Anatomy and Physiology of lungs Lecture 1 weekend 3 Flashcards
How many true, false and floating ribs
true 1-7 false 8-10 floating 11-12
What are lungs desing for and what attaches at the sternal angle and what bifurcates behind it???
The sternal angle rib 2 attaches and trachea bifurcates right at sternal angle and the purpose of the lungs is provide mobility at the expense of stability
What joints provide more stability than mobility think posterior
Provides posterior support and is stability driven
- vertebral column stacking - ligamentous support - difference in upper and lower rib costo-transverse joints
Difference between upper and lower costal joints think direction
Ribs 1-7 rotate increasing thoracic dimensions in the anterior and superior directions
Ribs 8-10 glide increasing thoracic dimensions in the lateral and superior directions
Where does functional mobility of the chest increase????
As you go move inferior and ____________? Where does the “most” mobility lie???
Potential mobility of the Chest
Potential mobility increases as you move inferiorly on the rib cage
Potential mobility increases as you move anteriorly on the rib cage
The most potential mobility lies along the xiphoid process and the inferior borders of the anterior and lateral ribs
Upper ribs which way
Middle ribs move primairly which way
Lower Ribs move primairly which way???
Upper ribs: move mostly anteriorly and superiorly
Middle ribs: transition between the upper and lower ribs, movement in all directions in fairly equal
Lower ribs: move mostly laterally and superiorly
Does Every muscle originating or inserting on the trunk is it a respiratory muscle and or postural muscle?????
YES
Sequence of a normal breath
Easy onset, subtle rise of the upper abdomen
Lateral costal expansion of the lower chest
Gentle rise of the upper chest primarily in the superior and anterior planes
Triad of Normal Ventilation
Abs, intercostals, diaphragm
What is the diaphargm innervated by how much is it responsible for breathing and provides what percent to all tidal volume
Innervation: phrenic n. C3-5 Performs 60-70% of the work of breathing Major muscle of passive ventilation Provides 2/3 to ¾ of tidal volume effort and volume Moves in all planes
How is the central tendon of the diaphargm stablizied.
Dependent on the intercostal and abdominals to help the diaphragm generate adequate pressure changes between the thoracic (neg) and abdominal (pos) cavities during inhalation
Uses the positive pressure of the abdominal cavity to “stabilize” the central tendon of the diaphragm. Once stable, the peripheral fibers of the diaphragm can produce lateral and superior expansion
Intercostals how are they innervated what ribs??
what is there function
Innervation: T1-T12
Functions to stabilize the rib cage during inhalation to prevent chest wall collapse toward the negative pressure generated in the thoracic cavity
Concentric contractions
Lateral and superior expansion in the lower chest
Anterior and superior in the upper chest
Abdominals what innervates them and what is there purpose???
Innervation: T6-L1
Stabilizes the inferior border of the rib cage as it interfaces the lower rib cage onto the abdomen
Provides visceral support
Provides positive pressure support for the diaphragm
Provides necessary intrathoracic pressure for an effective cough
Erector spinae innervated by:
Innervation: T1-S3
Stabilizes the thorax posteriorly to allow normal anterior chest wall movement to occur
Pecs what nerves innervate them??? and can they provide exspasion while in trunk flexion
Innervation: C5-T1
When used in reverse, provide upper chest anterior and lateral expansion
Can assist in expiratory maneuvers if trunk moves in flexion
Can substitute for rib cage stabilization in the case of intercostal paralysis thereby preventing paradoxical breathing.
Innervation: C5-T1
When used in reverse, provide upper chest anterior and lateral expansion
Can assist in expiratory maneuvers if trunk moves in flexion
Can substitute for rib cage stabilization in the case of intercostal paralysis thereby preventing paradoxical breathing.
Serratus anterior purpose and innervation
is it the only “inspiratory muscle that is paired with trunk flexion instead of trunk extension movements
Innervation: C5-C7
Provides posterior expansion of the rib cage when the upper extremities are fixed
Helpful in the case of patients with CF
Detrimental in the cases of brain injury where the patient may perceive it as the only respiratory pattern and will therefore have difficulty sitting up straight
It is the only inspiratory muscle that is paired with trunk flexion movements rather than trunk extension movements
Scalenes innervation: what does it does
Innervation: C3-C8
Provides superior and anterior expansion of the upper chest
Stabilizes the upper chest during inhalation
SCM same purpose as the scalenes and its innervation
Innervation: C2-C3 and accessory cranial nerve
Provides superior and anterior expansion of the upper chest
Stabilizes the upper chest during inhalation
Traps purpose and is it efficent at its job? and its innervation
Innervation: C2-C4 and “spinal” accessory cranial nerve
Provides superior expansion of the upper chest
Least energy efficient accessory muscle. Must lift the weight of the entire upper extremity to assist in inhalation
Viscreal pleura vs. Pariteal pleura
Visceral pleura
Covers surface of each lung
Inseparable from the lung tissue
Vascular supply from the broncheal vessels
Does not receive somatosensory nerve fibers.
Parietal pleura
Covers the inner surface of the chest wall
Blends with visceral pleura to enclose the root of the lung
Separate from visceral pleura by a thin serrous film, this potential space is known as the pleural space.
Right vs Left lung how many lobes in each???
right upper, middle and lower Left: upper and lower due to the heart.
Pulmonary veins and arteries do you have less at birth than you do at ten years of age??????
Delivers deoxygenated blood to the lungs and returns oxygenated blood to the heart
Low pressure system
Number of pulmonary arteries and veins going to and from the terminal respiratory units is complete at birth; however, the number of vessels within the terminal respiratory units at birth is markedly less than the number present after the first 10 years of life.
Bronchial circulation how may bronchial arteries are on right how many on left????
Delivers nutrient blood supply to the lungs.
One right bronchial artery
Two left bronchial arteries
Total bronchial blood flow to both lungs is estimated to be approximately 1-2% of the cardiac output.
Close Relationship between the bronchial and pulmonary circulation which allows tissue preservation when circulation is impaired in either system.
Lymphatic ciruclation what is its realtionship with the avelovi (think removal)
Drains excess fluid from interstitial spaces and serves as a pathway for elimination of particulate matter and microorganisms that reach the alveoli
Components of upper airways and purpose
Components: nose, mouth, pharynx, and larynx
Function
-cleanse, heat and humidify the incoming air
-provide resonance for phonation
Purpose the cilia??? what is mainly immersed in??
Sol layer: 90% water
Gel layer: sticky, catches pollutants
Cilia are present
What does dehydration due to the lungs??? think thick mucous of the cilia what does it need to be like
Dehydration leads to immobility of secretions
Gel layer is very viscous and does not allow the cilia to function
What are the respiratory centers yes brainstem but what does the medulla control and what does the pons control.
Respiratory centers in the brainstem
Respiratory center in the medulla: breathing that is not quite normal in character
Apneustic center in the pons: inspiratory gasps
Pneumotaxic center in the pons: balances the above two centers
Current research suggests that there may be many “mini-centers” in the brainstem, perhaps dozens of these “mini-centers”
to about the 12th generation of lung divisions (ANS control)
Chemorecptors both Central and Peripheral
Where are the central ones located and what is the normal range
Where are the peripheral ones located??
Chemoreceptors: CO2 sensitive
Central
Located in the medulla
Extremely sensitive and efficient at monitoring CO2 within a very narrow range (35-45mmHg)
Peripheral
Located in the carotid bodies
Less sensitive to changes in CO2 than the central receptors
Reflexes two types
Cough/Gag (take it bitch)
Muscle Spindle (lungs are expanded to far and the GTO’s come into play.
What is compliance?? explain difference between two much and too little
Compliance: ease at which the lungs expand
Too much: can’t return to baseline effectively, resulting in air trapping
Too little: can’t expand easily, resulting in a decreased inspiratory capacity
What about the chest wall??
Airway resistance:
Too much air what happens
too little air what happens (people need what kind of device)
Too much: air cannot move in a unidirectional flow
Too little:
If beyond the level of the cartilage support, the small airways collapse at the end of inspiration
These patients may need positive pressure support for exhalation to keep the airways patent (eg. CPAP, BiPAP, PEEP)
Ventilation/Perfusion Matching
Explain a shunt vs a deadspace
Position dependent blood flow (Q)
Ventilation (V) moves into the least resistant opening
V/Q mismatches occur when
Deadspace: ventilation in excess of perfusion (eg PE)dead space is the volume of air which is inhaled that does not take part in the gas exchange, either because it (1) remains in the conducting airways, or (2) reaches alveoli that are not perfused or poorly perfused. In other words, not all the air in each breath is available for the exchange of oxygen and carbon dioxide. (Think of ballon example for shunt)
Shunt: perfusion in excess of ventilation (eg atelectasis or airway obstruction)physiological condition which results when the alveoli of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region. In other words, the ventilation/perfusion ratio (the ratio of air reaching the alveoli to blood perfusing them) is zero.[1] A pulmonary shunt often occurs when the alveoli fill with fluid, causing parts of the lung to be unventilated although they are still perfused
3 factors that affect the chest wall development??
Gravity
Muscle Strength
Muscle Tone
Normal Chest Wall Development
Newborn
Shape and Size: triangular in the frontal plane and circular in the horizontal plane; it occupies about 1/3 of trunk
Narrow intercostal spacing & horizontal ribs
Musculoskeletal development
Functions similarly to the pelvis for stability
Parallel gross motor development
Breathing patterns: obligatory diaphragm breathers!! No accessory muscles and no pulmonary reserves
RR of 40-60
3-6 months
Shape and size More rectangular, but still not elongated Musculoskeletal development Upper thorax still functioning similar to pelvis—no axial rotation in T/S Parallel gross motor development Log rolling Breathing patterns Upper chest expansion is possible Still primarily diaphragmatic breathers RR is decreasing
6-12 months
Shape and Size
More rectangular; now elongating and ribs begin to rotate downward; lung size has increase 4x since birth!!
Musculoskeletal development
Once the ribs have rotated downward elongation and rotation is possible
Parallel gross motor development
Transition from creeping to walking (greater O2 demands
Breathing patterns: all patterns are available
over 12 months I dont think development is that big of a deal???
Trends continue but at a less dramatic rate
Flaring of the ribs becomes less apparent as the abdominals and intercostals become stronger
Trends with age
Increased lung compliance
Decreased elastic recoil of the lung tissue
Decreased chest wall compliance
Stiff chest wall
Decreased lung volumes and expiratory flow rates
Except residual volume which increases
Brain stem lesions
Cheyne-Stokes: consists of alternating crescendos to hyperpnea and decrescendos to apnea. Associated with lesions deep inside the cerebellum and the basal ganglia
Cental Neurogenic hyperventilation: respirations that are rapid (>24), continual, regular, and deep. Associated with lesions in the lower midbrain to middle pons area.
Whats apneusis ?????
Whats cluster breathing???
Apneusis: Prolonged inspiration with a pause at the inspiratory peak and sometimes the expiratory peak. Associated with lesions in the middle to lower pons area with extensive brain stem damage
Cluster breathing: Irregular spurts of breathing interspursed with periods of apnea. Associated with lesions in the upper medulla
whats biots respirations
whats central apnea:
Biot’s respirations: completely irregular, unpredictable patterns, with deep and shallow random breaths and pauses. Associated with lesions in the medulla.
Central Apnea: All respiratory centers of the central nervous system are impaired resulting in complete apnea. Associated with severe increased intracranial pressure and patient’s often require long term mechanical ventilation
Paralyzed intercostals and ABS vs Paralyzed diaphargm think about each region that each controls
Paralyzed intercostals &/or Abdominals
Upper chest collapses during inspiration
Belly rises excessively—diaphragm does not encounter any resistance as the central tendon descends.
Paralyzed diaphragm
Lower chest and abdomen collapse during inspiration
Upper chest rises excessively
Diaphragm paralyzed and paralyzed intercostals due to ????
Paralyzed diaphragm due to ?
Upper accessory musles only ( SCM, Traps, scalenes)
Diaphragm and upper accessory muscles only (paralyzed intercostals
Isolated diaphragm (eg SCI)
Upper accessory muscles only (eg High SCI)
Lateral breathers
Asymmetrical breathers
Shallow breathers
Altered speech supporters
Lateral Breathers: weakness, not paralysis of the trunk muscles
Asymmetrical breathers: eg hemiplegia, post surgical patients
Shallow breathers: eg high tone patients
Altered speech support patterns: poor breath support or poor eccentric control
