Chapter 21 Flashcards by Deborah Karp

Tidal volume

The amount of air inspired or expired during nl respiration

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FRC

The amount of air contained in the lungs after nl expiration

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The amount of air exhaled following maximal inspiration and forced expiration

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The amount of air remaining in the lungs after maximal expiration

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FEV1

The volume of air exhaled in 1 second with a maximum expiratory effort

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Criteria for operative risk for pulmonary resection

Preoperative FEV1:
>40% predicted: little increased risk
30-40% predicted: increased risk of pulmonary complications
<30% predicted: prohibitive risk

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Etiologies of hypoxemia

Hypoventilation
Diffusion gradient
V/Q mismatch

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Presence of a new solitary nodule in a pt with smoking hx

Must be assumed to be a lung CA until proven otherwise

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What is the most common cause of cancer-related death in men and women

Lung CA

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____ of lung cancer is non-small cell lung CA

80%

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What percentages of NSCLC are resectable?

5-yr survival?

20%

70%

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What is the cornerstone of therapy for stage I and stage II dz for NSCLC?

Surgical resection

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What has demonstrated a clear benefit in stage II and III dz for NSCLC?

Adjuvant therapy

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Who are considered not to be operative candidates, particularly with contralateral positive nodes?

Stage IIIB

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What are signs of inoperability in lung CA?

Bloody pleural effusion
Horner syndrome
SVC syndrome
Distant metastases

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What is the central purpose of respiration?

Deliver oxygen to erythrocytes and clear carbon dioxide

This enables the body’s cells to undergo aerobic metabolism to efficiently produce ATP

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What does gas exchange in respiration consist of?

Ventilation
Blood-gas interface
Perfusion

Ventilation

The process by which atmospheric air travels to the alveoli

Blood-gas interface

The site of gas exchange

Perfusion

Whereby blood passes through this interface

How is the pressure gradient required for air movement generated?

By the primary and accessory respiratory muscles

What is the upper airway composed of?

Mouth
Pharynx
Larynx

What is the conducting zone of the lung composed of?

The trachea and the first 16 generations of the airways

This zone is the anatomical dead space because there is an absence of alveoli

What comes after the conducting zone?

17th-19th generations: respiratory bronchioles (transition zone)
Generations 20-23- lined with alveolar ducts and sacs (respiratory zone)

Composition of conducting airways distal to the pharynx

Have cartilaginous walls with minimal smooth muscle | Lined with ciliated epithelium interspersed with mucus-secreting goblet cells

Smokers and pathology

Demonstrate abnormalities in both mucous production and ciliary motility that contribute to their difficulties with secretion clearance

Bronchiectasis

A condition in which the bronchi are dilated and a loss of ciliary action occurs Secretions pool and can become chronically infected, a situation that may be associated with hemoptysis

What is the transition zone composed of?

Membranous and terminal bronchioles | They do not contain cartilage and are innervated by the autonomic nervous system.

Histologic morphology of the respiratory zone

Contains 300 million alveoli

What is the critical component of the alveoli that is integral for movement?

The elastin that is embedded within the basal lamina in the alveolar septal interstitium

What are the two major types of alveolar epithelial cells?

Type I cells: the major lining cells, large, flat, squamous cells with cytoplasmic extensions and are primarily responsible for gas exchange Type II cells: Granular pneumocyte that are thicker and are responsible for producing surfactant

Where are surfactant levels decreased?

Respiratory distress syndrome Acute pancreatitis Smokers

How is ventilation achieved?

Achieved by air movement to and from the alveoli Accomplished by a decrease in intrathoracic pressure relative to the atmosphere when the diaphragm contracts and the thoracic cavity expands

What occurs when large volumes of air are required?

The external intercostal muscles contract, which further expands the thoracic cavity

How is ventilation assessed?

By the measurement of the partial pressure of arterial carbon dioxide

What is the driving pressure for airflow through the entire system?

The difference between the alveolar pressure and pressure at the airway opening (atmospheric pressure)

What are the components of alveolar pressure?

Elastic recoil pressure and the pleural pressure

Hypoxemia

``` Clinically manifested as low oxygen tension in the arterial blood Typically results from: -Hypoventilation -Diffusion gradients -Shunt -Ventilation-perfusion mismatch ```

Causes of hypoventilation

Drugs Mechanical impairments of the chest wall Paralysis of the respiratory muscles

What can cause arterial hypoxemia?

Any interstitial lung process such as collagen vascular dz, sarcoidosis, and idiopathic interstitial fibrosis

Shunt

The fraction of blood that enters the systemic arterial system without passing through a ventilated portion of the lung

Causes of shunt

Occur due to intracardiac communications such as in congenital heart disease, arteriovenous malformations of the lung, lung consolidation, and vasodilators such as nitroprusside