Anatomical- Clinical Correlates of the Respiratory System Flashcards by Camelita Thrift

The rib cage provides a space in which the lungs inflate. What can a clinician logically infer from this statement?

Deformities of the thoracic wall directly impact upon the inflation of the lungs. Deformities of the vertebral column reduce the volyme of the pleural cavity and inflation of the lungs.

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What factors are important in increasing vascular resistance of the lungs?

Reduced inflation of the lungs
Hypoxia

NOTE: Hypoxia is a potent stimulus for vasoconstriction

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Kyphoscolosis may result in a significant __________ (increase/ decrease) in resistance and pressure in pulmonary circulation.

Increase

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In the fetus, pressure is higher in the pulmonary vessels than systemic vessels thuse there is right-left shunting of blood through the __________.

Foramen ovale

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When the lungs are fully inflated, resistance to pulmonary blood flow _________________ (increases/ decreases/ remains the same).

Increases

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When the lungs are fully expanded, pulmonary resistance goes up because of compression of the _____________.

Pulmonary capillaries

NOTE: This is due to the ballooning alveoli

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What are possible consequences of an increase in pulmonary resistance?

Dilation of the right heart
Dilation of the pulmonary artery
Pulmonary hypertension

NOTE: In extreme cases, cardiorespiratory failure and death may result

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Cor pulmonali

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

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What are the symptoms of cor pulmonali?

Ascites
Enlarged liver
Hypertrophy of the right ventricle
Distention of the external jugular vein
Edema around the ankles

NOTE: Pulmonary congestion is NOT a symptom of cor pumonali

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Anything that reduces blood flow through the right heart results in __________ congestion.

Systemic

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What are the symptoms of right heart failure and systemic congestion?

Engorgement of jugular veins
Elevated venous pressure
Ascites
Enlarged and tender liver
Cyanosis
Edema
Dilation of right heart

REMEMBER: Engorgement of jugular veins and edema are NOT symptoms of cor pulmonali

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Cor Pulmonale image

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Hepatojugular reflux

The distension of the neck veins precipitated by the maneuver of firm pressure over the liver.

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During inspiration, air pressure is lowest in what areas?

Alveoli

Bronchi

Trachea

Pleural cavity

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Contraction flattens the diaphragm and increases the volume of the _____________ and decreases volume of ___________.

thoracic cavity; abdomen

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What is required for the lungs to be fully inflated?

Thoracic wall must be structurally sound
Pleural cavities must remain empty (potential space)

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Flail chest

Multiple fractures resulting in a “floating” and unstable portion of the thoracic wall

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What hapens to the flail wall during inspiration and expiration?

Inspiration
- Flail wall moves in, opposite in direction to the expanding chest
Expiration
- The flail wall moves outward in the opposite direction

*This is due to the ambient pressure in comparison to the pressure inside the lungs. This is called paradoxical breathing.

What occurs during inspiration and expiration, in a blowing pneumothorax?

Inspiration

Air is “sucked” into the pleural cavity, collapsing the lung

Expiration

Air is “blown” out of the pleural cavity

Symptoms of an open pneumothorax

Cyanosis

Severe respiratory distress

Shock

NOTE: It is imperative to close the wound with gauze or a hand

In cases of an open pneumothorax, a _____________ promotes re-expansion of the collapsed lung.

Thoracostomy tube

In cases of a tension pneumothorax, what occurs during inspiration and expiration?

Inspiration

Air enters the pleural cavity through a valve-like opening

Expiration

The tissue valve closes preventing air from escaping

In cases of pneumothorax, the pressure continues to increases. What are the results of this?

Trachea is shifted
Contralateral lung is compressed and ventilation is impaired
Diaphragm is depressed
Venous return to the heart is impaired

What are the clinical manifestions of tension pneumothorax?

Respiratory distress
Cyanosis
Tracheal deviation
Chest pain
Hyper-resonance

Spontaneous pneumothorax

Air-filled blisters on the surface of an **emphysemic** lung can rupture releasing air into the pleural cavity and producting a pneumothorax **NOTE:** This is the most common type of pneumothorax

Chyle

A milky fluid consisting of **fat droplets and lymph.** It drains from the lacteals of the small intestine into the lymphatic system during digestion. **NOTE:** This substance can fill the pleural cavity, known as a **chylothorax**

Embolism

Obstruction of a blood vessel by a _transported_ clot, mass of bacteria or foreign bacteria.

What are predisposing factors for pulmonary embolism?

* Venous stasis * Coagulation disorders * Trauma * Post-operative or post-partum

What are the most common sources of pulmonary emboli?

* External iliac vein * Femoral vein * Deep femoral vein * Popliteal vein * Posterior tibial veins * Soleal plexus of veins

Following the flow of blood from the lesser saphenous vein, at what point do vessels first begin to get smaller?

After the pulmonary artery

What are the cardinal signs of a massive pulmonary embolism?

Sudden onset of **dyspnea** **Tachycardia** (in predisposed individuals)

What are the symptoms of a pulmonary infarction?

Pleural pain Breathlessness

Emphysema

Enlargement of alveoli because of the deterioration of alveolar septi and walls

\_\_\_\_\_\_\_\_\_\_ results in decreased elasticity, making expiration difficult.

Fibrosis \*Air becmes trapped in the alveoli during expiration

Centriacinar emphysema

Dsitended respiratory bronchioles of all orders communication with one another

Panacinar emphysema

All airways and alveoli involved with breakdown of diving walls

Signs of chronic obstuctive pulmonary disease

1. Exertional dyspnea 2. Trachypnea 3. Hyper-resonance 4. Asthenic body build 5. Use of respiratory muscles 6. Sternal lift 7. Diaphragm is flattened, inactive, and atrophied

What are the anatomical consequences of lung cancer?

* Metastasis to hilar and carinal nodes * Distortion of trachea * Collapse of right upper lobe due to compression of lobar bronchus * Superior vena cava syndrome

Signs of superior vena cava syndrome

* Edema and rubor of face, neck, and chest * Distention of superficial veins * Arm veins fail to drain on elevation

When is superior vena cava syndome most serious?

When the superior vena cava is obstructed _inferior_ to the entrance of the azygos vein. **NOTE:** They azygos vein and its tributaries provide an import collateral by which blood may return to the heart if the superior vena cava is obstructed.

Symptoms of Pancost syndrome

1. Horner's syndrome 2. Parathesia and paresis of arm and hand 3. Superior vena cava syndrome 4. Dyspnea 5. Dysphonia 6. Dysphargia 7. Paralysis of 1/2 of the diaphragm

A tumor of the thoracic inlet in also known as \_\_\_\_\_\_\_\_\_.

Pancoast's Syndrome **NOTE:** CN X, the brachial plexus, and phrenic nerve are found in this area

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the most common cause of a positive pressure pneumothorax.

Emphysema