Pulmonary Physiology

by Levitzky, Michael G., Ph.D.

• ISBN13: 9780071345439
• ISBN10: 0071345434
• Edition: 5th
• Format: Paperback
• Copyright: 1999-03-31
• Publisher: McGraw-Hill

Summary

Provides a solid background in the structure and function of the respiratory system which is essential for the understanding of clinical medicine. The book utilizes clear, simple illustrations to stress concepts rather than facts, which helps foster understanding rather than memorization. Each chapter clearly states the learning objectives, so users will know what they are expected to learn before reading a chapter, thereby encourage self-instruction. Lastly, study questions allow the reader to test their understanding of the key concepts presented, and an extensive listing of up-to-date references is included for further reading.

Table of Contents

Preface	xiii
Function and Structure of the respiratory system	1	(12)
Objectives	1	(1)
Functions of the Respiratory System	2	(2)
Gas Exchange	2	(1)
Other Functions	2	(2)
Structure of the Respiratory System	4	(9)
The Alveolar-Capillary Unit	4	(3)
The Airways	7	(3)
The Muscles of Respiration and the Chest Wall	10	(1)
The Central Nervous System and the Neural Pathways	11	(2)
Mechanics of Breathing	13	(42)
Objectives	13	(1)
Generation of a Pressure Gradient Between Atmosphere and Alveoli	14	(7)
Passive Expansion of Alveoli	14	(1)
Negative Intrapleural Pressure	14	(1)
The Muscles of Respiration	15	(5)
Summary of the Events Occurring During the Course of a Breath	20	(1)
Pressure-Volume Relationships in the Respiratory System	21	(11)
Compliance of the Lung and the Chest Wall	23	(3)
Elastic Recoil of the Lung	26	(2)
Pulmonary Surfactant	28	(3)
Alveolar Interdependence	31	(1)
Interaction of Lung and Chest Wall: The Static Pressure-Volume Curve	32	(2)
Airways Resistance	34	(19)
Laminar, Turbulent, and Transitional Flow	35	(3)
Distribution of Airways Resistance	38	(1)
Control of Bronchial Smooth Muscle	38	(1)
Lung Volume and Airways Resistance	39	(1)
Dynamic Compression of Airways	40	(3)
Assessment of Airways Resistance	43	(7)
Dynamic Compliance	50	(3)
The Work of Breathing	53	(2)
Elastic Work	53	(1)
Resistive Work	54	(1)
Alveolar Ventilation	55	(30)
Objectives	55	(1)
The Lung Volumes	56	(2)
The Standard Lung Volumes and Capacities	56	(2)
Measurement of the Lung Volumes	58	(8)
Spirometry	60	(2)
Measurement of Lung Volumes Not Measurable with Spirometry	62	(4)
Anatomic Dead Space and Alveolar Ventilation	66	(2)
Measurement of Alveolar Ventilation	68	(4)
Measurement of Anatomic Dead Space	68	(1)
Physiologic Dead Space: The Bohr Equation	69	(3)
Alveolar Ventilation and Alveolar Oxygen and Carbon Dioxide Levels	72	(5)
Partial Pressures of Respiratory Gases	73	(2)
Alveolar Ventilation and Carbon Dioxide	75	(1)
Alveolar Ventilation and Oxygen	75	(2)
Regional Distribution of Alveolar Ventilation	77	(4)
Demonstration of Differences Between Dependent and Nondependent Regions	77	(1)
Explanation for Differences in Regional Alveolar Ventilation	78	(2)
Alterations of Distribution at Different Lung Volumes	80	(1)
The Closing Volume	81	(2)
The Effects of Aging	83	(2)
Blood Flow To The Lung	85	(28)
Objectives	85	(1)
The Bronchial Circulation	86	(2)
The Functional Anatomy of the Pulmonary Circulation	88	(4)
Determination of Pulmonary Vascular Resistance	89	(1)
Distribution of Pulmonary Vascular Resistance	90	(1)
Consequences of Differences in Pressure Between the Systemic and Pulmonary Circulations	90	(2)
Pulmonary Vascular Resistance	92	(7)
The Concept of a Transmural Pressure Gradient	92	(1)
Lung Volume and Pulmonary Vascular Resistance	92	(3)
Recruitment and Distensibility	95	(3)
Control of Pulmonary Vascular Smooth Muscle	98	(1)
The Regional Distribution of Pulmonary Blood Flow: The Zones of the Lung	99	(7)
Measurement of Total Pulmonary Blood Flow	100	(2)
Determination of Regional Pulmonary Blood Flow	102	(1)
The Regional Distribution of Pulmonary Blood Flow	102	(2)
The Interaction of Gravity and Extravascular Pressure: The Zones of the Lung	104	(2)
Hypoxic Pulmonary Vasoconstriction	106	(1)
Mechanism of Hypoxic Pulmonary Vasoconstriction	106	(1)
Physiologic Function of Hypoxic Pulmonary Vasoconstriction	107	(1)
Pulmonary Edema	107	(6)
The Factors Influencing Liquid Movement in the Pulmonary Capillaries	107	(1)
Lymphatic Drainage of the Lung	108	(1)
Conditions That May Lead to Pulmonary Edema	109	(4)
Ventilation-Perfusion Relationships	113	(18)
Objectives	113	(1)
The Concept of Matching Ventilation and Perfusion	113	(1)
Consequences of High and Low VA/QC	114	(3)
Testing for Nonuniform Distribution of Inspired Gas and Pulmonary Blood Flow	117	(9)
Testing for Nonuniform Distribution of Inspired Gas	117	(3)
Testing for Nonuniform Distribution of Pulmonary Blood Flow	120	(1)
Testing for Mismatched Ventilation and Perfusion	120	(6)
Regional VA/QC Differences and Their Consequences in the Lung	126	(5)
Regional Differences in the Ventilation-Perfusion Ratios in the Upright Lung	127	(1)
The Consequences of Regional Ventilation-Perfusion Differences in the Normal Upright Lung	128	(3)
Diffusion of Gases	131	(12)
Objectives	131	(1)
Fick's Law for Diffusion	132	(2)
Limitations of Gas Transfer	134	(2)
Diffusion Limitation	134	(2)
Perfusion Limitation	136	(1)
Diffusion of Oxygen	136	(1)
Diffusion of Carbon Dioxide	137	(2)
Measurement of Diffusing Capacity	139	(4)
The Transport of Oxygen And Carbon Dioxide in The Blood	143	(22)
Objectives	143	(1)
Transport of Oxygen by the Blood	144	(2)
Physically Dissolved	144	(1)
Chemically Combined with Hemoglobin	145	(1)
Chemical Reaction of Oxygen and Hemoglobin	146	(1)
Hemoglobin and the Physiologic Implications of the Oxyhemoglobin Dissociation Curve	146	(4)
The Oxyhemoglobin Dissociation Curve	146	(4)
Influences on the Oxyhemoglobin Dissociation Curve	150	(9)
Effects of pH and PCO2	150	(1)
Effects of Temperature	151	(1)
Effects of 2,3-BPG	151	(1)
Physiologic Consequences of the Effects of Temperature, pH, PCO2, and 2,3-BPG	151	(3)
Other Factors Affecting Oxygen Transport	154	(5)
Transport of Carbon Dioxide by the Blood	159	(2)
Physically Dissolved	159	(1)
As Carbamino Compounds	160	(1)
As Bicarbonate	160	(1)
The Carbon Dioxide Dissociation Curve	161	(1)
The Bohr and Haldane Effects Explained	161	(4)
The Regulation of Acid-Base Status	165	(24)
Objectives	165	(1)
The Chemistry of Acids, Bases, and Buffers	166	(2)
The Quantification of Acidity	166	(1)
The Importance of Body pH Regulation	167	(1)
Sources of Acids in the Body	168	(1)
Buffer Systems of the Human Body	168	(6)
Bicarbonate	170	(2)
Phosphate	172	(1)
Proteins	173	(1)
Buffers of the Interstitial Fluid	174	(1)
Bone	174	(1)
Intracellular Buffering	174	(1)
Acidosis and Alkalosis	174	(4)
Respiratory Acidosis	174	(2)
Respiratory Alkalosis	176	(1)
Metabolic Acidosis	177	(1)
Metabolic Alkalosis	178	(1)
Respiratory and Renal Compensatory Mechanisms	178	(3)
Respiratory Compensatory Mechanisms	178	(1)
Renal Compensatory Mechanisms	179	(2)
Summary of Renal and Respiratory Contributions to Acid-Base Balance	181	(1)
Clinical Interpretation of Blood Gases and Acid-Base Status	181	(2)
Base Excess	182	(1)
Anion Gap	183	(1)
The Causes of Hypoxia	183	(6)
Hypoxic Hypoxia	184	(2)
Hypoperfusion Hypoxia	186	(1)
Histotoxic Hypoxia	187	(1)
Other Causes of Hypoxia	187	(1)
The Effects of Hypoxia	187	(2)
The Control of Breathing	189	(28)
Objectives	189	(1)
The Generation of Spontaneous Rhythmicity	190	(1)
The Medullary Respiratory Center	191	(2)
The Dorsal Respiratory Group	191	(2)
The Ventral Respiratory Group	193	(1)
The ``Apneustic Center''	193	(1)
The Pontine Respiratory Group	194	(1)
Spinal Pathways	194	(1)
Reflex Mechanisms of Respiratory Control	195	(7)
Respiratory Reflexes Arising from Pulmonary Stretch Receptors	195	(4)
Respiratory Reflexes Arising from Receptors in the Airways and the Lungs	199	(1)
Respiratory Reflexes Arising from Pulmonary Vascular Receptors (J Receptors)	199	(2)
Respiratory Reflexes Arising from the Cardiovascular System	201	(1)
Respiratory Reflexes Arising from Muscles and Tendons	201	(1)
Reflex Respiratory Responses to Pain	202	(1)
Influences of Higher Centers	202	(1)
The Response to Carbon Dioxide	202	(7)
Peripheral Chemoreceptors	207	(1)
Central Chemoreceptors	207	(2)
The Response to Hydrogen Ions	209	(1)
The Response to Hypoxia	210	(2)
The Response to Exercise	212	(5)
Nonrespiratory Functions of The Lung	217	(14)
Objectives	217	(1)
Pulmonary Defense Mechanisms	217	(6)
Air-Conditioning	218	(1)
Olfaction	218	(1)
Filtration and Removal of Inspired Particles	218	(5)
Nonrespiratory Functions of the Pulmonary Circulation	223	(3)
Reservoir for the Left Ventricle	223	(1)
The Pulmonary Circulation as a Filter	224	(2)
Fluid Exchange and Drug Absorption	226	(1)
Metabolic Functions of the Lung	226	(5)
Metabolism of Vasoactive Substances	227	(1)
Formation and Release of Chemical Substances for Local Use	228	(1)
Formation and Release into the Blood of Substances Produced by Lung Cells	229	(1)
Other Metabolic Functions	229	(2)
The Respiratory System Under Stress	231	(22)
Objectives	231	(1)
Exercise and the Respiratory System	231	(7)
Acute Effects	232	(4)
Training Effects	236	(2)
Altitude and Acclimatization	238	(6)
Acute Effects	239	(3)
Acclimatization	242	(2)
Diving and the Respiratory System	244	(9)
Physical Principles	244	(1)
Effects of Immersion up to the Neck	245	(1)
Breath-Hold Diving	246	(1)
The Use of Underwater Breathing Apparatus	247	(6)
STUDY QUESTIONS	253	(22)
APPENDIX	275	(4)
I. Symbols Used in Respiratory Physiology	275	(1)
II. The Laws Governing the Behavior of Gases	275	(1)
III. Frequently Used Equations	276	(1)
IV. Pulmonary Function Test Decision Tree	277	(1)
V. Table of Normal Respiratory and Circulatory Values	278	(1)
Suggested Readings	279	(14)
Index	293