Module-3

Lungs
The lungs are the foundational organs of the respiratory system, whose most basic function is to
facilitate gas exchange from the environment into the bloodstream.
Human being have two lungs, the left lung and the right lung. The left lung is slightly smaller
and give room (accommodation ) for the heart.

The lungs are located on either side of the breastbone in the chest cavity and are divided into five
main sections (lobes). The lungs are responsible for removing carbon dioxide from the blood and
adding oxygen to it. The heart and lungs work together

Lungs as Purification System

 Filtration: The nose and mouth serve as a first line of defense against harmful
substances in the air such as dust, dirt and bacteria. The tiny hairs in the nose called
cilia and the mucus produced by the respiratory system trap these substances and
prevent them from entering the lungs.
 Moisturization: The air is also humidified as it passes over the moist lining of the
respiratory tract, which helps to keep the airways moist and prevent them from drying
out.

3.1.1 Architecture of Lungs as Purification System

  Trachea: It is a long U-Shaped tube connects larynx & lungs. It is also called as
windpipe. It is lined with cilia (hair like structure) and mucus-secreting glands that
help to filter out harmful substances and trap them in the mucus.
 Bronchi: The trachea branches into two main bronchi..Bronchi is the plural form of
the bronchus. The left bronchus carries air to left lung & The right bronchus carries air
to right lung.
 Bronchioles: Bronchi branches into smaller and smaller passageways. These smallest
passageways/airways called bronchioles. The bronchioles are smaller airways that
eventually lead to the alveoli.
 Alveoli (al·vee·oh·lai): They are tiny air sacs that function as basic respiratory unit.
The alveoli are the center of your respiratory system's gas exchange.
 Diaphragm: The diaphragm is a muscle that helps you inhale & exhale. This thin
dome shaped muscles sits below the lungs & heart.
 Pleura membrane: Its function is to allow optimal expansion & contraction of the
lungs.
Gas Exchange: Once the air reaches the alveoli, the gas exchange process occurs, where
oxygen diffuses across the thin alveolar and capillary walls into the bloodstream, and carbon
dioxide diffuses in the opposite direction, from the bloodstream into the alveoli to be exhaled.
This process ensures that the bloodstream is supplied with fresh, oxygen-rich air, while waste
carbon dioxide is removed from the body.
 Gas exchange takes place in the millions of alveoli in the lungs and the capillaries that
envelop them.

.This process is known as diffusion and occurs due to differences in partial pressures of
oxygen and carbon dioxide.
 Oxygen Diffusion: The partial pressure of oxygen in the air in th ealveoli is higher
than the partial pressure of oxygen in the bloodstream. This difference creates a
gradient that causes oxygen to diffuse from the alveoli into the bloods stream, where it
binds to hemoglobin of red blood cells to form oxyhemoglobin.
 Carbon Dioxide Diffusion: The partial pressure of carbon dioxide in the bloodstream
is higher than the partial pressure of carbon dioxide in the air in the alveoli. This
difference creates a gradient that causes carbon dioxide to diffuse from the bloodstream
into the alveoli, where it is exhaled.
 Note: Gas molecules move down a pressure gradient; in other words, gas moves from a
region of high pressure to a region of low pressure. The partial pressure of oxygen is
high in the alveoli and low in the blood of the pulmonary capillaries.

Spirometry: is the most common type of pulmonary function or breathing test. This test
measures how much air you can breathe in and out of your lungs, as well as how easily and fast
you can the blow the air out of your lungs. Your doctor may order spirometry if you have
wheezing, shortness of breath, or a cough.

3.1.1 Spirometry
Spirometry is the most common type of pulmonary function or breathing test, that
measures the function of the lungs by measuring the amount and flow rate of air that can be
exhaled. The test is commonly used to diagnose lung conditions such as asthma, chronic
obstructive pulmonary disease (COPD), and interstitial lung disease.
 Principle: The principle behind spirometry is to measure the volume of air that can be exhaled
from the lungs in a given time period. By measuring the volume of air exhaled.
Working: A device that consists of a mouth piece, it help you breathe out only through the
tube attached to the Spirometry. It consists of a flow sensor and a volume sensor. The patient
take a deep breath in and blow into a tube connected to the spirometer.The spirometer measures
the volume and flow rate of the exhaled air. The volume of air exhaled is displayed on a graph
called a flow-volume loop, which provides information about the lungs function.
Applications/Uses: Spirometry can provide information about the functioning of the lungs
and the ability of the lungs to move air in and out.

Conditions:
 The patients should wear loose fitting clothing.
 The patients do not smoke for 24 hours before the test.
 Avoid eating a heavy meal two to four hours before the test.
 Avoid vigorous exercise 30 minutes before the test.
 3.1.1 AbnormalLungPhysiology-COPD

Abnormal lung physiology or Lungs diseases: It refers to any deviation from the normal
functioning of the respiratory system. This may due to diseases, injuries, or genetic conditions.
 Asthma: Asthma is a chronic lung disease affecting people of all ages. It is caused by
inflammation and muscle tightening around the airways, which makes it harder to
breathe. Symptoms are coughing, wheezing, shortness of breath and chest tightness
 Lung Cancer: When cancer starts in the lungs, it is called lung cancer. Lung cancer
begins in the lungs and may spread to lymph nodes or other organs in the body.
 Pneumonia : It s an infection that affects one or both lungs. It causes the air sacs or
alveoli, of the lungs to fill up with fluid or pus. Bacteria, viruses or fungi may cause
pneumonia.
 Pulmonary fibrosis: Pulmonary fibrosis is a lung disease that occurs when lung tissue
becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for
your lungs to work properly. No cure exists. Medications may slow down scarring and
help preserve lung function
 A pulmonary embolism (PE): It occurs when a blood clot and gets stuck in an artery
in the lung It blocks blood flow to part of the lung. Blood clots most often start in the
legs and travel up through the right side of the heart and into the lungs.

Chronic obstructive pulmonary disease (COPD) : It is characterized by poorly reversible

airflow obstruction and an abnormal inflammatory response in the lungs. Symptoms include
breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by
long-term exposure to irritating gases or particulate matter, cigarette smoke. People with COPD
are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

There is no cure for COPD, but treatment can help manage the symptoms and slow the
progression of the disease. Treatment options include medication, such as bronchodilators and
steroids, oxygen therapy and lung rehabilitation. surgery may also be an option. In addition
quitting smoking and avoiding exposure to irritants is managing COPD.
Ventilators: A ventilator is a machine that helps you breathe. The ventilator partially or
completely supports your lung functions. It pumps oxygen-rich air into your lungs. It also
helps you breathe out carbon dioxide.
ventilator in an emergency if a condition makes it difficult to breathe on own (called
respiratory failure), may also need a ventilator during surgery.
Types of ventilators
 Volume-controlled ventilators,
 Pressure-controlledventilators, and
 Bilevel positive air way pressure(BiPAP) devices.
 The type of ventilator used depends on the patient's individual needs and the type of
respiratory failure being treated.
 Ventilators work by delivering pressurized air or oxygen into the lungs through a breathing
tube or mask. The pressure can be adjusted to match the patient's needs and to help
maintain adequate oxygen levels in the blood.
 While ventilators can be lifesaving for individuals with acute respiratory failure, they also
come with potential risks and complications. For example, prolonged use of a ventilator
can increase the risk of ventilator-associated pneumonia, and patients may experience
discomfort or pain from the breathing tube.
 The use of ventilators is carefully monitored and managed by healthcare professionals to
ensure that the patient receives the appropriate level of support while minimizing potential
risks and complications.
Disadvantages
 Patients under this condition can develop respiratory muscle fatigue and severe adverse
events, such as barotrauma.
 Fluid and mucus build-up in your throat and windpipe can allow germs to accumulate
on the breathing tube.
 It may leads Pneumonia.
 Heart-Lung Machine: A heart-lung machine is a piece of equipment that temporarily
takes over the work of the heart and/or lungs, providing blood and oxygen to the body.
 It is most often used during serious procedures that require the heart to be stopped.
 To stop the heart without harming the patient, oxygenated blood must continue to circulate
through the body during surgery without stopping. The cardiopulmonary bypass pump
does the work of the heart, pumping blood through the body and making sure that the
tissues of the body get the oxygen.
 A heart failure patient may be placed on the pump to support the patient until a heart
transplant becomes available.
 During some open-heart procedures, it may be necessary to stop the heart in order to repair
the heart's muscle, valves, or other structures.
 The heart-lung machine works by circulating blood outside of the body through a series
of tubes and pumps. Blood is taken from the body, oxygenated, and then returned to the
body. This allows the heart to be stopped during the surgery with out causing any harm to
the patient.
 The use of a heart-lung machine during surgery carries some risks, including the potential
for blood clots, bleeding and infections. Additionally, there may be some long-term effects
on the body, such as cognitive decline, that are not yet fully understood. However, the use
of a heart-lung machine has revolutionized the field of cardiovascular surgery,

Kidney:

 Kidney as filtrating system

 kidneys are part of your urinary system.
 Kidneys are located in the abdomen, one on either side of the backbone.
 The kidneys are two reddish-brown bean-shaped organs that filter your blood.
 Their main job is to cleanse the blood of toxins and transform the waste into urine.
 Each kidney weighs about 160 grams and gets rid of between one and one-and-a-half
liters of urine per day. The two kidneys together filter 200 litres of fluid every 24 hours.
 Kidney removes the nitrogenous wastes such as urea or urea acid ( The purpose of
making urine is to filter out waste products from the blood.).
 It is roughly the size of a fist.

Function of Kidney

 Remove waste products from the body

 Remove drugs from the body
 Balance the body's fluids by reabsorbing the water.
 Release hormones rennin that regulate blood pressure
 Produce an active form of vitamin D that promotes strong, healthy bones
 Control the production of red blood cells.
  Important compounds such as glucose, amino acids, salts and a major amount of water
are selectively re-absorbed by the kidney.

Architecture of filtering unit

Nephron:
 The nephron is the functional unit of the kidney.
 Each kidney contains approximately one million nephrons.
 Nephron performs the functions of filtration, reabsorption, and secretion.
Bowman’s Capsule:

 This is a cup-shaped structure that surrounds the Glomerulus

 Bowman's capsule collects blood, filtrate it and sends it to renal tubule for further
processing in order to form urine.

Glomerulus: A network of tiny blood vessels within the Bowman's capsule that filters waste
and excess fluid from the blood stream.
Proximal convoluted tubule (PCT): is a segment of the renal tubule responsible for the
reabsorption and secretion of various solutes and water. The PCT is located in the renal cortex,
the outer part of the kidney.
Loop of Henle: This part of the nephron is called the loop of Henle. Its main function is to
reabsorb water and sodium chloride from the filtrate. This conserves water for the organism,
producing highly concentrated urine.
Collection dust: collects urine and transports it to the pelvis through ureters where it is
temporarily stored in the urinary bladder.

Mechanism of filtration-Urine Formation

The mechanism of filtration in the kidneys is a complex process that involves

multiplestepstoremovewasteandexcessfluidsfromthebloodstream.Thefollowingisasummaryoft
hesteps involvedinthefiltrationprocess:
 Blood enters the kidney through the renal arteries and flows into tiny filtering units
called glomeruli.
 At the glomerulus, the pressure in the blood vessels causes a portion of the plasma and
dissolved substances to filter out and enter a structure allied Bowman's capsule.
 In Bowman's capsule, the filtrate is then transferred into the renal tubules, which are
the main filtering units of the kidneys.
 In the renal tubules, the filtrate passes through a series of specialized cells, such as
proximal tubular cells and distal tubular cells, which are absorb important substances
such as glucose, amino acids and electrolytes back into the blood stream.
 At the same time, the renal tubules secrete waste products, such as urea and creatinine,
back into the filtrate.
 Finally, the filtered fluid, now known as urine, is transported through the renal pelvis
and ureters to the bladder, where it is eventually laminated from the body.

Chronic Kidney Disease(CKD)

 CKD is a condition in which the kidneys are damaged and cannot filter blood. Because of
this excess fluid and waste from blood remain in the body and may cause other health
problems.

 There's no cure for chronic kidney disease (CKD). Treatment can help relieve the
symptoms and stop it getting worse. The treatment will depend on the stage of your
 CKD. The main treatments are lifestyle changes (Healthy food, excise, Mediation,
Regular check up & fallow the doctor advice).

Symptoms

 Weight loss and poor appetite.

 Swollen ankles, feet or hands
 Shortness of breath.
 Tiredness.
 Blood in urine
 Difficulty sleeping (insomnia)
 Itchy skin.
More risk in high blood pressure, Diabetic conditions patients

Dialysis is a type of treatment that helps your body remove extra fluid and waste
products from your blood when the kidneys are not able to.
 Removing waste and extra fluids in your body to prevent them from building up in the
body
 Keeping safe levels of minerals in your blood, such as potassium, sodium, calcium, and
bicarbonate
 Helping to regulate your blood pressure.
There are two main types of dialysis systems: hemodialysis and peritonealdialysis.

Hemodialysis (HD)
Hemodialysis is a dialyzer (filtering machine). It is used to remove waste and extra
fluid from blood and then return the filtered blood into body.
During hemodialysis,blood is removed from the body, passed through a dialysis
machine that filters out waste and excess fluids and then returned to the body.
Hemodialysis can be done at a dialysis center, hospital or at home. Treatments usually
last about four hours and are done three times per week.
 Peritoneal Dialysis (PD)

 In peritoneal dialysis blood is filtered inside the body instead of using a dialyzer
machine.
 Before starting peritoneal dialysis, a minor surgery is needed to place a catheter (soft
tube) in belly. During each treatment, belly area is slowly filled with dialysate (a
cleansing fluid made from a mixture of water, salt, and other additives) through the
catheter.
 As blood flows naturally through the area, extra fluid and waste products are pulled out of the
blood vessels and into the belly area by the dialysate (almost like a magnet). After a few
hours, the fluid mixture is drained from your belly using the same catheter and bag that was
used at the beginning of the treatment. Peritoneal dialysis can be done almost anywhere if you
have the supplies required to perform the treatment.
Artificial Kidney
While much progress has been made in developing an artificial kidney, it is still in the
experimental stage and is not yet widely available. Further research and development is
needed to improve the efficiency and safety of artificial kidney devices, and to ensure that
they can be widely adopted as at treatment for chronic kidney disease.

a)

b)
Figure: a) Schematic representation b) a proto type of artificial kidney
An artificial kidney is a device that is being developed to mimic the functions of the
human kidney. The goal of an artificial kidney is to provide a more effective and efficient
means of treating patients with chronic kidney disease, who currently rely on dialysis or
kidney transplantation.
There are currently two main approaches to developing an artificial kidney: a
biological approach and a technological approach.