Anatomy and Physiology of lungs Lecture 1 weekend 3

Question 1

How many true, false and floating ribs

Answer 1

true 1-7 false 8-10 floating 11-12

Question 2

What are lungs desing for and what attaches at the sternal angle and what bifurcates behind it???

Answer 2

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

Question 3

What joints provide more stability than mobility think posterior

Answer 3

Provides posterior support and is stability driven

- vertebral column stacking
- ligamentous support
- difference in upper and lower rib costo-transverse joints

Question 4

Difference between upper and lower costal joints think direction

Answer 4

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

Question 5

Where does functional mobility of the chest increase????

As you go move inferior and ____________? Where does the “most” mobility lie???

Answer 5

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

Question 6

Upper ribs which way

Middle ribs move primairly which way

Lower Ribs move primairly which way???

Answer 6

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

Question 7

Does Every muscle originating or inserting on the trunk is it a respiratory muscle and or postural muscle?????

Answer 7

YES

Question 8

Sequence of a normal breath

Answer 8

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

Question 9

Triad of Normal Ventilation

Answer 9

Abs, intercostals, diaphragm

Question 10

What is the diaphargm innervated by how much is it responsible for breathing and provides what percent to all tidal volume

Answer 10

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

Question 11

How is the central tendon of the diaphargm stablizied.

Answer 11

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

Question 12

Intercostals how are they innervated what ribs??

what is there function

Answer 12

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

Question 13

Abdominals what innervates them and what is there purpose???

Answer 13

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

Question 14

Erector spinae innervated by:

Answer 14

Innervation: T1-S3

Stabilizes the thorax posteriorly to allow normal anterior chest wall movement to occur

Question 15

Pecs what nerves innervate them??? and can they provide exspasion while in trunk flexion

Answer 15

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.

Question 16

Serratus anterior purpose and innervation

is it the only “inspiratory muscle that is paired with trunk flexion instead of trunk extension movements

Answer 16

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

Question 17

Scalenes innervation: what does it does

Answer 17

Innervation: C3-C8
Provides superior and anterior expansion of the upper chest
Stabilizes the upper chest during inhalation

Question 18

SCM same purpose as the scalenes and its innervation

Answer 18

Innervation: C2-C3 and accessory cranial nerve
Provides superior and anterior expansion of the upper chest
Stabilizes the upper chest during inhalation

Question 19

Traps purpose and is it efficent at its job? and its innervation

Answer 19

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

Question 20

Viscreal pleura vs. Pariteal pleura

Answer 20

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.

Question 21

Right vs Left lung how many lobes in each???

Answer 21

right upper, middle and lower Left: upper and lower due to the heart.

Question 22

Pulmonary veins and arteries do you have less at birth than you do at ten years of age??????

Answer 22

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.

Question 23

Bronchial circulation how may bronchial arteries are on right how many on left????

Answer 23

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.

Question 24

Lymphatic ciruclation what is its realtionship with the avelovi (think removal)

Answer 24

Drains excess fluid from interstitial spaces and serves as a pathway for elimination of particulate matter and microorganisms that reach the alveoli

Question 25

Components of upper airways and purpose

Answer 25

Components: nose, mouth, pharynx, and larynx
Function
-cleanse, heat and humidify the incoming air
-provide resonance for phonation

Question 26

Purpose the cilia??? what is mainly immersed in??

Answer 26

Sol layer: 90% water
Gel layer: sticky, catches pollutants
Cilia are present

Question 27

What does dehydration due to the lungs??? think thick mucous of the cilia what does it need to be like

Answer 27

Dehydration leads to immobility of secretions

Gel layer is very viscous and does not allow the cilia to function

Question 28

What are the respiratory centers yes brainstem but what does the medulla control and what does the pons control.

Answer 28

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)

Question 29

Chemorecptors both Central and Peripheral

Where are the central ones located and what is the normal range

Where are the peripheral ones located??

Answer 29

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

Question 30

Reflexes two types

Answer 30

Cough/Gag (take it bitch)

Muscle Spindle (lungs are expanded to far and the GTO’s come into play.

Question 31

What is compliance?? explain difference between two much and too little

Answer 31

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??

Question 32

Airway resistance:

Too much air what happens

too little air what happens (people need what kind of device)

Answer 32

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)

Question 33

Ventilation/Perfusion Matching

Explain a shunt vs a deadspace

Answer 33

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

Question 34

3 factors that affect the chest wall development??

Answer 34

Gravity
Muscle Strength
Muscle Tone

Question 35

Normal Chest Wall Development

Answer 35

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

Question 36

3-6 months

Answer 36

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

Question 37

6-12 months

Answer 37

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

Question 38

over 12 months I dont think development is that big of a deal???

Answer 38

Trends continue but at a less dramatic rate

Flaring of the ribs becomes less apparent as the abdominals and intercostals become stronger

Question 39

Trends with age

Answer 39

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

Question 40

Brain stem lesions

Answer 40

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.

Question 41

Whats apneusis ?????

Whats cluster breathing???

Answer 41

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

Question 42

whats biots respirations

whats central apnea:

Answer 42

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

Question 43

Paralyzed intercostals and ABS vs Paralyzed diaphargm think about each region that each controls

Answer 43

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

Question 44

Diaphragm paralyzed and paralyzed intercostals due to ????

Paralyzed diaphragm due to ?

Upper accessory musles only ( SCM, Traps, scalenes)

Answer 44

Diaphragm and upper accessory muscles only (paralyzed intercostals

Isolated diaphragm (eg SCI)

Upper accessory muscles only (eg High SCI)

Question 45

Lateral breathers

Asymmetrical breathers

Shallow breathers

Altered speech supporters

Answer 45

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