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lec7 حسام العزاوي.د respiratory system The main function of the respiratory system is to provide oxygen to body cells for energy metabolism and to eliminate carbon dioxide, a byproduct of metabolism. Because these gases must be carried to and from the cells in the blood, the respiratory system works closely with the cardiovascular system to accomplish gas exchange . This activity has two phases: ■ External gas exchange occurs between the outside atmosphere and the blood. ■ Internal gas exchange occurs between the blood and the tissues. External exchange takes place in the lungs, located in the thoracic cavity. The remainder of the respiratory tract consists of a series of passageways that conduct air to and from the lungs. No gas exchange occurs in these regions Terminology Key Terms Normal Structure and Function adenoidsالغدانیات AD-e-noyds Lymphoid tissue located in the nasopharynx; the pharyngeal tonsils alveoli al-VĒ-ō-lī The tiny air sacs in the lungs through which gases are exchanged between the atmosphere and the blood in respiration (singular: alveolus). An alveolus, in general, is a small hollow or cavity; the term also applies to the bony socket for a tooth bronchioleشعیبة BRONG-kē-ōl One of the smaller subdivisions of the bronchial tubes (root: bronchiol) bronchusقصبة BRONG-kus One of the larger air passageways in the lungs. The bronchi begin as two branches of the trachea and then subdivide within the lungs (plural: bronchi) (root: bronch) carbon dioxide (CO2) A gas produced by energy metabolism in cells and eliminated through the lungs carbonic acid kar-BON-ik An acid formed when carbon dioxide dissolves in water; H2CO3 diaphragmالحاجز الحجاب DĪ-a-fram The dome-shaped muscle under the lungs that flattens during inspiration (root: phren/o) epiglottisالمزمار لسان ep-i-GLOT-is A leaf-shaped cartilage that covers the larynx during swallowing to prevent food from entering the trachea expiration ek-spi-RĀ-shun The act of breathing out or expelling air from the lungs; exhalation glottisالمزمار GLOT-is The opening between the vocal cords hemoglobin HĒ-mō-glō-bin The iron-containing pigment in red blood cells that transports oxygen inspiration in-spi-RĀ-shun The act of drawing air into the lungs; inhalation larynxالحنجرة LAR-inks The enlarged, superior portion of the trachea that contains the vocal cords (root: laryng/o) lung A cone-shaped, spongy respiratory organ contained within the thorax (roots: pneum, pulm) mediastinumاألمامي المنصف mē-dē-as-TĪ-num The space between the lungs together with the organs contained in this space pharynx FAR-inks The throat; a common passageway for food entering the esophagus and air entering the larynx (root: pharyng/o) عصب حجابيphrenic nerve FREN-ik The nerve that activates the diaphragm (root: phrenic/o) غشاء الجنبpleura PLŪR-a A double-layered membrane that lines the thoracic cavity (parietal pleura) and covers the lungs (visceral pleura) (root: pleur/o) حیز جنبيpleural space The thin, fluid-filled space between the two layers of the pleura; pleural cavity sinusجیب SĪ-nus A cavity or channel; the paranasal sinuses are located near the nose and drain into the nasal cavity sputumبلغم SPŪ-tum The substance released by coughing or clearing the throat; expectoration. It may contain a variety of material from the respiratory tract فاعل بالسطحsurfactant sur-FAK-tant A substance that decreases surface tension within the alveoli and eases lung expansion trachea TRĀ-kē-a The air passageway that extends from the larynx to the bronchi (root: trache/o) عظام المحارة( عظام قرینturbinate bones TUR-bi-nāt The bony projections in the nasal cavity that contain receptors for the sense of smell. Also called conchae (KON-kē); singular: concha (KONka) حبال صوتیةvocal cords VŌ-kal Membranous folds on either side of the larynx that are important in speech production. Also called vocal folds. Clinical Aspects of the Respiratory System acidosis as-i-DŌ-sis Abnormal acidity of body fluids. Respiratory acidosis is caused by abnormally high carbon dioxide levels متالزمة الضائقة التنفسیة لديacute respiratory distress syndrome (ARDS) البالغین Pulmonary edema that can lead rapidly to fatal respiratory failure; causes include trauma, aspiration into the lungs, viral pneumonia, and drug reactions; shock lung acute rhinitis rī-NĪ-tis Inflammation of the nasal mucosa with sneezing, tearing, and profuse secretion of watery mucus, as seen in the common cold alkalosis al-ka-LŌ-sis Abnormal alkalinity of body fluids. Respiratory alkalosis is caused by abnormally low carbon dioxide levels aspiration as-pi-RĀ-shun The accidental inhalation of food or other foreign material into the lungs. Also means the withdrawal of fluid from a cavity by suction asthmaربو AZ-ma A disease characterized by dyspnea and wheezing caused by spasm of the bronchial tubes or swelling of their mucous membranes atelectasisانخماص at-e-LEK-ta-sis Incomplete expansion of a lung or part of a lung; lung collapse. May be present at birth (as in respiratory distress syndrome) or be caused by bronchial obstruction or compression of lung tissue (prefix atel/o means “imperfect”) توسع القصباتbronchiectasis brong-kē-EK-ta-sis Chronic dilatation of a bronchus or bronchi bronchitis brong-KĪ-tis Inflammation of a bronchus الداء الرئوي الساد المزمنchronic obstructive pulmonary disease (COPD) Any of a group of chronic, progressive, and debilitating respiratory diseases, which includes emphysema, asthma, bronchitis, and bronchiectasis cyanosis sī-a-NŌ-sis Bluish discoloration of the skin caused by lack of oxygen in the blood (adjective: cyanotic) ضیق التنفسdyspnea disp-NĒ-a Difficult or labored breathing, sometimes with pain; “air hunger” emphysema em-fi-SĒ-ma A chronic pulmonary disease characterized by enlargement and destruction of the alveoli empyemaانتفاخ em-pī-Ē-ma Accumulation of pus in a body cavity, especially the pleural space; pyothorax نفث الدمhemoptysis hē-MOP-ti-sis The spitting of blood from the mouth or respiratory tract (ptysis means “spitting”) صدر مدمىhemothorax hē-mō-THOR-aks Presence of blood in the pleural space موه الصدرHydrothorax hī-drō-THOR-aks Presence of fluid in the pleural space hyperventilation hī-per-ven-ti-LĀ-shun Increased rate and depth of breathing; increase in the amount of air entering the alveoli الشاھوق، السعال الدیكيpertussis per-TUS-is An acute, infectious disease characterized by a cough ending in a whooping inspiration; whooping cough إراقة جنبیة،انصباب جنبيpleural effusion PLŪR-al e-FŪ-zhun Accumulation of fluid in the pleural space. The fluid may contain blood (hemothorax) or pus (pyothorax or empyema) pleurisy PLŪR-i-sē Inflammation of the pleura; pleuritis. A symptom of pleurisy is sharp pain on breathing تغبر الرئةpneumoconiosis nū-mō-kō-nē-Ō-sis Disease of the respiratory tract caused by inhalation of dust particles. Named more specifically by the type of dust inhaled, such as silicosis, anthracosis, asbestosis ذات الرئةpneumonia nū-MŌ-nē-a Inflammation of the lungs generally caused by infection. May involve the bronchioles and alveoli (bronchopneumonia) or one or more lobes of the lung (lobar pneumonia) التھاب رئويpneumonitis nū-mō-NĪ-tis Inflammation of the lungs; may be caused by infection, asthma, allergy, or inhalation of irritants استرواح الصدرpneumothorax nū-mō-THOR-aks Accumulation of air or gas in the pleural space. May result from injury or disease or may be produced artificially to collapse a lung متالزمة الضائقة التنفسیةrespiratory distress syndrome (RDS) A respiratory disorder that affects premature infants born without enough surfactant in the lungs. It is treated with respiratory support and surfactant administration متالزمة موت الرضیع المفاجئsudden infant death syndrome (SIDS) The sudden and unexplained death of an apparently healthy infant; crib death tuberculosis،درن سُل tū-ber-kū-LŌ-sis An infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis. Often involves the lungs but may involve other parts of the body as well. Diagnosis arterial blood gases(ABGs) The concentrations of gases, specifically oxygen and carbon dioxide, in arterial blood. Reported as the partial pressure (P) of the gas in arterial (a) blood, such as PaO2 or PaCO2. These measurements are important in measuring acid–base balance bronchoscope BRONG-kō-skōp An endoscope used to examine the tracheobronchial passageways. Also allows access for tissue biopsy or removal of a foreign object pulse oximetry ok-SIM-e-trē Determination of the oxygen saturation of arterial blood by means of a photoelectric apparatus (oximeter), usually placed on the finger or the ear; reported as SpO2 in percent pulmonary function tests Tests done to assess breathing, usually by spirometry spirometer spī-ROM-e-ter An apparatus used to measure breathing volumes and capacities; record of test is a spirogram thoracentesis thor-a-sen-TĒ-sis Surgical puncture of the chest for removal of air or fluids, such as may accumulate after surgery or as a result of injury, infection, or cardiovascular problems. Also called thoracocentesis . tuberculin test tū-BER-kū-lin A skin test for tuberculosis. Tuberculin (PPD), the test material made from products of the tuberculosis organism, is injected below the skin. A hard, raised lump appearing within 48 to 72 hours indicates an active or inactive TB infection. Terminology Supplementary Terms Normal Structure and Function hilum HĪ-lum An anatomic depression in an organ where vessels and nerves enter nares NĀ-rēz The external openings of the nose; the nostrils (singular: naris) nasal septum The partition that divides the nasal cavity into two parts (root sept/o means “septum”) Symptoms and Conditions anoxia an-OK-sē-a Lack or absence of oxygen in the tissues; often used incorrectly to mean hypoxia asphyxia as-FIK-sē-a Condition caused by inadequate intake of oxygen; suffocation (literally “lack of pulse”) bronchospasm BRONG-kō-spazm Narrowing of the bronchi caused by smooth muscle spasms; common in cases of asthma and bronchitis Cheyne-Stokes respiration chān stōks A repeating cycle of gradually increased and then decreased respiration followed by a period of apnea; caused by depression of the breathing centers in the brainstem; seen in cases of coma and in terminally ill patients cor pulmonale kor pul-mō-NĀ-lē Enlargement of the heart’s right ventricle caused by disease of the lungs or pulmonary blood vessels coryza kō-RĪ-za Acute inflammation of the nasal passages with profuse nasal discharge; acute rhinitis croup krūp A childhood disease usually caused by a viral infection that involves upper airway inflammation and obstruction. Croup is characterized by a barking cough, difficulty breathing, and laryngeal spasm epiglottitis ep-i-glo-TĪ-tis Inflammation of the epiglottis that may lead to upper airway obstruction. Commonly seen in croup (also spelled epiglottiditis) epistaxis ep-i-STAK-sis Hemorrhage from the nose; nosebleed (Greek -staxis means “dripping”) fremitus FREM-i-tus A vibration, especially as felt through the chest wall on palpation Kussmaul respiration KOOS-mawl Rapid and deep gasping respiration without pause; characteristic of severe acidosis pleural friction rub A sound heard on auscultation that is produced by the rubbing together of the two pleural layers; a common sign of pleurisy rales rahlz Abnormal chest sounds heard when air enters small airways or alveoli containing fluid; usually heard during inspiration; singular: rale (rahl). Also called crackles rhonchi RONG-kī Abnormal chest sounds produced in airways with accumulated fluids; more noticeable during expiration (singular: rhonchus) stridor STRĪ-dor A harsh, high-pitched sound caused by obstruction of an upper air passageway wheeze A whistling or sighing sound caused by narrowing of a respiratory passageway Disorders sleep apnea AP-nē-a Intermittent periods of breathing cessation during sleep. Central sleep apnea arises from failure of the brainstem to stimulate breathing. Obstructive sleep apnea results from airway obstruction during deep sleep, as from obesity or enlarged tonsils Diagnosis mediastinoscopy mē-dē-as-ti-NOS-kō-pē Examination of the mediastinum by means of an endoscope inserted through an incision above the sternum plethysmograph ple-THIZ-mō-graf An instrument that measures changes in gas volume and pressure during respiration thoracoscopy thor-a-KOS-kō-pē Examination of the pleural cavity through an endoscope; pleuroscopy Treatment aerosol therapy Treatment by inhalation of a drug or water in spray form continuous positive airway pressure (CPAP) Use of a mechanical respirator to maintain pressure throughout the respiratory cycle in a patient who is breathing spontaneously extubation Removal of a previously inserted tube intermittent positive pressure breathing (IPPB) Use of a ventilator to inflate the lungs at intervals under positive pressure during inhalation intermittent positive pressure ventilation (IPPV) Use of a mechanical ventilator to force air into the lungs while allowing for passive exhalation nasal cannula KAN-ū-la A two-pronged plastic device inserted into the nostrils for delivery of oxygen orthopneic position or-thop-NĒ-ik An upright or semiupright position that aids breathing positive end-expiratory pressure (PEEP) Use of a mechanical ventilator to increase the volume of gas in the lungs at the end of exhalation, thus improving gas exchange postural drainage POS-tū-ral Use of body position to drain secretions from the lungs by gravity. The patient is placed so that secretions will move passively into the larger airways for elimination Surgery adenoidectomy ad-e-noyd-EK-tō-mē Surgical removal of the adenoids intubation in-tū-BĀ-shun Insertion of a tube into a hollow organ, such as into the larynx or trachea for entrance of air. Patients may be intubated during surgery for administration of anesthesia or to maintain an airway. Endotracheal intubation may be used as an emergency measure when airways are blocked lobectomy lō-BEK-tō-mē Surgical removal of a lobe of the lung or of another organ tracheotomy trā-kē-OT-ō-mē Incision of the trachea through the neck, usually to establish an airway in cases of tracheal obstruction tracheostomy trā-kē-OS-tō-mē Surgical creation of an opening into the trachea to form an airway or to prepare for the insertion of a tube for ventilation ; also the opening thus created Terminology Abbreviations ABG(s) Arterial blood gas(es) AFB Acid-fast bacillus (usually Mycobacterium tuberculosis) ARDS Acute respiratory distress syndrome; shock lung ARF Acute respiratory failure BCG Bacillus Calmette-Guérin (tuberculosis vaccine) BS Breath sounds CF Cystic fibrosis CO2 Carbon dioxide COPD Chronic obstructive pulmonary disease CPAP Continuous positive airway pressure CXR Chest radiograph, chest x-ray DTaP Diphtheria, tetanus, pertussis (vaccine) FEV Forced expiratory volume FRC Functional residual capacity FVC Forced vital capacity IC Inspiratory capacity O2 Oxygen PaCO2 Arterial partial pressure of carbon dioxide PaO2 Arterial partial pressure of oxygen PEEP Positive end-expiratory pressure PFT Pulmonary function test(s) RDS Respiratory distress syndrome RSV Respiratory syncytial virus RV Residual volume SIDS Sudden infant death syndrome SpO2 Oxygen percent saturation TB Tuberculosis TV Tidal volume URI Upper respiratory infection VC Vital capacity