Chapter Five

Pressure in body organs

Pressure is defined as the force per unit area in a gas or liquid (For solid
the term pressure is replaced by "stress"). In the metric system pressure is
measured in (1) dynes per square centimeter (Dy/cm2) or (2) Newton per square meter
(N/m2) or Pascal (Pa).
P = F/A = N/m2 or dyne/cm2
In medicine, the unit of the pressure is used by the height of a column of mercury (Hg)
or column of water .
1 atmosphere = 1 × 105 N/m2 (Pascal) =760 mmHg = 1033 cm H2O
The peak systolic pressure = 120mm Hg = a pressure of a liquid mercury of this height
on its base. While the atmospheric pressure = 760mm Hg

Table: Lists some of the common units used to measure Pressure and gives the
atmospheric pressure in each system.

Atmospheres N/m² cm H2O mmHg

1 atmosphere 1 1.01*105 1033 760

1 N/m2 0.987*10-5 1 0.0102 0.0075
1 cm H2O 9.68*10-4 98.1 1 0.735
1 mm Hg 0.00132 133 1.36 1

The pressure P under a column of liquid can be calculated from the following low:
P=ρgh
h : the height of the column (m)
ρ : is the density of the liquid
density of mercury (Hg) = 13.6 gm/cm3 or 13600 Kg/m3
density of water (H2O) = 1.0 gm/cm3 or 1000 Kg/m3
g = 9.8 m/s2 or 980 cm/s2
g is the acceleration due to the gravity

Example -1-
Find the pressure of 10 m of water in Dy/cm2 and N/m2?
10 × 100 = 1000 cm 1m=100cm
... P = ρ g h =1×980×1000=980000=9.8×105 Dy/cm2 P
= ρ g h =1000 × 9.8 ×10 =9.8×104 N/m2
Example -2-
what height of water will be produced the same pressure as 120 mmHg?
Solution:
P = ρ g h = 13.6 x 980 x 12
= 1.6 x 105 dy/cm2
For water P=ρgh
1.6x105 = 1 x 980x h
So h = 163 cm H2O
Or PHg = P H2O
(ρ g h)Hg = ( ρ g h) H2O
ρHg hHg = ρ H2O h H2O
h H2O = (13.6x12)/1 = 163 cm H2O
The most common method of indicating pressure in medicine is by the height of a
column of mercury (Hg). For example , a peak (systolic )blood pressure reading of 120
mmHg indicates that a column of mercury of this height has a pressure at its base equal
to the patients systolic blood pressure .
Gauge Pressure
The excess pressure over atmospheric pressure .

Gauge Pressure (P) = Absolute pressure – Atmospheric pressure

Gauge pressure =ρ g h
=1000 x 9.8x10
=105 N/m2 = 1 atm
Absolute pressure=atmospheric pressure + gauge pressure
=1+ 1= 2 atm Or In N/m2
=105 + 105= 2x 105 N/m2
Atmospheric pressure = ρHg g hHg =13600x 9.8 x0.76
=105 N/m2

Negative Pressure
Any pressure lower than atmospheric pressure . There are numbers of places in the
body where the pressure is lower than atmospheric pressure or negative .For example
when we breathe (inspire) the pressure in the lungs must be lower than the atmospheric
pressure .
The most common clinical instrument used in the measuring pressure is the
sphygmomanometer, which measures blood pressure.

Typical pressure in the normal body

Different parts of the body Arterial
Typical pressure(mmHg)
blood pressure
Maximum (systole) 100 - 140
Minimum (diastole ) 60 - 90
Venous blood pressure 3-7
Middle ear pressure less than 1
Eye pressure (aqueous humor) 20
CSF inside the brain 5 – 12
Measurement of pressure in the body
1. Manometer
This is a U-shaped tube containing a fluid that is connected to the pressure to be
measured Fig (1) . The levels in the arms change until the different in the levels (h) is
equal to the pressure.
• It is a U- tube
• Containing fluid (Hg or H2O)
• Connected to the pressure to be measured
• this type of manometer can measure both (positive) and (negative)
pressure.
* The fluid used can be:
• 1. Mercury for high pressure measurements.
• 2. Water or other low density fluid for low pressures.

P0 = atmospheric pressure h = height of liquid

P = the pressure of container.

Po

Figure (1): U tube manometer for measuring pressure can be expressed

as the height of the fluid.
 2. Sphygmomanometer
It´s the most common clinical instrument used in measuring blood pressure is the
sphygmomanometer .three types of pressure gauges are used in sphygmomanometer,
are :-
a. Mercury manometer : the pressure is indicated by The height of column of
mercury inside glass tube .
b. Electronic system : contains a digital screen .
c. Aneroid type : the pressure changes the shape of a sealed flexible container
which causes a needle to move on a dial .
Example :-
1. Ear : is very sensitive to pressure .
A person going up or down in an elevator or an airplane is often aware of the change in
atmospheric pressure on the ears .
2. Veins : as a hand is raised slightly above the level of the heart these veins
become smaller due to the lower venous blood pressure .
Method :
A simple method to measure the venous pressure at the heart is to observe the veins
on the back of the hands . when the hands are lower than the heart the veins stand out
because of increased venous pressure . as the hands are slowly raised above the level
of the heart a point is reached at which the veins collapse : this indicates a pressure of
(zero)(0 cm)of blood . the height of the hand veins above the heart gives the venous
pressure at the heart in centimeter of blood . venous pressure normally averages (8-16
cmH20) or (blood) . A pressure in excess of 16 cmH20 may indicate congestive heart
failure .

Pressure inside the skull

The brain contains approximately 150 ml (cm3) of cerebrospinal fluid (CSF) in a series of
interconnected openings called ventricles . One of the ventricles, the aqueduct is
especially narrow. CSF is generated inside the brain and flows through the ventricles
into the spinal column and eventually into the circulatory system.
A cross-section of the brain showing the location of the cerebrospinal fluid (shaded area) and the aqueduct
(narrow).

If at birth this opening is blocked for any reason, the CSF is trapped inside the skull and
increases the internal pressure. The increased pressure causes the skull to enlarge. This
serious condition is called hydrocephalous (water-head) . Hydrocephalous occurs in
infants .

Measuring the CSF pressure

It is not convenient to measure the SCF pressure directly. There are two methods:
1- Crude method:
- This method can measure the pressure inside the skull by measuring the
circumference of the skull just above the ears.
- The Normal values for newborn infants are from (32-37) cm
- larger value than (32-37) cm may indicate hydrocephalus.
 2- Transillumination: is a qualitative method of detection. Make use of the light –
scattering properties of the rather clear CSF inside the skull.

Eye pressure

The clear fluid (water) in the eyeball (aqueous humors) maintains the internal pressure
of the eye. The pressure in normal eyes range (12-23 mmHg). That transmit the light to
the retina (the light sensitive part of the eye), are under pressure and maintain the eyeball
in a fixed size and shape. A change of only 0.1mm in the eye diameter has a significant
effect on the clarity of vision. The eye continuously produces aqueous humors and a drain
system allows escaping. If a partial blockage of this drain system occurs, If the pressure
increased due to a partial blockage then the blood supply to the retina will be restricted
and thus affecting vision (glaucoma) which produces tunnel vision in moderate cases and
blindness in sever cases.
Measuring the eye pressure
1- By feel
Estimated the pressure inside the eye by feel as they pressed on the eye with their
fingertips.
 2- Tonometer
Is an instrument used to measure the eye pressure in arbitrary units rather than in
mmHg .

Pressure in the digestive system:

The digestive system is an opening through the body with about 6 meter length
from the mouth to anus.
* It has several values and sphincters (circular muscles) which open for the passage of
food, drink, and their by-products, in a unidirectional flow.

Figure. The valves and sphincters of the digestive tract

Esophagus: The pressure is less than the atmospheric because it is coupled to the
pressure between the lungs and chest wall (intra-thoracic pressure).

Stomach: The pressure is higher than the atmospheric pressure because of the
stretching of the stomach walls and due to air swallowed during eating.
A-Eating increases the pressure in the stomach slowly due to increased volume
B-Air swallowed during eating increases the pressure in the stomach
Gut: gas flatus generated by the bacterial action increases the pressure, and hence it
is higher the atmospheric.
* Occasionally a blockage forms in the small or large intestine and a pressure build up
between the blockage and the pylorus. If this pressure becomes great enough to restrict
blood flow to critical organs, it can cause death. And can be solved by:
1. Intubation: - passing of a hollow tube through nose, stomach, and pylorus.
2. Surgery: - chosen when the intubations don't work.

Pressure in the skeleton

• The highest pressures in the body are found in the weight bearing bone
(joints). for example when all the weight of the body is on one leg,
• The pressure in the knee joint may be more than 10 atmospheres
P= F/A (1)
• The surface area of a bone at the joint is greater than its area either above or
below the joint. The larger area at the joint distributes the force, thus reducing
the pressure, according to equation (1).

Figure. The surface area of a bone at the joint is greater than its area either
above or below the joint.

a. Bone joint lubrication (the higher the pressure , the better the
lubrication) .
b. The finger bones are flat rather than cylindrical on the gripping side , the
force is spread over a larger surface, this reduces the pressure in the tissues
over the bones according to P = F/A.
Pressure in the urinary bladder
The interval pressure in the bladder is due to the accumulation of urine. The figure below
shows the typical pressure volume curves for the bladder, which stretches as the volume
increase.

1- The internal pressure in the bladder is due to the accumulation of urine.

2- The figure below shows the typical pressure-volume (P-V) relationship in the
urinary shows in fig .
 3- When the bladder is filled with urine , the volume of the bladder = 4/3πR3 is
increases , (this mean ; for a given increase in (R)the volume increases as
(R2) the volume increases as (R3, while the pressure (P=F/A=F/ πR2) only
increases as (R2) .
4- For adults , the typical maximum Volume in the bladder before voiding =
500ml and at some pressure nearly=30 cmH2O . when the micturition
reflex occurs.
→ The resulting sizable muscular contraction in the bladder wall produces a momentary
pressure of up to 150 cmH2O .
→ normally voiding pressure is fairly low ( 20 to 40 cmH2O) for men who suffer from
prostates obstruction of the urinary passage it may be over 100 cmH2O .
PV= constant
P1V1= P2V2

The pressure in the bladder can be measured:

1. (indirect method) catheter . The pressure in the bladder is measured by passing a
catheter with a pressure sensor to the bladder through the urinary passage
(Urethra).
2. (direct method) cystometry .: A needle is inserted through the walls of the
abdomen directly to the bladder. This technique gives information about the
function of the exit valves that cannot be obtained with the catheter technique.
The bladder pressure increases during coughing , straining , sitting up , also during
pregnancy, the weight of the fetus over the bladder increase the bladder pressure and
causes frequent urination.
Pressure effects while diving
The body is composed primarily of solids and liquids, which are nearly incompressible.
Pressure changes; do not greatly affect most of it . However, there are gas cavities in
the body where sudden pressure changes can produce profound effects.

Boyles law
States For a fixed quantity of gas a fixed temperature the product of the absolute and volume
is constant.
Pressure × Volume = constant ( at constant temperature)
P × V= constant P1V1=P2V2 = constant
That is, if the absolute pressure is doubled, the volume is halved.

Example :-
What volume of air at an atmospheric pressure of 1×105 n/m2 is needed to fill a
14.2 liter scuba tank to a pressure of 1.45×107 n/m2 .
P1V1=P2V2
(1×105)( V1) = (1.45×107) ×(14.2)
V1 = 2 × 103 liters
The middle ear is one of the air cavities that exist within the body. For comfort the
pressure in the middle ear should be equal to the pressure to the pressure on the
outside of the eardrum.
P middle ear = P outside eardrum
This equalized is produced by air flowing through the Eustachian tube, which is usually
closed except during swallowing, chewing, and yawning
When diving many people has difficulty obtaining pressure equalization and feels
pressure on their ears . if the pressure across the eardrum = (120mmHg) , which can occur
in about 1.7 m of water ,can cause damage (rupture) to the eardrum . One method of
equalization used by diver is to raise the pressure in the mouth by holding the nose and
trying to blow out .

Henrys law
States: The amount of gas that will dissolve in a liquid is proportional to the partial pressure
of the gas in contact with the liquid.
Example :
At sea level
The air contains : 20% O2 and 80% N2
The partial pressure of oxygen (PO2) = 20/100×760 = 150 mmHg
The partial pressure of the (N2) = 80/100×760 = 610 mmHg Under
water ( at depth 30 meter )

The pressure in the lung

Pressure in the lung at any depth in water greater than the pressure in the lung at
sea level.
Pin the lung at any depth > Pin the lung at sea level
This means that the air in the lung is denser under water and that the partial pressure
of all the air components (O2 and N2) are higher than 150 and 610 mmHg ( at sea level)
.

- The higher partial pressure of O2 causes more O2 molecules to be

transformed into the blood, and oxygen poisoning results if the partial
pressure of the O2 gets too high.
- Partial pressure of O2 is (0.8 atm) and absolute air pressure is (4 atm) at depth
of 30m.
- Breathing air at a depth of (30m) is also dangerous because it may result in
excess N2 in the blood and tissues ,there is a possibility of having :
• Nitrogen narcosis (intoxication effect).
• The bends or decompression sickness (a scant problem).
- O2 is attached to red blood cells , while N2 is dissolved in the blood and tissues

Hyperbaric oxygen therapy (HOT)

The body normally lives in an atmosphere that is about one fifth O2 and four- fifth N2.
In some medical applications, it is useful to increase the percentage (%) of O2 in order
to provide more O2 to the tissue. It's used Hyper – Oxygen Chamber .

Medical application :-
1- Gas gangrene:
The bacillus causes gas gangrene then its treated with (HOT) . That is due to bacillus cannot
survive in the presence of oxygen (O2).
2- Carbon monoxide poisoning:
• The red blood cells cannot carry O2 to the tissues because the carbon
monoxide fasters to the hemoglobin at the places normally used by O 2.
• Normally the amount of O2 dissolved in the blood is about 2% of that carried
on the red blood cells RBC .
• By using the (HOT) technique , the partial pressure of O2 can be increased by
a factor of 15, permitting enough O2 to be dissolved to fill the body’s needs
Treatment of cancer:
(HOT) with radiation is given to the patient in transparent plastic tank. The
theory was that more oxygen would make the poorly oxygenated radiation –
resistant cell in the center of the tumor more susceptible to radiation damage.

PROBLEMS
Q1. Assume you are a shallow water diver preparing for 10 m dive into
salt water ?
a-What absolute pressure and gauge pressure will you experience ?
b-Normally your lungs have an available volume of 6 liters . what
will happen to that volume ?