bronchi Lumen

Segmental Mucosa
bronchi
Mucous gland

Perichondrium
(a) (c)
Fig. 22.8 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Cilia

Goblet cell

4 µm
© Prof. P.M. Motta/Univ. “La Sapienza,” Rome/Science Source
Fig. 22.9 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Larynx:
Thyroid cartilage

Cricoid cartilage

Trachea
Apex of lung Main bronchi

Superior lobe

Superior lobar
bronchus
Costal
Horizontal fissure surface

Middle lobar
bronchus Superior
lobe
Middle lobe
Inferior lobar Cardiac
bronchus impression
Mediastinal
Oblique fissure
surfaces
Inferior lobe
Inferior lobe
Oblique
Base of lung fissure
(a) Anterior view

Apex

Superior lobe

Pulmonary Lobar bronchi

arteries

Pulmonary
veins

Hilum
Middle lobe Pulmonary
ligament
Inferior lobe

Diaphragmatic
surface
(b) Mediastinal surface, right lung
Fig. 22.10

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Anterior

Breast

Sternum

Pericardial Ribs
cavity
Heart

Left lung Right lung

Visceral
pleura
Aorta
Pleural cavity Vertebra
Parietal Spinal cord
pleura

Posterior
© McGraw-Hill Education/Rebecca Gray, photographer/Don Kincaid, dissections
Fig. 22.11

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Alveoli

Bronchial
cartilage

Bronchial mucosa
Bronchiole
Bronchial smooth
muscle
Segmental
(tertiary) bronchus
Alveoli

Branches of
Pulmonary
artery

(a) 1 mm (b) 1 mm
a: © Microscape/SPL/Science Source; b: © Biophoto Associates/Science Source
Fig. 22.12

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Respiratory membrane
Capillary endothelial cell
Bronchiole
Fluid with surfactant
Pulmonary arteriole
Squamous alveolar cell
Pulmonary venule
Lymphocyte

Alveoli
Alveolar sac

(b)
Great Alveolar
Capillary alveolar macrophage
networks cell
around
Terminal alveoli
bronchiole

Respiratory Air Respiratory membrane:

bronchiole
Squamous alveolar cell
CO2
Shared basement membrane
O2 Capillary endothelial cell

Blood
(a)

(c)
Fig. 22.13 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Inspiration

Sternocleidomastoid
(elevates sternum)

Scalenes
(fix or elevate ribs 1–2)

External intercostals
(elevate ribs 2–12,
widen thoracic cavity)

Pectoralis minor (cut)

(elevates ribs 3–5) Forced expiration

Internal intercostals,
interosseous part
Internal intercostals, (depress ribs 1–11,
intercartilaginous part narrow thoracic cavity)
(aid in elevating ribs)
Diaphragm
(ascends and
Diaphragm reduces depth
(descends and of thoracic cavity)
increases depth Rectus abdominis
of thoracic cavity) (depresses lower ribs,
pushes diaphragm upward
by compressing
abdominal organs)

External abdominal oblique

(same effects as
rectus abdominis)
Fig. 22.14 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Key
Inputs to respiratory
centers of medulla
Outputs to spinal centers
and respiratory muscles

Output from
hypothalamus,
limbic system, and
higher brain centers

Pons

Pontine respiratory
group (PRG)

Dorsal respiratory
group (DRG)
Central chemoreceptors
Glossopharyngeal n.
Ventral respiratory
Vagus n. group (VRG)
Medulla oblongata

Intercostal
nn.

Spinal integrating
centers
Phrenic n.

Diaphragm and intercostal muscles

Accessory muscles
of respiration
Fig. 22.15 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Sensory nerve fiber

in glossopharyngeal Carotid body
nerve

Sensory nerve fibers

in vagus nerves

Common carotid artery

Aortic bodies

Aorta

Heart
Table 22.1
Fig. 22.16 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

No airflow

Pleural cavity Intrapulmonary pressure 0 cm H2O

Diaphragm Intrapleural pressure –5 cm H2O

Ribs swing upward 1 At rest, atmospheric and

like bucket handles intrapulmonary pressures
during inspiration. are equal, and there is
no airflow. Ribs swing downward
like bucket handles
during expiration.

2 Inspiration 4 Pause

Airflow
Airflow

Intrapleural
Intrapleural pressure –5 cm H2O
pressure –8 cm H2O
Intrapulmonary
Intrapulmonary pressure +1 cm H2O
pressure –1 cm H2O

Diaphragm rises
Diaphragm flattens 3 Expiration

Rib

Rib Rib

Sternum
Rib Sternum Sternum
Sternum
Ribs elevated, thoracic Sternum swings up, Ribs depressed, thoracic Sternum swings down,
cavity expands laterally thoracic cavity expands cavity narrows thoracic cavity contracts
anteriorly posteriorly

2 In inspiration, the thoracic cavity expands laterally, vertically, 3 In expiration, the thoracic cavity contracts in all three directions;
and anteriorly; intrapulmonary pressure drops 1 cm H2O below intrapulmonary pressure rises 1 cm H2O above atmospheric
atmospheric pressure, and air flows into the lungs. pressure, and air flows out of the lungs.
Fig. 22.17 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

(a)
Maximum possible inspiration
6,000

5,000

Inspiratory
Vital capacity Inspiratory
4,000 reserve volume capacity
Lung volume (mL)

Tidal
volume
3,000
Total lung capacity

2,000 Expiratory
reserve volume

1,000 Functional residual

Maximum voluntary Residual capacity
expiration volume

0
(b)
a: © BSIP/Science Source
Table 22.2
Table 22.3
Table 22.4
Fig. 22.18 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Air Air

Time

Blood Blood

Initial state Equilibrium state

(a) Oxygen

Air Air

Time

Blood Blood

Initial state Equilibrium state

(b) Carbon dioxide

Fig. 22.19 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Expired air Inspired air

Po2 116 mm Hg Po2 159 mm Hg
Pco2 32 mm Hg Pco2 0.3 mm Hg

Alveolar
gas exchange
Alveolar air
O2 loading Po2 104 mm Hg
Pco2 40 mm Hg
CO2 unloading
CO2 O2

Gas transport
Pulmonary circuit
O2 carried
from alveoli
to systemic
tissues
Deoxygenated
CO2 carried blood Oxygenated blood
from systemic Po2 40 mm Hg Po2 95 mm Hg
tissues to Pco2 46 mm Hg Pco2 40 mm Hg
alveoli

Systemic circuit

CO2 O2
Systemic
gas exchange

O2 unloading
CO2 loading
Tissue fluid
Po2 40 mm Hg
Pco2 46 mm Hg
Fig. 22.20
Copyright © McGraw-Hill Education. Permission required for reproduction or display.
2,500
Air in hyperbaric chamber
(100% O2 at 3 atm)

Ambient PO2 (mm Hg)

Air at sea level

(1 atm)

158

Redu
110 ced g
radie
nt, slo
wer O
2 diffus
ion
Air at 3,000 m
(10,000 ft)
40

Atmosphere Venous blood

arriving at
alveoli
Pressure gradient of O2
 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Fig. 22.21

(a) Normal

Fluid and
blood cells
in alveoli

Alveolar
walls
thickened
by edema

(b) Pneumonia

Confluent
alveoli

(c) Emphysema
Fig. 22.23 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

100 20

Percentage O2 saturation of hemoglobin

22%
80 15

mL O2/dL of blood
60
10

40

5
20

0
0 20 40 60 80 100

Systemic tissues Alveoli

Partial pressure of O2 (Po2) in mm Hg
Fig. 22.24

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Respiring tissue Capillary blood

7%
CO2 Dissolved CO2 gas
CO2 + plasma protein Carbamino compounds

23%
CO2 CO2 + Hb HbCO2 Chloride shift
Cl–
HCO3–

HCO3– – Cl–
Cl– antiport
70%
CAH
CO2 CO2 + H2O H2CO3 HCO3 – + H+

98.5%
O2 O2 + HHb HbO2 + H+

1.5%
O2 Dissolved O2 gas Key
Hb Hemoglobin
HbCO2 Carbaminohemoglobin
HbO2 Oxyhemoglobin
HHb Deoxyhemoglobin
CAH Carbonic anhydrase
Fig. 22.25 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Alveolar air Respiratory membrane Capillary blood

7%
CO2 Dissolved CO2 gas

CO2 + plasma protein Carbamino compounds

Chloride shift
23% Cl–
CO2 CO2 + Hb HbCO2 HCO3–

HCO3– – Cl–
Cl– antiport
70%
CAH
CO2 CO2 + H2O H2CO3 HCO3– + H+

98.5%
O2 O2 + HHb HbO2 + H+

1.5%
O2 Dissolved O2 gas
Key
Hb Hemoglobin
HbCO2 Carbaminohemoglobin
HbO2 Oxyhemoglobin
HHb Deoxyhemoglobin
CAH Carbonic anhydrase
Fig. 22.26 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
100
10°C

Percentage saturation of hemoglobin

90 20°C
38°C
80 43°C
70
60
Normal body
50
temperature
40
30
20
10
0
0 20 40 60 80 100 120
Po2 (mm Hg)
(a) Effect of temperature

100
Percentage saturation of hemoglobin

90 pH 7.60
80
pH 7.40
70 (normal blood pH)
60
pH 7.20
50
40
30
20
10
0
0 20 40 60 80 100 120
Po2 (mm Hg)
(b) Effect of pH
Table 22.5
Fig. 22.27
Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Tumors

(a) Healthy lung, mediastinal surface (b) Smoker’s lung with carcinoma
a: © McGraw-Hill Education/Dennis Strete, photographer; b: © Biophoto Associates/Science Source
Page 882 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
All SYSTEMS
Delivers oxygen to the tissues and removes their carbon dioxide; maintains proper acid–base balance in the tissues

INTEGUMENTARY SYSTEM
Respiratory disorders can cause CIRCULATORY SYSTEM
such skin discolorations as Thoracic pump aids venous return of blood;
the cyanosis of hypoxemia or proplatelets break up into platelets in the lungs;
the cherry-red color of carbon angiotensin II, produced in the lungs, stimulates
monoxide poisoning. vasoconstriction and helps regulate blood volume
and pressure; respiration strongly influences blood
pH; obstruction of pulmonary circulation can lead
to right-sided heart failure; lungs filter blood clots
and emboli and prevent them from obstructing
vital arteries elsewhere.

SKELETAL SYSTEM
Any respiratory disorder that
causes hypoxemia stimulates LYMPHATIC/
accelerated erythropoiesis in the IMMUNE SYSTEM
red bone marrow. Thoracic pump promotes
lymph flow and its return to the
bloodstream.

URINARY SYSTEM
Valsalva maneuver aids in
MUSCULAR SYSTEM
Acid–base imbalances of urination; urinary and respiratory
respiratory origin can affect systems collaborate in acid–
base balance and compensate
neuromuscular function.
for each other’s deficiencies
in maintaining normal pH;
hypoxemia stimulates kidneys to
secrete erythropoietin.

NERVOUS SYSTEM DIGESTIVE SYSTEM

Respiration affects the pH of the Valsalva maneuver aids in
cerebrospinal fluid, which in turn defecation.
affects neural function with effects
ranging from hyperexcitability to
depressed excitability and coma.

ENDOCRINE SYSTEM REPRODUCTIVE SYSTEM

Lungs produce angiotensin- Valsalva maneuver aids in
converting enzyme (ACE), which childbirth.
converts angiotensin I to the
hormone angiotensin II; hypoxemia
stimulates secretion of
erythropoietin.

left (1): © iconogenic/Getty Images RF’ left (2): © U.H.B. Trust/Tony Stone Images/Getty Images; left (3): © angelhell/Getty Images RF; left (3): © angelhell/Getty Images RF;
left (4): © Monika Wisniewska/Getty Images RF; right (1): © Russell Kightley/Science Source; right (2): © Mediscan/Alamy; right (3): © Medical Body
Scans/Science Source; right (4): © Eraxion/Getty Images RF