79 - The Physiological Consequences of Disruption or Destruction of the Alveolar Capillary Membrane Flashcards

1
Q

Number of alveoli in lungs

A

~200-300 million

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2
Q

Interstitium in lungs

A

Space between alveolar membranes and capillaries

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3
Q
What is the alveolar-capillary membrane composed of?
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A

Layer of surfactant
Type I alveolar cells (forms alveolar membrane)
Basement membrane
Vascular endothelial cell

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4
Q
Features of A-C membrane 
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A

Thin (0.5 microns)
Large surface area (50-100M2)
Alveolar volume is ~3-6L
Capillary volume is ~80L (increases is increased cardiac output)

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5
Q
Examples of diseases/processes that can disrupt A-C membrane
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A
Acute H1N1 (pandemic influenza)
Emphysema
Lymphangitis carcinomatosis (infiltrating cancer)
Drug-induced pneumonitis
Idiopathic pulmonary fibrosis 
Tuberculosis
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6
Q

Pneumonitis

A

Inflammation of alveoli (also called alveolitis).

Pneumonia is a subtype of pneumonitis (implies an infectious aetiology)

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7
Q

Likely physiological effects of disrupting A-C membrane
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A

Abnormal gas exchange
Abnormal lung mechanics
Pulmonary vascular complications

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8
Q

What affects partial pressures of gasses in the alveoli?

A

Ventilation of alveoli

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9
Q

Equation that describes rate of diffusion of a gas

A

Fick’s law

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10
Q

Fick’s law

A

Rate of ventilation is proportional to (surface area x gas constant x (difference in partial pressures)) / Thickness of membrane

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11
Q

Amount of time that an average RBC spends in contact with alveolar membrane at rest

A

~0.75 second

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12
Q

Amount of time that an average RBC spends in contact with alveolar membrane at rest

A

~0.25 second

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13
Q

Rough amount of time required for RBC Hb molecules to become oxygenated

A

~0.25 second

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14
Q

What doesn’t limit gas exchange in a normal person?

A

Diffusion (only takes ~0.25 second to oxygenate Hb in an RBC)

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15
Q

When is O2 transfer diffusion-limited at rest?

A

Only when there is a gross abnormality of the AC membrane (EG: thickening).
With exercise, can become apparent with less-severe disease).

Can desaturate O2 with exercise

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16
Q

Effect of thickened A-C membrane on O2 saturation

A

Takes a longer time to saturate RBC Hb

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17
Q

Difference in diffusion between CO2 and O2

A

The same, except CO2 diffusion is 20 times faster.

18
Q

V/Q mismatch of CO2

A

Doesn’t really affect CO2.

If hypercapnic, is from poor alveolar ventilation, not from poor diffusion, as CO2 diffuses so well

19
Q

What can cause low PaO2

A
Low PiO2 (low inspired oxygen, EG: altitude)
Low ventilation
Abnormal gas exchange (low V/Q, shunt, diffusion impairment)
20
Q

What does abnormal gas exchange for O2 mean?

A

Wide A/a gradient for O2

21
Q

What can cause high PaCO2?

A

Low ventilation

22
Q

Effect of low ventilation

A

Not breathing in enough O2, not breathing out enough CO2.

23
Q

Causes of low PaO2 with normal A-a gradient

A

Low PiO2 and low ventilation

24
Q

Most common cause of abnormal gas exchange

A

V/Q mismatch.
Particularly units with inadequate ventilation for the amount of perfusion (amount of blood going through segment). Extreme form is shunts.

25
Q

When is diffusion impairment most obvious?

A

During exercise

26
Q

Mechanical effects of restrictive lung disease

A

Like having a tight band around your chest (lungs stiffer, harder to inflate).
–> breathless, increased work of breathing, reduced lung volumes, altered patterns of breathing

27
Q

Why do alveolar-capillary membrane diseases increase work of breathing ?

A

Because the inspiratory muscles need to generate higher

pressures to overcome the stiffness (reduced compliance) of the lungs (elastic work of breathing)

28
Q

Important consequences of increased WOB
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A
  1. Recruitment of accessory muscles of inspiration (scalene and sternomastoid muscles)
  2. Increased oxygen consumption by respiratory muscles
  3. Risk of respiratory muscle fatigue, if the airway obstruction is severe
29
Q

Effect on lung volumes of stiff lungs

A

All lung volumes reduced

30
Q

Effect on FEV1 and FVC of stiff lungs

A

Decreased FEV1, FVC.

Normal FEV1/FVC ratio

31
Q

Effect on FEV1 and FVC of narrowed airways

A

Decreased FEV1, normal FVC.

Decreased FEV1/FVC raito

32
Q

FER

A

Forced expiratory ratio (FEV1/FVC)

33
Q

Only constrictive lung disease without stiff lungs

A

Emphysema

34
Q

Components of lungs leading to compliance
1
2

A

1) Tissue composition (elastic, fibrous)

2) Surface tension in alveoli. Reduced by surfactant.

35
Q

Example of a disease leading to reduced surfactant

A

Premature baby hyaline membrane disease

36
Q

What determines elastic properties of the lungs

A

Lung compliance

37
Q

Lung resistance in emphysema

A

Decreased, because of destruction of elastic tissue,

Emphysematous lungs hyperinflate

38
Q

Breathing pattern of those with restrictive lung disease

A

Prefer rapid, short breaths (to try to maintain alveolar ventilation)

39
Q

Breathing pattern of those with airflow obstruction

A

Prefer fewer, longer, deeper breaths (because difficult to get air through airways, so try to do this less)

40
Q

Effect of restrictive lung disease on maximum lung volume

A

Decreases

41
Q

What often limits exercise capacity of those with restrictive lung disease

A

Hypoxia with or without pulmonary hypertension

42
Q
Gas exchange and mechanical effects of restrictive lung disease
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A
  1. Increased sensation of breathing
  2. Increased elastic WOB
  3. Reduced lung volumes
  4. Altered pattern of breathing
  5. Reduced maximum ventilation
  6. Abnormal gas exchange, which
    worsens with exercise