Module 3 Part 2

Lungs as purification system (architecture, gas exchange mechanisms,

spirometry, abnormal lung physiology - COPD, Ventilators, Heart-lung
machine).Kidney as a filtration system (architecture, mechanism of
filtration, CKD, dialysis systems).
 Lungs as purification system
The lung purifies air by removing harmful substances and
adding oxygen to the bloodstream. The process of purifying
air in the lungs can be described as follows:
• 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.
• Gas Exchange: Once the air reaches the alveoli, the gas • Air enters the lungs through the air passage, which includes the
exchange process occurs, where oxygen diffuses across nasal cavities, pharynx, larynx, trachea, bronchi and bronchioles.
the thin alveolar and capillary walls into the
bloodstream, and carbon dioxide diffuses in the opposite • The lungs are elastic bags located in a closed cavity called thorax
direction, from the bloodstream into the alveoli to be or thoracic cavity.
exhaled. • The right lungs consists of three lobes(upper, middle and lower)
and left lungs has two lobes (upper and lower).
• This process ensures that the bloodstream is supplied
with fresh, oxygen-rich air, while carbon dioxide is • The larynx sometimes called as “voice box”(vocal cords) is
removed from the body. Overall, the lung serves as a connected to the bronchi through trachea, called as windpipe.
vital purification system, filtering out harmful • Above the larynx is the epiglottis, a valve that closes whenever a
substances, adding oxygen to the bloodstream, and person swallows, so that food and liquids are directed to the
removing carbon dioxide. It plays a critical role in esophagus.
maintaining the body's homeostasis and supporting life.
Architecture of Lungs as Purification System
• Bronchioles: The diameter is reduced to 0.1cm, this air
The lung is divided into several parts, including the trachea, conducting tubes are called bronchioles. The bronchioles are
bronchi, bronchioles, and alveoli. smaller airways that eventually lead to the alveoli, which are
• Trachea: The trachea is the main airway that leads from the the sites of gas exchange.
larynx (voice box) to the lungs. It is lined with cilia and
• Alveoli: The alveoli are tiny air sacs that are lined with a
mucus-secreting glands that help to filter out harmful
substances. It is about 1.5 to 2.5 cm diameter and 11cm
network of capillaries. This close proximity of the alveoli and
long, extending from larynx to the upper boundary of the
capillaries allows for efficient diffusion of oxygen and carbon
chest. Here, it bifurcates into right and left main stem
dioxide between the air in the alveoli and the bloodstream.
bronchi.
The alveoli are each about 0.02cm in diameter.
• Bronchi: The trachea branches into two main bronchi, one • The bronchioles are embedded within alveolar lung tissue;
for each lung. The bronchi are larger airways that continue and within the expansion and relaxation of the lung, their
to branch into smaller airways called bronchioles. diameter are greatly affected by the lung size or lung volume.
• The lungs are covered by a thin membrane called pleura,
which passes from the lung at its root onto the interior of the
chest wall and upper surface of the diaphragm.
• The two membranous sacs so formed are called pleural
cavities, one on each side of the chest, between lungs and the
thoracic boundaries.
• The diaphragm is a special dome or bell shaped muscle
located at the bottom of the thoracic cavity, which when
contracted pulls down to enlarge the thorax, this action is the
principal force involved in inspiration.
• INSPIRATION-As the diaphragm moves downwards, the intercostal muscles lifts the rib cage and
sternum, this lifting action increases the diameter of the thoracic cavity which creates the negative
pressure(vacuum) in the thorax.
• EXPIRATION- A set of abdominal muscles pushes the diaphragm upward very powerfully while the
intercoastal muscles pull the rib cage downward and apply pressure (positive pressure) against the lungs
to force the air out.
• During inspiration, the pressure is about -3mm Hg and at the time of expiration the pressure is about
+3mm Hg.
• The ability of the lungs and thorax to expand during breathing is called compliance, which is expressed
as the volume increase in the lungs per unit increase in intra-alveolar pressure.
• The resistance to the flow of air into and out of the lungs is called airway resistance.
• Overall, the architecture of the lung is designed to provide a large surface area for gas exchange, while filtering out
harmful substances and humidifying the air. The close proximity of the alveoli and capillaries, along with the moist
lining of the respiratory tract, ensures that the air is properly purified and the bloodstream is supplied with fresh,
oxygen-rich air.
 GAS EXCHANGE MECHANISMS
• The exchange of gases in any biological process is called respiration.
• The process of taking the oxygen from the environment, transporting the oxygen to the cells, removing the carbon dioxide from the cells and exhausting
this waste product into the atmosphere is called respiration.
• The exchange of gases takes place in the lungs, is termed as external respiration.
• The function of the lungs is to oxygenate the blood and to eliminate carbon dioxide in a controlled manner.
• During inspiration, fresh air enters the respiratory tract, becomes humidified and heated to body temperature, and is mixed with gases already present in
the region comprising the trachea and bronchi.
• This gas is then mixed further with the gas residing in the alveoli as it enters these small sacs in the walls of the lungs.
• Oxygen diffuses from the alveoli to the pulmonary capillary blood supply, whereas carbon dioxide diffuses from the blood to the alveoli.
• The oxygen is carried from the lungs and distributed among the various cells of the body by the blood circulation system, which also returns the carbon
dioxide to the lungs.
• The entire process of inspiring and expiring air, exchange of gases, distribution of oxygen to the cells and collection of CO2 from the cells is known as
pulmonary function.
• The gas exchange mechanism in the lung involves the transfer of oxygen from the air in the alveoli to the bloodstream, and the transfer of carbon dioxide
from the bloodstream to the air in the alveoli. 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 the alveoli 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 bloodstream, where it binds to hemoglobin in red blood cells to form
oxyhemoglobin. (oxygen air>bloodstream)

• 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. (carbondioxide
bloodstream> carbondioxide air)
 SPIROMETRY
• The most widely used laboratory instrument for respiratory
volume measurement is the recording spirometer.
• All lung volumes and capacities that can be determined by
measuring the amount of gas inspired or expired under a
given set of conditions, is by the use of spirometer.
• The standard spirometer consists of a movable bell inverted
over a chamber of water.
• Inside the bell, above the water line, is the gas that is to be
breathed.
• The bell is counterbalanced by a weight to maintain the gas
inside at atmospheric pressure so that its height above the
water is proportional to the amount of gas under the bell.
• A breathing tube connects the mouth of the patient with the • Various bell volumes are available, but 9 and 13.5 litters are most
gas under the bell. common
• Thus, as the patient breathes into the tube, the bell moves • 9 litters are often considered for recording largest vital capacities,
up and down with each inspiration and expiration in extended period oxygen uptake determinations. However, physician's
proportion to the amount of air breathed In or out. prefer larger size of 13.5 due to their extra capacity.
• Attached to the bell or the counter balancing mechanism is • Several other types are also available:
a pen that writes on an adjacent drum recorder called 1. Waterless spirometer
kymograph.
2. Wedge spirometer
• As the kymograph rotates, the pen traces the breathing 3. Electronic spirometer
pattern of the patient.
4. Broncho spirometer
1. Waterless spirometer
The volume of the chamber is varied by means of a lightweight piston that moves freely in a cylinder as air is withdrawn and replaced in
breathing.
2. Wedge spirometer
In this instrument the air to be breathed is held in a chamber enclosed by two parallel metal pans hinged to each other along one edge.
The space between the two pans is enclosed by a flexible bellows to form the chamber.
One of the pans which contains an inlet tube, is fixed to a stand and the other swings freely with respect to it.
As air is introduced into the chamber or withdrawn from it, the moving pan changes its position to compensate for the volume changes.
Construction is such that the pan moves in response to very slight changes in volume.
The instrument provides electrical outputs proportional to both volume and airflow, from which the required determinations can be obtained.
3. Electronic spirometer
It measures the airflow and by use of electronic circuitry, it calculates the various volumes and capacities.
It is a dual spirometer that measures the volumes and capacities of each lung individually.
The air-input device is a double-lumen tube that divides for entry into the airway to each lung and thus provides isolation for differential
measurement.

4. Broncho spirometer
The main function of the broncho spirometer is the preoperative evaluation of oxygen consumption of each lung.
The usual output of a spirometer is the spirogram.
The recording is read from right to left. In this particular example, inspiration moves the pen toward the bottom of the chart and expiration
toward the top.
Some spirometers, however, provide spirograms with inspiration toward the top.
 WORKING PRINCIPLE OF
SPIROMETER
❖ In order to produce a spirogram, the patient is TYPICAL SPIROGRAM
instructed to breathe through the mouthpiece of
the spirometer.
❖ His nose is blocked with a cup so that all
breathing is through the mouth.
❖ The recorder is first set to a slow speed to
measure vital capacity (typically, 32 mm/min).
❖ To produce the spirogram, the patient breathed
quietly for a short time at rest so as to provide a
baseline.
❖ He was then instructed to exhale completely
and then to inhale as much as he could.
❖ The patient was then instructed to blow out all
the air he could as quickly as possible to
produce the forced expiratory volume (FEV),
curve on the record.
 Abnormal Lung Physiology - COPD

Abnormal lung physiology refers to any deviation from the normal functioning of the respiratory
system. This can be caused by a variety of factors, including diseases, injuries, or genetic conditions.
Some common examples of abnormal lung physiology include:
• Asthma: A chronic inflammatory disease that causes the airways to narrow, making it difficult to
breathe.
• Chronic obstructive pulmonary disease (COPD): A progressive lung disease that makes it hard to
breathe and can include conditions such as emphysema and chronic bronchitis.
• Pulmonary fibrosis: A disease in which scar tissue builds up in the lungs, making it difficult to
breathe and reducing lung function.
• Pneumonia: An infection in the lungs that can cause inflammation and fluid buildup in the air sacs.
• Pulmonary embolism: A blockage in one of the pulmonary arteries, usually by a blood clot, which
can cause lung damage and reduce oxygen flow to the body.
• Lung cancer: A type of cancer that originates in the lung and can impair lung function by
interfering with normal air flow and oxygen exchange.
 Chronic Obstructive Pulmonary Disease-COPD

Chronic Obstructive Pulmonary Disease (COPD) is a group of

progressive lung diseases that cause breathing difficulties.
It's characterized by persistent airflow limitation that is not fully
reversible.
The two main forms of COPD are chronic bronchitis and
emphysema.
Chronic bronchitis:
It is a chronic inflammation of the lower respiratory tract
characterized by excessive mucous secretion, cough and dyspnea.
Emphysema:
It is a complex lung disease characterized by damage to the gas-
exchanging surfaces of the lung (alveoli).
In COPD, the airways and small air sacs (alveoli) in the lungs
become damaged or blocked, leading to difficulty in exhaling air.
VENTILATORS
POSITIVE PRESSURE VENTILATOR
BLOCK DIAGRAM OF VENTILATORS
❖ A heart-lung machine, also known as a cardiopulmonary
bypass machine, is a device used in cardiovascular surgery
to temporarily take over the functions of the heart and lungs.
❖ The heart-lung machine is used during open-heart surgery,
such as coronary artery bypass graft (CABG) surgery and
valve replacement surgery, to support the patient's
circulatory and respiratory functions while the heart is
stopped.
❖ 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
without 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, allowing for more
complex procedures to be performed and greatly improving
patient outcomes.
 Kidney as a Filtration Architecture of Kidney
System • The kidney is composed of functional units called nephrons, which
are the basic structural and functional units of the kidney.
• The kidney is a complex organ that acts as a • Each kidney contains approximately one million nephrons, and each
filtration system for the body. nephron performs the functions of filtration, reabsorption, and
secretion.
• It removes waste and excess fluid from the
• The nephron is comprised of several key structures:
bloodstream and maintains a delicate balance
of electrolytes, hormones, and other • Bowman's capsule: This is a cup-shaped structure that surrounds the
substances that are critical for the body's glomerulus and filters waste and excess fluid from the bloodstream
normal functioning.
into the renal tubule.
• Glomerulus: A network of tiny blood vessels within the Bowman's
• The kidney also plays an important role in capsule that filters waste and excess fluid from the bloodstream.
regulating blood pressure by secreting the
hormone renin, which helps control the • Proximal convoluted tubule: A segment of the renal tubule that
reabsorbs important substances, such as glucose, amino acids, and
balance of fluid and electrolytes in the body. electrolytes, back into the bloodstream.
• It also regulates red blood cell production
and the levels of various minerals in the
blood, such as calcium and phosphorus.
• Without the kidney, waste and excess fluid
would accumulate in the body, leading to
serious health problems.
Mechanism of Filtration
Chronic Kidney Disease (CKD)
• CKD stands for Chronic Kidney Disease. It is a long-term Dialyzer
condition in which the kidneys gradually become less able to
function properly.
• Dialysis machines are artificial kidney that perform most,
• It can be caused by a variety of factors, including diabetes, high but not all, kidney function for patients who have
blood pressure, and other health problems that damage the permanent or temporary renal failure
kidneys.
• The machine use HEMODIALYSIS to cleanse the blood
• Symptoms of CKD include fatigue, swelling in the legs and feet, and balance its constituents.
trouble sleeping, and difficulty concentrating.
• In HEMO DIALYSIS, blood is removing from the body
• As the disease progresses, it can lead to more serious and filtered through a manmade membrane called a
complications, such as anemia, nerve damage, and an increased dialyzer or artificial kidney and then the filtered blood is
risk of heart disease and stroke. returned on the body.
• Treatment for CKD may include lifestyle changes, such as eating a • The average person has about 10 to 12 pints of blood
healthy diet and exercising regularly, as well as medications to during dialysis only one pint (about two cups) is outside
manage symptoms and underlying health conditions. of the body at a time High clearance of small and medium
MW.
• In severe cases, kidney transplant or dialysis may be necessary. It
is important for individuals with risk factors for CKD to get • Properly functioning kidneys prevent extra water, waste,
regular check-ups and to talk to their doctor about how to best and other impurities from accumulating in your body.
manage their condition. They also help control blood pressure and regulate the
levels of chemical elements in the blood. These elements
may include sodium and potassium.
• kidneys even activate a form of vitamin D that improves
the absorption of calcium.
• When your kidneys can’t perform these functions due to
disease or injury, dialysis can help keep the body running
as normally as possible. Without dialysis, salts and other
waste products will accumulate in the blood, poison the
body, and damage other organs.
• A dialyzer is composed of a dialysis membrane and supporting structure three or four Dialysis is a medical treatment that helps to filter waste and excess fluids
components.
from the blood when the kidneys are unable to function properly.
• Blood compartment. There are two main types of dialysis systems:
• Dialysate compartment.
• Semi permeable membrane separating Hemodialysis and peritoneal dialysis.
• Membrane support structure. Hemodialysis is a procedure that uses a machine to clean the blood.
Working
During hemodialysis, blood is removed from the body, passed through a
dialysis machine that filters out waste and excess fluids, and then returned
• Dialysis work on the principle of the diffusion of solutes and ultra-filtration of fluid across
a to the body. Hemodialysis typically takes place in a hospital or dialysis
• Semi Permeable Membrane. center, and is typically performed three times a week for three to four
• The dialysis machine mixes and monitors the Dialysate. Dialysate is the fluid that helps
hours at a time.
remove the unwanted waste products from your blood.
• It also helps get your electrolytes and minerals to their proper levels in your body. Peritoneal dialysis is a type of dialysis that uses the lining of the abdomen,
• The machine also monitors the flow of your blood while it outside of your body. called the peritoneum, to filter waste and excess fluids from the blood. A
sterile solution is introduced into the abdomen, where it absorbs waste
and excess fluids, and is then drained and replaced with fresh solution.
Peritoneal dialysis can be performed at home and allows for more
flexibility in scheduling.

Both hemodialysis and peritoneal dialysis can effectively treat the

symptoms of kidney failure, but each has its own advantages and
disadvantages. The choice of dialysis system depends on various factors
such as the individual's overall health, lifestyle, and personal preferences.