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Pathophysiology > 3 Levels of Respiration > Flashcards

3 Levels of Respiration Flashcards

1
Q

External Respiration Long Overview

A

Anatomy:

  • Upper airway
  • Lower airway
  • A-C membrane

Pleural Pressure of the lung at rest:

  • Elastic forces of the lung
    • Connective Tissue
    • Surface Tension
    • Surfactant
  • Elastic Forces of the chest wall
    • muscle
    • bone
  • Effects of Gravity

Neurology of breathing

  • Chemoreceptors
    • peripheral
    • central
  • Brainstem center
    • DRG
    • VRG
    • Apeunistic
    • Pneumotaxic
  • Reflexes
  • Phrenic nerve

Muscles of Inspiration

  • Diaphragm
  • Accesory

Pressure Gradient

  • Transthoracic
  • Transairway
  • Transpulmonary

Work of Breathing

  • Airway Resistance
    • Poiseuille’s Law
  • Lung Compliance
    • LaPlace’s Law
  • Time Constants
  • Retractions
  • Accessory Muscle Use

Diffusion

  • Ideal Gas Law
  • Dalton’s Law (PaO2)
  • Fick’s Law
  • Graham’s/Henry’s Law
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2
Q

External Respiration Anatomy

A
  • Upper Airways
  • Lower Airways
  • A/C Membrane

Upper Airways (upper respiratory tract)

  • nose and nasal passages, paranasal sinuses, the pharynx, and the portion of the larynx above the vocal folds (cords).

Lower Airways (lower respiratory tract)

  • larynx below the vocal folds, trachea, bronchi and bronchioles

A/C Membrane

  • a thin tissue barrier through which gases are exchanged between the alveolar air and the blood in the pulmonary capillaries. (aka blood-air barrier and blood-gas barrier)
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3
Q

External Respiration: Pleural Pressures of Lung at Rest

A
  • Elastic forces of the lung
    • connective tissue
    • surface tension
    • surfactant
  • Elastic forces of the chest wall
    • muscle
    • bone
  • Effects of Gravity
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4
Q

External Respiration: Neurology of Breathing

A
  • Chemoreceptors
    • perpheral
    • nervous
  • Brainstem Centers
    • DRG
      • dorsal respiratory group (DRG) has the most fundamental role in the control of respiration, initiating inspiration (inhalation)
    • VRG
      • ventral respiratory group (VRG) sends inhibitory impulses to the apneustic center (exhalation)
      • In quiet, restful breathing, the ventral respiratory group of neurons are inactive. They become active in forceful breathing.
    • Apeunistic (stimulating)
      • lower pons promotes inhalation by a constant stimulation of the neurons in the medulla oblongata
      • controls the intensity of breathing, giving positive impulses to the neurons involved with inhalation
      • inhibited by pulmonary stretch receptors and also by the pneumotaxic center
    • Pneumotaxic (inhibiting)
      • upper part of the pons that provides inhibitory impulses on inspiration and thereby prevents overdistension of the lungs and helps to maintain alternately recurrent inspiration and expiration.
  • Reflexes
  • Phrenic nerve
    • ​ originates in the neck (C3–C5) and passes down between the lung and heart to reach the diaphragm
    • passes motor information to the diaphragm and receives sensory information from it.
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5
Q

External Respiration: Muscles of Inspiration

A
  • Diaphragm
    • contracts and flattens when you inhale
    • creates a vacuum effect that pulls air into the lungs.
    • During exhalation, the diaphragm relaxes and the air is pushed out of lungs.
  • Accessory Muscles
    • external intercostal and scalene muscles, with accessory muscles being the sternocleidomastoid, pectoralis major and minor, serratus anterior, latissimus dorsi, and serratus posterior superior.
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6
Q

External Respiration: Pressure Gradients (TTT)

A
  • Transthoracic
    • the difference of pressure in the pleural space and the body surface
    • represents the total pressure required to expand or contract the lungs and chest wall.
  • Transairway
    • ​the pressure difference between the airway opening and the alveolus
    • required to produce airflow in the conductive airway
    • represents the pressure that must be generated to overcome resistance to gas in the airways.
  • Transpulmonary
    • ​ the difference between mean pulmonary artery pressure and mean wedge pressure.
    • A value greater than 12 mmHg is considered significant
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7
Q

External Respiration: Work of Breathing

A
  • Airway resistance
    • Poiseuille’s Law: a description of the pressure of a fluid as it travels through a cylindrical pipe.
  • Lung Compliance
    • LaPlace’s Law:
      • The behavior of the alveoli is largely dictated by LaPlace’s law and surface tension. It takes some effort to breathe in because these tiny balloons must be inflated, but the elastic recoil of the tiny balloons assists us in the process of exhalation.
  • Time Constants:
    • ​the amount of time it takes to inflate or deflate
  • Retractions
    • ​when the muscles between the ribs pull inward.
    • Intercostal retractions are due to reduced air pressure inside the chest
  • Accessory Muscle use
    • ​ assist, but do not play a primary role, in breathing
    • the sternocleidomastoid and the scalene muscles (anterior, middle and posterior scalene) are typically considered accessory muscles of breathing.
      • Both assist in elevating the rib cage.
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8
Q

External Respiration: Diffusion

A
  • Ideal Gas Law
    • an expanded volume will lower the pressure and allow air to flow into the lungs through the bronchial passages. Exhalation can be accomplished by just relaxing the chest and allowing the elastic recoil of the alveoli to force the air out of the lungs.
  • Dalton’s Law
    • implies that the relative concentration of gasses (their partial pressures) does not change as the pressure and volume of the gas mixture changes, so that air inhaled into the lungs will have the same relative concentration of gasses as atmospheric air.
  • Fick’s Law
    • the rate of diffusion of a gas across a permeable membrane is determined by the chemical nature of the membrane itself, the surface area of the membrane, the partial pressure gradient of the gas across the membrane, and the thickness of the membrane
  • Graham/Henry’s Law
    • The amount of oxygen that dissolves into the bloodstream is directly proportional to the partial pressure of oxygen in alveolar air. The partial pressure of oxygen is greater in alveolar air than in deoxygenated blood, so oxygen has a high tendency to dissolve into deoxygenated blood.
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9
Q

Internal Respiration Long Overview

A

Anatomy

  • Heart
    • muscle
    • valves
    • electrical
  • Arteries- 3 tunicas
  • Veins - 3 tunicas

Hemodynamics

  • Cardiac output
  • blood pressures
  • indexing to body mass
  • venticular workload
  • vascular resistance

Pulses

  • Central
  • peripheral

V/Q Ratio

  • shunt
  • low ratio mismatch
  • high ratio mismatch
  • deadspace

Oxygen Transport

  • A-a gradient
  • O2 content
  • O2 delivery
  • O2 consumption
  • O2 extraction ratio
  • shunt equation

CO2 & Acid/Base

  • Henderson-Hasselbalch
  • RQ
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10
Q

Internal Respiration: Anatomy

A
  • Heart
    • muscle
    • valves
    • electrical
  • Arteries (3 tunicas)
  • Veins (3 tunicas)
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11
Q

Internal Respiration: Hemodynamics

A
  • Cardiac output
    • The amount of blood the heart pumps through the circulatory system in a minute.
    • SV x HR = CO
  • Blood pressure
    • There are three primary factors that determine the resistance to blood flow within a single vessel: vessel diameter (or radius), vessel length, and viscosity of the blood. Of these three factors, the most important quantitatively and physiologically is vessel diamete
  • Indexing to body mass
  • ventricular workload
  • vascular resistance
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12
Q

Internal Respiration: Pulses

A
  • Central
  • Peripheral
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13
Q

Internal Respiration: V/Q Ratios

A

V /Q: (V) the amount of air that reaches your alveoli divided by the amount of (Q) blood flow in the capillaries in your lungs.

When your lungs are functioning properly, 4 liters of air enter your respiratory tract while 5 liters of blood go through your capillaries every minute for a V/Q ratio of 0.8

  • Shunt:
    • While in a pulmonary shunt, the ventilation/perfusion ratio is zero
    • V/Q (where V = ventilation, and Q = perfusion) ratio of less than 0.005 are indistinguishable from shunt from a gas exchange perspective.
  • low ratio mismatch
  • high ratio mismatch
    • Some common causes of hypoxemia due to V/Q mismatch include asthma, COPD, bronchiectasis, cystic fibrosis, interstitial lung diseases (ILDs), and pulmonary hypertension.
  • deadspace
    • ​Alveolar dead space, on the other hand, refers to the volume of air in alveoli that are ventilated but not perfused, and thus gas exchange does not take place.
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14
Q

Internal Respiration: Oxygen Transport

A
  • A-a gradient
    • ​the alveolar-arterial gradient, measures the difference between the oxygen concentration in the alveoli and arterial system. The A-a gradient has important clinical utility as it can help narrow the differential diagnosis for hypoxemia.
  • O2 content
  • O2 delivery
  • O2 consumption
  • O2 extraction ratio
  • shunt equation
    • ​quantifies the extent that venous blood bypasses oxygenation in the capillaries of the lung. Shunt and dead space are terms used to describe conditions where either blood flow or ventilation does not meet the other in the lung as it should for gas exchange to take place.
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15
Q

Internal Respiration: CO2 and Acid/Base

A
  • Henderson-Hasselbach:
    • describes the relationship between blood pH and the components of the H2 CO3 buffering system.
    • This qualitative description of acid/base physiology allows the metabolic component to be separated from the respiratory components of acid/base balance.
  • RQ
    • ​Respiratory quotient, also known as the respiratory ratio (RQ), is defined as the volume of carbon dioxide released over the volume of oxygen absorbed during respiration.
    • It is a dimensionless number used in a calculation for basal metabolic rate when estimated from carbon dioxide production to oxygen absorption
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16
Q

Cellular Respiration Long Overview

A

Anatomy

  • Cytoplasm
    • Glycolysis: carbohydrates and glucogenic
    • amino acids
  • Mitochondria
    • beta-oxidation: fatty acids and ketogenic
    • amino acids
    • Kreb’s cycle
    • oxidative phosphorylation

Lactate Level

  • Normal Range
  • Levels of concern

Pathophysiology (3 decks)

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