English for doctors. Mechanics of breathing (lecture notes)

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English for doctors. Mechanics of breathing (lecture notes)

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LECTURE No. 27. Mechanics of breathing

Muscles of respiration: inspiration is always an active process. The following muscles are involved: The diaphragm is the most important muscle of inspiration. It is convex at rest, and flattens during contraction, thus elongating the thoracic cavity. Contraction of the external intercostals lifts the rib cage upward and outward, expanding the thoracic cavity. These muscles are more important for deep inhalations. Accessory muscles of inspiration, including the scalene (elevate the first two ribs) and sternocleidomastoid (elevate the sternum) muscles, are not active during quiet breathing, but become more important in exercise. Expiration is normally a passive process. The lung and chest wall are elastic and naturally return to their resting positions after being actively expanded during inspiration. Expiratory muscles are used during exercise, forced expiration and certain disease states. Abdominal muscles (rectus abdominis, internal and exter nal obliques, and transversus abdominis) increase intra-abdominal pressure, which pushes the diaphragm up, forc ing air out of the lungs. The internal intercostal muscles pull the ribs downward and inward, decreasing the thoracic volume. Elastic properties of the lungs: the lungs collapse if force is not applied to expand them. Elastin in the alveolar walls aids the passive deflation of the lungs. Collagen within the pulmonary interstitium resists further expansion at high lung volumes. Compliance is defined as the change in volume per unit change in pressure (AV/AP). In vivo, compliance is measured by esophageal balloon pres sure vs. lung volume at many points during inspiration and expiration. Each measurement is made after the pressure and volume have equilibrated and so this is called static compli ance. The compliance is the slope of the pressure-volume curve. Several observations can be made from the pressure-volumecurve.

Note that the pressure-volume relationship is different with deflation than with inflation of air (hysteresis). The compliance of the lungs is greater (the lungs are more distensible) in the middle volume and pressure ranges.

At high volumes and expanding pressures, the compliance is lower (the lungs are stiffer). Even when the lung has no expanding pressure, some air remains in the lungs. When saline is used to fill the lung, compliance is much greater (small pressure changes bring about large changes in volume). With saline inflation, there is little difference in the pressure-volume relationship with inflation or defla tion. This indicates that the differences seen between inflation and deflation of air must be due to surface forces in the air-liquid interface of the alveoli.

Causes of decreased compliance: pulmonary fibrosis, pulmonary venous congestion and edema, deficiency of surfactant. Causes of increased compliance: emphysema, age.

new words

muscles - muscles, muscles

respiration - breath

inspiration - breath

always - always

process - process

following - next

to be involved - to be involved

diaphragm - diaphragm

the most - the most

important - important

inspiration - inspiration

convex - convex

rest - rest

to flattens - smooth out

contraction - contraction

elongating - lengthening

the thoracic cavity - chest cavity

the thoracic - chest

the rib cage - chest rib

up - up

outward - out

expanding - expanding

volume - volume

compliance - consent

some - some

to remain - stay

saline - saline

to fill - fill

Compare the following sentences.

1. After dinner he drank some juice. - He drank some juice after dinner.

2. He does not drink milk after dinner, he drinks juice. He didn't drink milk after dinner, he drank juice.

3. I brought some books from the library. - I borrowed some books from the library.

4. I like books. - I love books.

Enter some, any, no or leave blanks, depending on the meaning.

1. There is... ink in my pen.

2. Is there. snow in the tree this morning?

3. My mother likes... music.

4. Are there. chess-players here?

5. There are. diagrams in the new book.

6. Are there. newspapers on the table?

7. Was there. water in the glass or... milk?

8. There was. soap in the box; he used wash his hands.

9. There was. soap in the box: it smells of. soap.

10. There are... letters for you on the table.

11. Do you like... apples?

12. Were there. of our teachers at the stadium?

13. There were. students of our group at the consultation yesterday.

14. Will there be... concerts at the club next month?

15. There were. yellow and green pencils on the table.

16. People need... oxygen for breathing.

17. Are there. mistakes in my dictation?

18. There are. juice in your cup.

19. My brother doesn't like. carrots.

20. I have. books now.

Answer the questions.

1. Is inspiration always an active process?

2. What muscles are involved in the mechanism of breathing?

3. What muscle is the most important of inspiration?

4. What does contraction of the external intercostals lift do?

5. What muscles are more important for deep inhalations?

6. What muscles are not active during quiet breathing?

7. Is expiration normally a passive process?

8. Are the lung and chest wall elastic?

9. Where are the expiratory muscles used in?

10. Where do the internal intercostal muscles pull the ribs?

Make the sentences of your own using the new words (10 sentences).

Make your own sentences using SOME, ANY, NO, EVERY (10 sentences).

Find one word, which is a little bit different in meaning from others (find one word that is slightly different from others in meaning):

1) a) air; b) muscles; c) organs;

2) a) eyes; b) brows; c) arms;

3) a) teeth; b) tongue; c) ligament;

4) a) coccyx; b) pelvis; c)shoulder;

5) a) elbow; b) arm; c)ear.

Author: Elena Belikova

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