Chapter 9 Adult Resp. Flashcards
The primary function of the resp. system is
Continous exchange of gases between the body cells and the ATM by the process of ventilation, gas exchange, and transport
The Primary function of the Resp. system
Is the continuous exchange of gases between the body cells and the ATM by the processes of ventilation, gas exchange, and transport.
- CO2 is continually produce by the cells of the body and must be continuously removed and excreted into the atm
- body cells also need a continuous supply of O2 which must be absorbed from the atm
-both CO2 and O2 are transported to and from the lungs by the blood.
Inhaled air must be
- warmed to body temp
-humidified to the point of saturation
-filtered before it reaches the alveoli
Once air is in the lungs
the air in the alveoli and the blood in the pulmonary capillaries has to be equally matched on either side of the extremely thin A/C membrane (V/Q) matching.
External respiration
describe the process of breathing which includes the processes of ventilation, gas exchange, and gas transport.
- refers to alveolar ventilation ( breathing )
-passage of inhaled and exhaled gas through the conditioning-conducting region airways.
-inhaled gas through resp. bronchioles into the alveolar sacs
-exhaled gas from the alveolar sacs into the trachea-bronchial tree and exhalation through the airway opening.
Respiration ( aka internal respiration)
properly refers to the metabolic processes that mitochondria in the cells use to obtain energy by oxidizing glucose to produce ATP
- gas exchange (diffusion) of gases from the blood to the tissue cells.
- gas diffusion across the A/C membrane into the pulmonary capillary blood
-gas diffusion across the erythrocyte membrane into the red blood cells (RBCs) that are located in the pulmonary capillary blood.
-gas diffusion across the tissue capillary membrane into the tissue interstitial spaces around the body cells
-gas diffusion from the tissue interstitial fluid across the tissue cell membranes into the cytosol ( fluid inside the cells)
Mechanical process
moving air into and out of the alveoli is usually called breathing or ventilation.
The central anterior thoracic landmark
the sternum is made of three fused bones
-the manubrium, the body (gladiolus) and the xiphoid process.
> the xiphoid is the smallest of the three bones.
> - it provides an attachment point for attachment of some of the abdominal muscle
- during CPR the xiphoid process can be fractured and damage underlying organs.
The thorax
- Bony cage that contain and protect the cardiopulmonary system structure.
- The costal cartilage are normally flexible and allow the thorax to increase and decrease its size during breathing
- The clavicles, sternum, ribs, scapulae, and vertebrae are bony anatomical landmarks of the anterior, lateral and posterior thorax.
- The suprasternal notch- depressed at the base of the neck.
The angle of louis, aka the sternomanubrio angle, about 5cm below, the cartilage of the second ribs attach to the sternum at the sternal angle. - The intercostal spaces are named for the rib above each space.
- The first intercostal pace is located below rib 1 and above rib 2
- The intercostal VEIN, ARTERY, and nerve run along the costal grove on the inferior margin of each rib.
Thoracic landmarks to locate underlying structures
- The trachea bifurcates into the right and left mainstem bronchi (the tracheal carina) at the angle of Louis, anteriorly and at about the level of the 4 and 5 thoracic vertebra ( T4 or 5) posteriorly.
- At the end tidal expiration the right dome of the diaphragm is at about the level of the 5th rib anteriorly and T8 or T9 posteriorly (pushed up by the liver)
-The left dome of the diaphragm is at about the 6th
rib anteriorly and T9 or T10 posteriorly.
-The superior lung boarders are about 2-4 cm (Text says 1-2 cm) above the medial third of the
clavicles anteriorly and T1 posteriorly.
-The inferior lung boarders (bases) are at about the 6th
rib on the midclavicular line anteriorly,
extending to the 8 th rib laterally, and between T9 and T12 posteriorly (depending on the level of
ventilation).
-The pulmonic valve of the heart is located at the 2nd
left intercostal space near the sternal boarder. - The diaphragm has its normal dome shape. - the liver pushes the right dome of the diaphragm up about 1-3 cm higher than the left dome.
Thorax rib structure and articulation
- 12 pairs of ribs are elastic (flexible) arches of bones.
- The joints of the thorcic cage bones allow the thorax to change its anteroposterior and lateral dimensions during breathing
Intervertebral joints and disks
give the spinal column a degree of flexibility without reducing its stability.
Costovertebral joints
allow the heads of ribs 2-9 to articulate (joint, where two bones are attached to allow parts to move ) with the costal articular facets of the vertebra above and the one below.
- The costovertebral joints of rib 1, 10, 11 and 12 articulate with one facet on the adjacent vertebra ( rib 1 with the articular facet on t1, etc) and differ in other ways which is why they are called atypical ribs
Costotransverse joint
allow the tubercle of the rib to articulate with the articular facet on the transverse process of the adjacent vertebra
Costochondral joint
exits because the distal end of the ribs are connected to the sternum by flexible HYALINE cartilage
-The posterior rib attachments are higher than the anterior joints, so the ribs have a downward slant.
-All of these articulations gives the ribs two basic arcs of rotation called pump handle and the bucket handle movement.
1. The pump handle movement, muscle contraction rotates the rib head around the costovertebral joints. This rotation pulls up the distal ends of the ribs, especially rib 2 through 7, lifting the sternum and displacing it anteriorly. This rotation increase the anterposterior dimension of the thorax.
2. Bucket movement, the same muscle contraction rotates the long axis of the ribs and reduces their downward slant. This movement increases the lateral ( transverse) dimension of the thorax.
Typical ribs
consists of head, a neck and body.
- head is wedge shape and has two articular facets separated by a wedge of bone, one facet articulate with the verterbra, the other facets articulates with the vertebra above.
- The neck contains no bony prominences, but simple connects the head with the body, where the neck meets the body there is a roughed tubercle, with a facet for articulation with the transverse process of the corresponding vertabrae
- The body or shaft of the ribs is flat and curved
- The internal surface of the shaft has a groove for the neurovascular supply of thorax, protecting the vessel and nerves from damage.
Atypical ribs
Ribs 1,2,10,11 and 12 are atypical ribs because they have characteristics that are different than the other ribs.
- Rib 1 is the shortest, strongest, broadest, and most curved of all ribs.
- The rib only has one facet on its head for articulation with its corresponding vertebrae, this is because there is not a vertebra above rib 1.
The superior surface has two grooves, which make way for the subclavian vessels.
- Rib 2 is atypical for several reasons:
o It is thinner and longer than the rib above (rib 1).
o Rib 2 has a roughened area on its upper surface.
o The serratus anterior muscle attaches to rib 2 on this roughened surface.
- Rib 10 only has one facet for articulation with its numerically corresponding vertebrae.
- Ribs 11 and 12 have no neck, and have only one facet, for articulation with their corresponding
vertebrae
The thorax is covered with integumentary tissue (skin and subcutaneous fat) over a layer of skeletal muscle
Fascia ( a type of connective tissue covers the muscle and anchors it to any adjacent tissues)
The complex articulations between the thoracic vertebrae, the ribs and costal cartilages and the sternum produce a series of skeletal arches and planes that both stabilize the thorax and limit thoracic movement during breathing.
Xray
- The radiation is blocked by dense (radio opaque) material such a bone, muscle, tissue and liquid, producing a white or grey image.
- Air filled lung tissue is radiolucent, it does not block the radiation.
- In pleural effusion, it take about 175-200 ml of fluid to cause blunted costophrenic( place where the diaphragm meets the ribs) angles.
Chest x-ray background
X-ray are electromagnetic waves produced when high electrical voltage bombard s a cooper anode inside a vacuum tube.
-Dense material ( bone and liquid) absorb x-ray energy and stop it from passing through to the film.
- Dense materials that block energy are called opaque or radiopaque
-Radiopaque materials allow less energy to reach the film and produce whitish images on the films
- The white area on x-ray are called opacifications
- white areas in the lung tissue are called infiltrates.
- Less dense materials that allow x-ray energy to pass through are called lucent or radiolucent.
- the dark areas on xray are called lucencies.
When evaluating X-ray
Ideally chest films are taken with the patient standing, this way is called PA (posterior anterior or posteroantero) films.
To check for rotation- The medial ends of the clavicles and the spinous processes of the vertebra.
- spinous process should be midway between the medial ends of clavicles, trachea should be aligned with vertebral column.
Over and under exposure of xray
overexposed films have very dark lung fields in which the peripheral blood vessel cant be seen.
Underexposed films the lungs are whiter than normal and the vertebrae cant be seen through the heart shadow.
The Silhourette sign and Air Bronchogram sign
Help localize causes of opacities to the lung paraenchyma(issue which conducts the specific function of the organ) as opposed to the pleura and the thorax
The Silhourette sign
exist because the dense heart produces a white shadow with sharply defined borders in sharp contrast to the dark shadows of normal lung tissue.
- if the lung tissue in front or on either side of the heart becomes dense ( due to consolidation or atelectasis) the sharp contrast is lost and heart margins become “ blurred”
- Since the heart is located in the anterior chest, any lung density that obscures the heart borders must also be located in front of the heart in the anterior chest.
- If opacities appear to overlap the heart borders but dont obscure them, the area of lung density must be located behind the heart in the posterior chest and the dense lung tissue is not touching the heart
Air Bronchogram
relies on the fact that normal, air filled bronchi are very difficult to identify on an Xray.
- if air filled bronchi pass through dense consolidated or inflamed alveoli, the bronchi will produce a contrast and appear as tubular luncencies ( dark lines) opaques( whiter) lung fields.
- The air bronchogram sign indicates that the disease process is located in the alveolar spaces of the lung and not in the interstitium or the pleural space.
- if the lesion fills the airways as well as the alveoli, the air bronchogram sign will not be seen.
The pulmonary air meniscus sign
crescent shaped pocket of air (radiolucency) bordering (around) a mass lesion( an area of consolidated lung tissue)
Blunting of Costophrenic angles
sign of pleural effusion ( Fluid can accumulate around the lungs due to poor pumping by the heart or by inflammation)
Kerley Lines
are a pattern of whitish linear streaks throughout the lung. Kerley lines are seen in diffuse interstitial disease due to thickening or infiltration of the interlobular septa
- Kerley A lines - are long linear streaks
- Kerley B lines are short horizontal transverse streaks usually seen in the lung base, early cardiogenic pulmonary edema causes engorgement of the pulmonary lymphatics and a thickening of the interlobular septa, which is one entity that produces KERLY B lines.
- Kerley C lines are a diffuse network of streaks caused by the overlapping of A and B lines.
Disk, Discoid, or plate atelectasis ( collapse lung)
also called Fleischer’s lines, is pattern of one or more transverse, linear opacities that look like the edge of a dinner plate, often seen with the atelectasis caused pulmonary embolus and painful chest conditions like rib fractures and pleurisy.
