Pulmonary Physiology, Tenth Edition PDF
Preview Pulmonary Physiology, Tenth Edition
.. -V. r - g & frrWv i 10th edition Pulmonary Physiology Michael G. Levitzky - LANGE a a LANGE medical book Pulmonary Physiology Tenth Edition MichaelG.Levitzky,PhD EmeritusProfessorofPhysiology LouisianaSfofeUniversityHealthSciencesCenter NewOrleans,Louisiana Now York Chicago San Francisco Athens Ijondon Madrid MexicoCity Milan NowDelhi Singapore Sydney Toronto Copyright © 2022 by McGraw Hill, LLC. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-1-26-427005-7 MHID: 1-26-427005-4 The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-427004-0, MHID: 1-26-427004-6. eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners. 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Contents Preface Chapter 1 Function and Structure of the Respiratory System Functions of the Respiratory System Structure of the Respiratory System Key Concepts Suggested Readings Chapter 2 Mechanics of Breathing Generation of a Pressure Difference Between Atmosphere and Alveoli Pressure-Volume Relationships in the Respiratory System Interaction of Lung and Chest Wall: The Static Pressure-Volume Curve Airways Resistance The Work of Breathing Key Concepts Clinical Problems Suggested Readings Chapter 3 Alveolar Ventilation The Lung Volumes Measurement of the Lung Volumes Anatomic Dead Space and Alveolar Ventilation Measurement of Alveolar Ventilation Alveolar Ventilation and Alveolar Oxygen and Carbon Dioxide Levels Regional Distribution of Alveolar Ventilation The Closing Volume The Effects of Aging Key Concepts Clinical Problems Suggested Readings Chapter 4 Blood Flow to the Lung The Bronchial Circulation The Functional Anatomy of the Pulmonary Circulation Pulmonary Vascular Resistance The Regional Distribution of Pulmonary Blood Flow: The Zones of the Lung Hypoxic Pulmonary Vasoconstriction Effects of Mechanical Ventilation on Pulmonary Blood Flow Pulmonary Edema Key Concepts Clinical Problems Suggested Readings Chapter 5 Ventilation-Perfusion Relationships The Concept of Matching Ventilation and Perfusion Consequences of High and Low Testing for Nonuniform Distribution of Inspired Gas and Pulmonary Blood Flow Regional Differences and Their Consequences in the Lung Key Concepts Clinical Problems Suggested Readings Chapter 6 Diffusion of Gases and Interpretation of Pulmonary Function Tests Fick’s Law for Diffusion Limitations of Gas Transfer Diffusion of Oxygen Diffusion of Carbon Dioxide Measurement of Diffusing Capacity Interpretation of Pulmonary Function Tests Key Concepts Clinical Problems Suggested Readings Chapter 7 Transport of Oxygen and Carbon Dioxide in the Blood Transport of Oxygen by the Blood Hemoglobin and the Physiologic Implications of the Oxyhemoglobin Dissociation Curve Influences on the Oxyhemoglobin Dissociation Curve Transport of Carbon Dioxide by the Blood The Carbon Dioxide Dissociation Curve The Bohr and Haldane Effects Explained Key Concepts Clinical Problems Suggested Readings Chapter 8 Acid-Base Balance The Chemistry of Acids, Bases, and Buffers Buffer Systems of the Human Body Acidosis and Alkalosis Respiratory and Renal Compensatory Mechanisms Clinical Interpretation of Blood Gases and Acid-Base Status The Causes of Hypoxia Key Concepts Clinical Problems Suggested Readings Chapter 9 Control of Breathing The Generation of Spontaneous Rhythmicity The Medullary Respiratory Center The Pontine Respiratory Groups Spinal Pathways Reflex Mechanisms of Respiratory Control Influences of Higher Centers The Response to Carbon Dioxide The Response to Hydrogen Ions The Response to Hypoxia The Response to Exercise Altered Breathing Patterns Key Concepts Clinical Problems Suggested Readings Chapter 10 Nonrespiratory Functions of the Lung Pulmonary Defense Mechanisms Nonrespiratory Functions of the Pulmonary Circulation Metabolic Functions of the Lung Key Concepts Suggested Readings Chapter 11 The Respiratory System Under Stress Exercise and the Respiratory System Altitude and Acclimatization Diving and the Respiratory System Sleep and the Respiratory System Key Concepts Clinical Problems Suggested Readings Clinical Problem Answers Appendix I. Symbols Used in Respiratory Physiology II. The Laws Governing the Behavior of Gases III. Frequently Used Equations IV. Table of Normal Respiratory and Circulatory Values Index Preface The tenth edition of Pulmonary Physiology has been thoroughly updated. New figures and tables have been added and others revised to help students visualize concepts more clearly and learn the material more effectively. New references and clinical correlations have been added to the end of each chapter. It has been more than 40 years since Pulmonary Physiology was first published. The book is now older than most of its readers! Perhaps the greatest pleasure associated with the first nine editions has been receiving many favorable comments and helpful suggestions from students, readers, and colleagues, and I have used many of these suggestions in the preparation of this new edition. This book is intended to be used both as an introductory text for beginning students and as a review for residents and fellows in such fields as internal medicine, anesthesiology, pediatrics, and pulmonary medicine. Students who have studied the text should be able to review for licensure and certification examinations by concentrating on the figures, key concepts, tables, and appendices, which summarize nearly all of the material in the book. My goal in writing this book is to provide first-year medical students (as well as respiratory therapy, nursing, nurse-anesthesia, and other students) with a solid background on the aspects of pulmonary physiology essential for an understanding of clinical medicine. My approach is to encourage self- sufficiency not only in studying pulmonary physiology for the first time, but also in understanding the basic concepts of pulmonary physiology well enough to apply them with confidence to future patients. I believe that the ways to accomplish this are to inform the reader of the goals of each chapter with clearly stated learning objectives, to give detailed and complete explanations of physiologic mechanisms and demonstrate how they apply to pathologic states, and to give the reader a means of self-testing by providing clinical correlations, problems, and pulmonary function test data to interpret. The challenge is to write a book that students can read without difficulty in the limited amount of time allocated to pulmonary physiology in the typical curriculum. The material must be presented in a way that discourages memorization without real comprehension, because only those students who understand the basic mechanisms are able to apply them to new situations. The result of this approach should be a book that covers the essentials of the respiratory system as concisely as possible yet raises no questions in students’ minds without answering them. I hope that I have achieved these goals in writing this book. I would like to thank the many people whose comments have helped me revise the various editions of the book, including my colleagues in respiratory physiology and pulmonary medicine, my colleagues at LSU Health Sciences Center and Tulane University School of Medicine, and my students and readers. I give special thanks to Drs. Andy Pellett and Lisa Harrison-Bernard of Louisiana State University Health Sciences Center and Hershel Raff of the Medical College of Wisconsin. I would also like to thank everyone who has helped me prepare the manuscripts, illustrations, and proofs, including my many editors at McGraw Hill, Betsy Giaimo, and my wife Elizabeth. This book is dedicated in memory of Robert S. Alexander and Jim Miller. Michael G. Levitzky 1 Function and Structure of the Respiratory System OBJECTIVES The reader states the functions of the respiratory system and relates the structural organization of the system to its functions. Describes the exchange of oxygen and carbon dioxide with the atmosphere and relates gas exchange to the metabolism of the tissues of the body. Defines the role of the respiratory system in acid-base balance. Lists the nonrespiratory functions of the lungs. Defines and describes the alveolar-capillary unit, the site of gas exchange in the lungs. Describes the transport of gas through the conducting airways to and from the alveoli. Describes the structural characteristics of the airways. Lists the components of the chest wall and relates the functions of the muscles of respiration to the movement of air into and out of the alveoli. Describes the central nervous system initiation of breathing and the innervation of the respiratory muscles. The main functions of the respiratory system are to obtain oxygen from the external environment and supply it to the cells and to remove from the body the carbon dioxide produced by cellular metabolism. The respiratory system is composed of the lungs, the conducting airways, the parts of the central nervous system concerned with the control of the muscles of respiration, and the chest wall. The chest wall consists of the muscles of respiration—such as the diaphragm, the intercostal muscles, and the abdominal muscles—and the rib cage. FUNCTIONS OF THE RESPIRATORY SYSTEM The functions of the respiratory system include gas exchange, acid-base balance, phonation, pulmonary defense and metabolism, and the handling of bioactive materials.
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