Discuss the thoracic cage and the respiratory muscles?What roles these muscles play in thoracic cage activity and respiration?
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Question:Discuss the thoracic cage and the respiratory muscles?What roles these muscles play in thoracic cage activity and respiration?What types of lung volumes,lung capacities and pulmonary tests are performed by spirometery?How do we differentiate between restrictive lung diseases and obstructive lung diseases? Answer: THORACIC CAGE: (1)The thoracic cage (human rib cage) is a bony and cartilaginous structure which surrounds the thoracic cavity and supports the pectoral girdle, forming a core portion of the human skeleton. A typical human rib cage consists of 24 ribs, the sternum (with xiphoid process), costal cartilages, and the 12 thoracic vertebrae.The shape of the thoracic cage is like a domed bird cage with the horizontal bars formed by ribs and their associated costal cartilages.There are three general functions of the thoracic cage which are: 1. Protects heart, lungs and abdominal organs. 2. Supports the bones of the shoulder girdle & arms. 3. Helps in breathing. (1)
RESPIRATORY MUSCLES THEIR ROLE IN THORACIC CAGE ACTIVITY AND RESPIRATION (2)The lungs can be expanded(as during inspiration) and contracted(as during expiration) in two ways: (1) by downward and upward movement of the diaphragm to lengthen or shorten the chest cavity. (2) by elevation and depression of the ribs to increase and decrease the anteroposterior diameter of the chest cavity. Normally at rest breathing almost entirely takes place by first method that is by movement of diaphragm. The diaphragm is the major muscle responsible for breathing. It is a thin, dome-shaped muscle that separates the abdominal cavity from the thoracic cavity. During inhalation, the diaphragm contracts, so
that its center moves caudally (downward) and its edges move cranially (upward). This compresses the abdominal cavity, raises the ribs upward and outward and thus expands the thoracic cavity. This expansion draws air into the lungs. When the diaphragm relaxes, elastic recoil of the thoracic wall causes the thoracic cavity to contract, forcing air out of the lungs, and returning to its dome-shape. The second method for expanding the lungs is to raise the rib cage. Raising the rib cage expands the lungs because, in the natural resting position, the ribs slant downward, thus allowing the sternum to fall backward toward the vertebral column. When the rib cage is elevated, however,the ribs project almost directly forward, so the sternum also moves forward, away from the spine, making the anteroposterior thickness of the chest about 20 percent greater during maximum inspiration than during expiration. Therefore, all the muscles that elevate the chest cage are classified as muscles of inspiration, and the muscles that depress the chest cage are classified as muscles of expiration. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. These muscles are attached between the ribs and are important in manipulating the width of the rib cage. There are three layers of intercostal muscles. The external intercostal muscles are most important in inspiration.These have fibres that are angled obliquely downward and forward from rib to rib. The contraction of these fibres raises each rib toward the rib above, with the overall effect of raising the rib cage, assisting in inhalation.
The term “accessory muscles” refers to those that assist, but do not play a primary role, in breathing. Use of these while at rest is often interpreted as a sign of respiratory distress. There is no definitive list of accessory muscles,but the sternocleidomastoid(which lift upward the sternum)the scaleni(which lift the first two ribs) and anterior serrati muscles(which lift many of the ribs) are typically included. The involvement of these muscles seems to depend on the degree of respiratory effort. During quiet breathing, the scalenes are consistently physically active, while the sternocleidomastoids are quiet. With an increase in the respiratory volume, sternocleidomastoids also become active. These muscles are simultaneously activated when one breathes in at the maximal flow rate. During quiet breathing, there is little or no muscle contraction involved in exhalation; this process is simply driven by the elastic recoil of the lungs. When forceful exhalation is required, or when the elasticity of the lungs is reduced (as in emphysema), active exhalation can be achieved by contraction of the abdominal wall muscles the abdominal rectii(which have the powerful effect of pulling down the lower ribs and at the same time they and other abdominal muscles also compress the abdominal contents upward against the diaphragm), transverse abdominis, external oblique muscle and internal oblique muscle. These press the abdominal organs cranially (upward) into the diaphragm, reducing the volume of the thoracic cavity. The internal intercostal muscles have fibres that are angled obliquely downward and backward from rib to rib. These muscles can therefore assist in lowering the rib cage, adding force to exhalation.
Lung Volumes,Lung Capacities and Pulmonary Tests Performed By Spirometery Pulmonary function may be assessed clinically by means of a technique known as spirometry. In this procedure, a subject breathes in a closed system in which air is trapped within a light plastic bell floating in water. The bell moves up when the subject exhales and down when the subject inhales. The movements of the bell cause corresponding movements of a pen, which traces a record of the breathing called a spiro gram. More sophisticated computerized devices are now more commonly employed to assess lung function.Figure below shows a spirometer.
Pulmonary Volumes: There are four pulmonary volumes which are discussed below: Tidal volume: The volume of air inspired or expired in an unforced respiratory cycle is called tidal volume.Its normal value in average adult male is 500millilitres. Inspiratory reserve volume:The maximum volume of air that can be inspired during forced breathing in addition to tidal volume is called inspiratory reserve volume.Its value is 3000 millilitres. Expiratory reserve volume: The maximum volume of air that can be expired during forced breathing in addition to tidal volume is called expiratory reserve volume.Its normal value is about 1100 millilitres. Residual volume: The volume of gas remaining in the lungs after a maximum expiration is called residual volume.Its normal value is 1200 millilitres. Pulmonary capacities: In describing pulmonary cycle it is sometime desirable to comine two or more lung volumes such combinations are called lung capacities.There are four lung capacities which are described below:
Inspiratory capacity:The inspiratory capacity is the sum of tidal volume and respiratory reserve volume.This is the maximum amount of air a person can breathe in,beginning at the normal expiratorty level and distending the lungs to the maximum amount.Its normal value is: IC=VTI+RV, IC=3000+500=3500 Functional Residual Capacity: This is the sum of expiratory reserve volume and residual volume.This is the amount of air remaining in the lungs after a normal tidal expiration.Its normal value is: FRC=ERV+RV, FRC=1100+1200=2300 Vital Capacity: The vital capacity is the sum of three volumes i.e.inspiratory reserve volume,tidal volume and expiratory reserve volume.This is the maximum amount of air that a person can expired after a maximum inspiration.Its normal value is: VC=IRV+VT+ERV, VC=3000+500+1100=4600 Total Lung Capacity:It is the sum of the vital capacity and the residual volume.It is the maximum amount of air in the lungs after a maximum inspiration.Its normal value is: TLC=VC+RV, TLC=4600+1200=5800
Dead Space: Some of the air a person breathes never reaches the gas exchange areas but simply fills respiratory passages where gas exchange does not occur, such as the nose, pharynx, and trachea. This air is called dead space air because it is not useful for gas exchange. Dead Space Volume:The normal dead space volume in young adult men is about 150ml and this increases slightly with age. Respiratory Minute Volume(RMV):It is the total volume of air moving in to the lungs per minute.It is equal to tidal volume multiplied by respiratory rate per minute.Th normal tidal volume is 500millilitres and the normal respiratory rate is about 12 breaths per minute.So its value is normally (500ml/breath×12breaths/min)=6L.A person can live for a short period with respiratory minute volume as low as1.5L/min and a respiratory rate of only 2 to 4 breaths per minute. Maximal Voluntary Ventilation(MVV):Maximum voluntary ventilation is also reffered as maximal breathing capacity(MBC) and it is the maximumamount of air that can be moved in to and out of the lungs in 1min by voluntary effort.Its normal value is 140 to180L/min for healthy adult males. Respiratory minute volume and maximal voluntary ventilation are very important to pulmonary physician and changes in its normal value are indicative of lung dysfunction or some kind of pulmonary disease.
Pulmonary Function Tests Performed By Spirometery: Forced Expiratory Vital Capacity(FVC) and Forced Expiratory Volume(FEV1): It is a useful clinical pulmonary test and is also easily can be performed by a spirometer.First of all we should explain Forced expiratory vital capacity and forced expiratory volume. Forced expiratory vital capacity(FVC):It is the maximum volume of air that can be expired after a maximal inspiratory effort. Forced expiratory volume(FEV1):It is the volume of vital capacity that is expired during the first second of a forced expiration. The FEV1/FVC ratio, also called Tiffeneau-Pinelli index, is a calculated ratio used in the diagnosis of obstructive and restrictive lung diseases.The normal value of this ratio is 80% and(65% in people older then age 65).Lower value then this indicated some kind of pulmonary disease. In order to measure the FVC(forced vital capacity)the person first is allowed to inspire maximally to the TLC(total lung capacity)and then exhales in to the spirometer with the maximum expiratory effort as quickly and as completely as possible.Then a spirogram is obtain and from it we calculate the FEV1/FVC ratio.Study two graphs shown below (A) a person
with normal lungs and (B)a person with partial airway obstruction. Note that the the total volume changes of FVCs are not too much different and there is a slight difference in the basic lung volumes in the two persons.But there is a big difference in the amount of air that these persons expire during each second and especially during the first second.Therefore it is necessary to compare the forced expiratory volume during the first second(FEV1) with the normal.In normal person ratio value is 80% and in person with airway obstruction it is 47%.In persons with acute asthma this value decreases to 20%. Determination of Functional Residual Capacity(FRC),Residual Volume(RV) and total Lung Capacity(TLC):
These terms are very important in lung function.First we determine FRC and then from it we can calculate RV and TLC. The spirometer cannot be used directly to measure the FRC because air in the residual volume of lungs cannot be expired in to the spirometer,and this volume makes approximately one half of FRC.So spirometer is used indirectly to measure FRC usually by means of helium dilution method.In helium dilution method first a spirometer of known volume is filled with air mixed with helium at a known concentration. Before breathing from the spirometer, the person expires normally. At the end of this expiration, the remaining volume in the lungs is equal to the FRC. At this point, the person quickly begins to breathe from the spirometer, and the gases of the spirometer mix with the gases of the lungs. As a result, the helium becomes diluted by the FRC gases, and the volume of the FRC can be calculated from the degree of dilution of the helium, using the following formula: FRC=(CiHe/CfHe-1)ViSpir where FRC is functional residual capacity, CiHe is initial concentration of helium in the spirometer, CfHe is final concentration of helium in the spirometer, and ViSpir is initial volume of the spirometer. Once the FRC has been determined, the residual volume (RV) can be determined by subtracting expiratory reserve volume (ERV), as measured by normal spirometry, from the FRC. Also, the total lung capacity (TLC)
can be determined by adding the inspiratory capacity (IC) to the FRC. That is, RV=FRC-ERV and TLC=FRC-IC(2) How we can differentiate between obstructive lung diseases and restrictive lung diseases? (3) Spirometry is useful in the diagnosis of lung diseases. On the basis of pulmonary function tests, lung disorders can be classified as restrictive or obstructive. The normal value of FVC in healthy adult male is 5.0 L, FEV1 is approximately 4.0 L, so, the calculated FEV1/FVC is 80%. And in patients with obstructive or restrictive diseases have reduced FVC and its value is 3.0 L, and this measurement alone does not differentiate between the two. However, measurement of FEV1 can significantly vary between the two diseases. In obstructive disorders, patients spirogram show a slow, steady slope to the FVC, resulting in a small FEV1, and its value is 1.3 L. However, in the restrictive disorder patients, air flow tends to be fast at first, and then due to the loss of elasticity, quickly levels out to approach FVC. The resultant FEV1 is much greater, and its value is 2.8 L, even though FVC is equivalent. So calculation of FEV1/FVC ratio for obstructive (42%) and restrictive (90%) patients is used in evaluating these two diseases. Obstructive disorders result in a marked decrease in both FVC and FEV1/ FVC, whereas restrictive disorders result in a loss of FVC without loss in FEV1/FVC.Graph below explains it more clearly
Examples of obstructive pulmonary disesease are COPD(Chronic Obstructive Pulmonary Disease),Asthma and Bronchiectasis and examples of restrictive pulmonary diseases are Interstitial lung disease and scoliosis.(3) REFERENCES: (1)https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Thoraciccage#:~:text=The%20thoracic%20cage%20(human%20rib,and%20the%2012%20thoracic%20vertebrae (2)Guyton and Hall Textbook of Medical Physiology Fourteenth Edition Chapter 38#Pulmonary Ventilation Ganong Review of Medical Physiology 23 Edition Section7 Respiratory Physiology THANK YOU
Question:Discuss the thoracic cage and the respiratory muscles?What roles these muscles play in thoracic cage activity and respiration?What types of lung volumes,lung capacities and pulmonary tests are performed by spirometery?How do we differentiate between restrictive lung diseases and obstructive lung diseases? Answer: THORACIC CAGE: (1)The thoracic cage (human rib cage) is a bony and cartilaginous structure which surrounds the thoracic cavity and supports the pectoral girdle, forming a core portion of the human skeleton. A typical human rib cage consists of 24 ribs, the sternum (with xiphoid process), costal cartilages, and the 12 thoracic vertebrae.The shape of the thoracic cage is like a domed bird cage with the horizontal bars formed by ribs and their associated costal cartilages.There are three general functions of the thoracic cage which are: 1. Protects heart, lungs and abdominal organs. 2. Supports the bones of the shoulder girdle & arms. 3. Helps in breathing. (1)
RESPIRATORY MUSCLES THEIR ROLE IN THORACIC CAGE ACTIVITY AND RESPIRATION (2)The lungs can be expanded(as during inspiration) and contracted(as during expiration) in two ways: (1) by downward and upward movement of the diaphragm to lengthen or shorten the chest cavity. (2) by elevation and depression of the ribs to increase and decrease the anteroposterior diameter of the chest cavity. Normally at rest breathing almost entirely takes place by first method that is by movement of diaphragm. The diaphragm is the major muscle responsible for breathing. It is a thin, dome-shaped muscle that separates the abdominal cavity from the thoracic cavity. During inhalation, the diaphragm contracts, so
that its center moves caudally (downward) and its edges move cranially (upward). This compresses the abdominal cavity, raises the ribs upward and outward and thus expands the thoracic cavity. This expansion draws air into the lungs. When the diaphragm relaxes, elastic recoil of the thoracic wall causes the thoracic cavity to contract, forcing air out of the lungs, and returning to its dome-shape. The second method for expanding the lungs is to raise the rib cage. Raising the rib cage expands the lungs because, in the natural resting position, the ribs slant downward, thus allowing the sternum to fall backward toward the vertebral column. When the rib cage is elevated, however,the ribs project almost directly forward, so the sternum also moves forward, away from the spine, making the anteroposterior thickness of the chest about 20 percent greater during maximum inspiration than during expiration. Therefore, all the muscles that elevate the chest cage are classified as muscles of inspiration, and the muscles that depress the chest cage are classified as muscles of expiration. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. These muscles are attached between the ribs and are important in manipulating the width of the rib cage. There are three layers of intercostal muscles. The external intercostal muscles are most important in inspiration.These have fibres that are angled obliquely downward and forward from rib to rib. The contraction of these fibres raises each rib toward the rib above, with the overall effect of raising the rib cage, assisting in inhalation.
The term “accessory muscles” refers to those that assist, but do not play a primary role, in breathing. Use of these while at rest is often interpreted as a sign of respiratory distress. There is no definitive list of accessory muscles,but the sternocleidomastoid(which lift upward the sternum)the scaleni(which lift the first two ribs) and anterior serrati muscles(which lift many of the ribs) are typically included. The involvement of these muscles seems to depend on the degree of respiratory effort. During quiet breathing, the scalenes are consistently physically active, while the sternocleidomastoids are quiet. With an increase in the respiratory volume, sternocleidomastoids also become active. These muscles are simultaneously activated when one breathes in at the maximal flow rate. During quiet breathing, there is little or no muscle contraction involved in exhalation; this process is simply driven by the elastic recoil of the lungs. When forceful exhalation is required, or when the elasticity of the lungs is reduced (as in emphysema), active exhalation can be achieved by contraction of the abdominal wall muscles the abdominal rectii(which have the powerful effect of pulling down the lower ribs and at the same time they and other abdominal muscles also compress the abdominal contents upward against the diaphragm), transverse abdominis, external oblique muscle and internal oblique muscle. These press the abdominal organs cranially (upward) into the diaphragm, reducing the volume of the thoracic cavity. The internal intercostal muscles have fibres that are angled obliquely downward and backward from rib to rib. These muscles can therefore assist in lowering the rib cage, adding force to exhalation.
Lung Volumes,Lung Capacities and Pulmonary Tests Performed By Spirometery Pulmonary function may be assessed clinically by means of a technique known as spirometry. In this procedure, a subject breathes in a closed system in which air is trapped within a light plastic bell floating in water. The bell moves up when the subject exhales and down when the subject inhales. The movements of the bell cause corresponding movements of a pen, which traces a record of the breathing called a spiro gram. More sophisticated computerized devices are now more commonly employed to assess lung function.Figure below shows a spirometer.
Pulmonary Volumes: There are four pulmonary volumes which are discussed below: Tidal volume: The volume of air inspired or expired in an unforced respiratory cycle is called tidal volume.Its normal value in average adult male is 500millilitres. Inspiratory reserve volume:The maximum volume of air that can be inspired during forced breathing in addition to tidal volume is called inspiratory reserve volume.Its value is 3000 millilitres. Expiratory reserve volume: The maximum volume of air that can be expired during forced breathing in addition to tidal volume is called expiratory reserve volume.Its normal value is about 1100 millilitres. Residual volume: The volume of gas remaining in the lungs after a maximum expiration is called residual volume.Its normal value is 1200 millilitres. Pulmonary capacities: In describing pulmonary cycle it is sometime desirable to comine two or more lung volumes such combinations are called lung capacities.There are four lung capacities which are described below:
Inspiratory capacity:The inspiratory capacity is the sum of tidal volume and respiratory reserve volume.This is the maximum amount of air a person can breathe in,beginning at the normal expiratorty level and distending the lungs to the maximum amount.Its normal value is: IC=VTI+RV, IC=3000+500=3500 Functional Residual Capacity: This is the sum of expiratory reserve volume and residual volume.This is the amount of air remaining in the lungs after a normal tidal expiration.Its normal value is: FRC=ERV+RV, FRC=1100+1200=2300 Vital Capacity: The vital capacity is the sum of three volumes i.e.inspiratory reserve volume,tidal volume and expiratory reserve volume.This is the maximum amount of air that a person can expired after a maximum inspiration.Its normal value is: VC=IRV+VT+ERV, VC=3000+500+1100=4600 Total Lung Capacity:It is the sum of the vital capacity and the residual volume.It is the maximum amount of air in the lungs after a maximum inspiration.Its normal value is: TLC=VC+RV, TLC=4600+1200=5800
Dead Space: Some of the air a person breathes never reaches the gas exchange areas but simply fills respiratory passages where gas exchange does not occur, such as the nose, pharynx, and trachea. This air is called dead space air because it is not useful for gas exchange. Dead Space Volume:The normal dead space volume in young adult men is about 150ml and this increases slightly with age. Respiratory Minute Volume(RMV):It is the total volume of air moving in to the lungs per minute.It is equal to tidal volume multiplied by respiratory rate per minute.Th normal tidal volume is 500millilitres and the normal respiratory rate is about 12 breaths per minute.So its value is normally (500ml/breath×12breaths/min)=6L.A person can live for a short period with respiratory minute volume as low as1.5L/min and a respiratory rate of only 2 to 4 breaths per minute. Maximal Voluntary Ventilation(MVV):Maximum voluntary ventilation is also reffered as maximal breathing capacity(MBC) and it is the maximumamount of air that can be moved in to and out of the lungs in 1min by voluntary effort.Its normal value is 140 to180L/min for healthy adult males. Respiratory minute volume and maximal voluntary ventilation are very important to pulmonary physician and changes in its normal value are indicative of lung dysfunction or some kind of pulmonary disease.
Pulmonary Function Tests Performed By Spirometery: Forced Expiratory Vital Capacity(FVC) and Forced Expiratory Volume(FEV1): It is a useful clinical pulmonary test and is also easily can be performed by a spirometer.First of all we should explain Forced expiratory vital capacity and forced expiratory volume. Forced expiratory vital capacity(FVC):It is the maximum volume of air that can be expired after a maximal inspiratory effort. Forced expiratory volume(FEV1):It is the volume of vital capacity that is expired during the first second of a forced expiration. The FEV1/FVC ratio, also called Tiffeneau-Pinelli index, is a calculated ratio used in the diagnosis of obstructive and restrictive lung diseases.The normal value of this ratio is 80% and(65% in people older then age 65).Lower value then this indicated some kind of pulmonary disease. In order to measure the FVC(forced vital capacity)the person first is allowed to inspire maximally to the TLC(total lung capacity)and then exhales in to the spirometer with the maximum expiratory effort as quickly and as completely as possible.Then a spirogram is obtain and from it we calculate the FEV1/FVC ratio.Study two graphs shown below (A) a person
with normal lungs and (B)a person with partial airway obstruction. Note that the the total volume changes of FVCs are not too much different and there is a slight difference in the basic lung volumes in the two persons.But there is a big difference in the amount of air that these persons expire during each second and especially during the first second.Therefore it is necessary to compare the forced expiratory volume during the first second(FEV1) with the normal.In normal person ratio value is 80% and in person with airway obstruction it is 47%.In persons with acute asthma this value decreases to 20%. Determination of Functional Residual Capacity(FRC),Residual Volume(RV) and total Lung Capacity(TLC):
These terms are very important in lung function.First we determine FRC and then from it we can calculate RV and TLC. The spirometer cannot be used directly to measure the FRC because air in the residual volume of lungs cannot be expired in to the spirometer,and this volume makes approximately one half of FRC.So spirometer is used indirectly to measure FRC usually by means of helium dilution method.In helium dilution method first a spirometer of known volume is filled with air mixed with helium at a known concentration. Before breathing from the spirometer, the person expires normally. At the end of this expiration, the remaining volume in the lungs is equal to the FRC. At this point, the person quickly begins to breathe from the spirometer, and the gases of the spirometer mix with the gases of the lungs. As a result, the helium becomes diluted by the FRC gases, and the volume of the FRC can be calculated from the degree of dilution of the helium, using the following formula: FRC=(CiHe/CfHe-1)ViSpir where FRC is functional residual capacity, CiHe is initial concentration of helium in the spirometer, CfHe is final concentration of helium in the spirometer, and ViSpir is initial volume of the spirometer. Once the FRC has been determined, the residual volume (RV) can be determined by subtracting expiratory reserve volume (ERV), as measured by normal spirometry, from the FRC. Also, the total lung capacity (TLC)
can be determined by adding the inspiratory capacity (IC) to the FRC. That is, RV=FRC-ERV and TLC=FRC-IC(2) How we can differentiate between obstructive lung diseases and restrictive lung diseases? (3) Spirometry is useful in the diagnosis of lung diseases. On the basis of pulmonary function tests, lung disorders can be classified as restrictive or obstructive. The normal value of FVC in healthy adult male is 5.0 L, FEV1 is approximately 4.0 L, so, the calculated FEV1/FVC is 80%. And in patients with obstructive or restrictive diseases have reduced FVC and its value is 3.0 L, and this measurement alone does not differentiate between the two. However, measurement of FEV1 can significantly vary between the two diseases. In obstructive disorders, patients spirogram show a slow, steady slope to the FVC, resulting in a small FEV1, and its value is 1.3 L. However, in the restrictive disorder patients, air flow tends to be fast at first, and then due to the loss of elasticity, quickly levels out to approach FVC. The resultant FEV1 is much greater, and its value is 2.8 L, even though FVC is equivalent. So calculation of FEV1/FVC ratio for obstructive (42%) and restrictive (90%) patients is used in evaluating these two diseases. Obstructive disorders result in a marked decrease in both FVC and FEV1/ FVC, whereas restrictive disorders result in a loss of FVC without loss in FEV1/FVC.Graph below explains it more clearly
Examples of obstructive pulmonary disesease are COPD(Chronic Obstructive Pulmonary Disease),Asthma and Bronchiectasis and examples of restrictive pulmonary diseases are Interstitial lung disease and scoliosis.(3) REFERENCES: (1)https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Thoraciccage#:~:text=The%20thoracic%20cage%20(human%20rib,and%20the%2012%20thoracic%20vertebrae (2)Guyton and Hall Textbook of Medical Physiology Fourteenth Edition Chapter 38#Pulmonary Ventilation Ganong Review of Medical Physiology 23 Edition Section7 Respiratory Physiology THANK YOU
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