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Adv. Patho > Chapter 35: Pulmonary Structures > Flashcards

Chapter 35: Pulmonary Structures Flashcards

1
Q

primary function of pulm system

A

Exchange of gases between the environmental air and blood

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2
Q

gas exchange processes

A

Ventilation: Movement of air into and out of the lungs​

Diffusion: Movement of gases between air spaces in the lungs and the bloodstream​

Perfusion: Movement of blood into and out of the capillary beds of the lungs to body organs and tissues​

Pulmonary system: Carries out the first two processes​

Cardiovascular system: Carries out the third process

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3
Q

gas exchange airways: acinus

A

Respiratory bronchioles​

Alveolar ducts​

Alveoli: Primary gas exchange units

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4
Q

structures of pulm system

A

Upper airways​

Two lungs​

-> Lobes: Right lung (three lobes); left lung (two lobes)​

-> Segments, then lobules ​

Lower airways​

Blood vessels serve the pulmonary system​

Chest wall or thoracic cage​

Diaphragm: Involved in ventilation​, dome-shaped muscle separates the thoracic and abdominal cavities

Mediastinum: Space between the lungs in the chest cavity, containing the heart, great vessels, and esophagus​

Conducting airways

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5
Q

upper airways

A

Upper airways: Warms and humidifies air​

Nasopharynx​

Oropharynx​

Larynx: Connects the upper and lower airways​

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6
Q

lower airways

A

Trachea​

Bronchi​

Terminal bronchioles

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7
Q

trachea

A

Carina: Ridge where the trachea divides into the right and left bronchi.​

Hila: Where the right and left bronchi enter the lungs, along with blood and lymph vessels.​

Goblet cells: Produce mucus.​

Cilia: Are hairlike structures inside trachea and bronchial.​

Goblet and cilia help propel foreign material upward to enable it to be coughed up.​

​

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8
Q

common place of aspiration

A

Aspiration tends to be on the right side. Bacteria tends to migrate to right side. Right side is shorter, fatter, and straighter –path of less resistance. Left side is at more of an angle.

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9
Q

gas exchange airways

A

Alveoli: Primary gas exchange units ​

Oxygen enters the blood, and carbon dioxide (CO2) is removed.​

Type I alveolar cells​: Alveolar structure​

Type II alveolar cells​: surfactant production -> prevents lung collapse ​increase surface tension​

Contain alveolar macrophages: Ingest foreign material, and remove it through the lymphatic system.

One cell thick alveoli membrane. Capillaries membrane is one cell thick. O2 can diffuse through membrane fast. O2 -> blood -> Hg. CO2 -> lungs > breath out. ​

Smokers lose surfactant -> prone to alveoli collapse ​

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10
Q

chest walls

A

Includes the skin, ribs, and intercostal muscles.​

Functions: Protects the lungs from injury; its muscles, in conjunction with the diaphragm, perform the muscular work of breathing.​

Thoracic cavity: Is contained by the chest wall and encases the lungs.

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11
Q

pleura

A

Serous membrane​

Adheres firmly to the lungs​

Folds over itself, and firmly attaches to the chest wall​

Visceral pleura: Membrane covering the lungs​

Parietal pleura: Lining the thoracic cavity

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12
Q

pleural space or pleural cavity

A

Fluid lubricates the pleural surfaces, allowing the two layers to slide over each other without separating.​

Pressure in the pleural space: Negative or sub atmospheric (−4 to −10 mm Hg)​

Between lungs and chest wall ​

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13
Q

ventilation

A

Is the mechanical movement of gas or air into and out of the lungs.​

Is not the same as respirations.​

Minute volume​: ventilatory rate is multiplied by the volume of air per breath.​ normal is 6 L/min. tidal vol (mL) x breathing rate per minute. amount of air moved in or out of the lungs per minute. increases with exercise as both tidal volume and breathing rate increase.

Alveolar ventilation​: Must be measured by arterial blood gases.​ Measures partial pressure of carbon dioxide (Paco2) =bets indicator of ventilation.

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14
Q

neurochemical control of ventilation

A

PaCO2 -> central chemoreceptors (brain) -> brainstem resp center -> mm of breath -> alveolar vent. *pCO2 is drive to breath

PaO2 and blood pH -> peripheral chemoreceptors -> brainstem resp centers -> mm of breathing -> alveolar vent

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15
Q

resp. center

A

Is located in the brainstem.​

Receives impulses from chemoreceptors in the carotid and aortic bodies: Detects the Paco2 and the amount of oxygen in the arterial blood. ​

Becomes active when increased ventilatory effort is required.

phrenic nerve innervates diaphragm -> contracts -> ventilation

Pneumotaxic and apneustic centers: Are located in the pons.​

Modifiers of the inspiratory depth and rate are established by the medullary centers.

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16
Q

lung receptors

A

irritant, stretch, juxta pulmonary cap repcetors

17
Q

irritant receptors

A

Are sensitive to noxious substances.​

When stimulated cause cough, bronchoconstriction, and increase respiratory rate.​

sense: chemicals, dust, cold air

effects: coughing, bronchoconstriction

18
Q

stretch receptors

A

Are sensitive to noxious substances.​

When stimulated cause cough, bronchoconstriction, and increase respiratory rate.​

sense: lung inflation

effect: inflation terminates

19
Q

juxta pulmonary cap receptors

A

Are sensitive to increased pulmonary capillary pressure.

sense: chemicals, stretch, pulm edema

effect: shallow breathing, bronchoconstriction, mucus secretion

20
Q

muscle, joint receptors

A

sense: chest wall position, muscle tension
effect: normal breathing

21
Q

ANS

A

ANS -> PSNS (ACH) -> cause smooth mm to contract (bronchoconstriction) are the main controllers of airway caliber

ANS -> SNS (E) -> cause smooth mm relaxation (bronchodilation)

22
Q

mechanics

A
  • lungs always want to come in and chest wall always wants to come out

end of expiration: lung and chest wall recoil, diaphragm relax.

inspiration: diaphragm contracts, lung and chest wall expand, muscular contraction dominates.

end of inspiration: diaphragm still contracted, muscular contraction maintains inflation

expiration: diaphragm relaxing, lung recoil dominates

23
Q

lung compliance

A

Elastic properties of the lungs and chest wall​

Compliance: Measures lung and chest wall distensibility.​ Represents the relative ease with which these structures can be stretched​. Reciprocal of elasticity​

Low: Increased work of inspiration​. Stiff lungs. Pulmonary fibrous, ARDS, anything that cases restriction ​

High: Increased work of expiration​. Easy to inflate; has lost some elastic recoil​. Ex. Emphysema ​

24
Q

gas transport

A

Delivery of oxygen to the cells of the body and the removal of CO2​

Four steps​
1. Ventilation of the lungs​
2. Diffusion of oxygen from the alveoli into the capillary blood​
3. Perfusion of systemic capillaries with oxygenated blood​
4. Diffusion of oxygen from systemic capillaries into the cells​

Diffusion of CO2 occurs in the reverse order.​

25
Q

02 transport in the blood

A

O2 from the alveoli diffuse into the blood, then O2 enters the RBC and binds to Hb. 3% of O2 is dissolved in plasma while 97% is bound to Hb -> oxyHb. the binding is reversible.

26
Q

pulmonary gas exchange

A

Respiration- Movement of gasses across alveoli- capillary membrane AND systemic capillary-cell.​

Diffusion-Movement of gases down a pressure gradient from an area of high pressure to an area of low pressure​
ex. pO2 in alveoli ~104 and pO2 in venous end of cap 40 -> O2 diffuses to cap.

Partial pressure of gasses: ​
The pressure exerted on a surface by the molecules of individual gasses​.
PP of O2 can be calculated for a given atmospheric pressure by multiplying concentration of a gas by the atmospheric (barometric pressure)​.
example: 760 mm Hg x 21% = 150 mm Hg​

27
Q

factors affecting diffusion through alveolar-cap membrane

A

Partial Pressure of Gasses​: higher altitude decrease partial pressure of atmospheric O2

Pressure Gradient​

Lung Surface Area​: Emphysema decreased lung SA​

Membrane Thickness​: Interstitial lung dz​, Lung fibrous ​increased thickness.

Length of Gas Exposure​: Increased activity decreases gas exposure ​

28
Q

gas exchange in the alveolus

A

inhaled O2 diffuses across membrane to oxygenate blood. CO2 diffuses into alveolus to be expelled thru exhalation

29
Q

determinants of O2 status

A

3 Major determinants​

PaO2​: Must Get from ABG results​, PP of Oxygen dissolved in arterial blood​, 3% of total O2​, Normal range 80-100mm Hg​

SaO2 and SpO2​: Percentage of oxygen bound to Hgb in the blood​, Normal value > 95%​, COPD Pat: 88-93%***​, Qualify for home O2 < 88%​

Hemoglobin​: Major carrier of O2 therefore important in tissue oxygenation

30
Q

classifications of hypoxemia

A

normal: 80-mmHg
mod: 60-80 mmHg * not uncommon for COPD
severe: 40-60 mmHg
very severe: <40 mmHg

31
Q

oxyhb dissociation curve

A

plays an important part in determining the affinity of O2 to Hb, which directly affects diffusion. relationship of pp of PaO2 and SaO2

Once we get to a certain spot, curve bottoms out. Sao2 90 an PaO2 60 -.> o2 starts unloading quickly

32
Q

right shift of oxyhb curve

A

causes: acidosis, hyperthermia, hypercapnia, increased 2,3 DPG

O2 doesn’t leave Hg or bind to Hg the normal way. Sa02 90 PaO2 80. O2 available for tissues. Ex. Exercise and septic. Doesn’t last forever. O2 readily leaves Hg in these conditions

33
Q

left shift of oxyHb curve

A

causes: alkalosis, hypothermia, hypocapnia, decreased 2,3-DPG

Hg holds onto O2. SaO2 90 PaO2 40. Early resp. Failure.

34
Q

pulm gas exchange: perfusion

A

Perfusion: pumping or flow of blood into tissues and organs. Altered by (3) factors:

Cardiac output​: mCO =SV X HR​, MAP is used clinically to reflect adequate perfusion​

  1. Gravity​
  2. ventilation/perfusion. Zones of west -> zone 1: apex, perfusion is absent. zone 2. perfusion is sporadic. zone 3. perfusion is constant
    ​
35
Q

CO2 transport

A

CO2 is carried in the blood 3 ways​:

Dissolved in plasma​

Transported as Bicarb​

Combined with blood proteins

*indirect measurement of bicarb

Adv. Patho (5 decks)

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