Gas Exchange And Transport Flashcards
Bronchial circulation
Is systemic but small, brings nutrients to bronchioles
Pulmonary circulation
High flow, low pressure (25mmHg, normal is 120)
PACO2
40mmHg
PaCO2
40mmHg
PAO2
100mmHg
PaO2
100mmHg
PvCO2
46mmHg
PvO2
40mmHg
Things that affect rate of diffusion across membrane
Partial pressure gradient, gas solubility, available surface area, thickness of membrane
Why does CO2 diffuse faster than O2
It is much more soluble
Emphysema
Destruction of alveoli decreases surface area for gas exchange, PAO2 decreases
Fibrotic lung disease
Thickened alveolar membrane slows gas exchange, PAO2 decreases. Shows on xray
Pulmonary oedema
Fluid in interstitial space increases diffusion distance, PACO2 may still be normal as CO2 is very water soluble
Asthma
Bronchioles are constricted, O2 low in both
Ventilation perfusion relationship
Should ideally match each other in L/min
Blood flow and ventilation in Base of lungs
Blood flow > ventilation as arterial pressure>alveolar pressure, alveoli are compressed
Blood flow and ventilation in apex of lungs
Blood flow < ventilation as arterial pressure < alveolar pressure so arterioles are compressed.
Where does ventilation match perfusion
Rib 3
Ventilation perfusion ratio
Mostly mismatches at apex, 75% works well
Autoregulation when ventilation < blood flow
Creates a shunt which dilutes oxygenated blood. Decreased PO2 around these alveoli constricts their arterioles and blood is diverted. This response only happens in pulmonary vessels. Increased PO2 also causes mild bronchodilation.
Autoregulation when ventilation > blood flow
Alveolar dead space is created. Increased PO2 causes pulmonary vasodilation and decreased PCO2 causes mild bronchial constriction.
Physiologic dead space
Anatomical DS + Alveolar DS
How much O2 dissolves per litre plasma
3ml
What is the O2 carrying capacity in blood due to Hb
200ml
How is CO2 transported in the blood
In solution
Why is arterial PO2 different to arterial O2 concentration
PaO2 is just the dissolved oxygen not what is carried by Hb. It is determined by O2 solubility and the partial pressure of O2 in the gaseous phase driving it into solution.
Oxygen tension
100mgHg in arteries
Cardiac output
5L/min (1000ml/min of O2)
How much oxygen binds to each gram of Hb
1.34ml
92% of Hb is in
HbA (adult form)
HbA2
Lambda chains replace beta chains
HbF
Gamma chains replace beta chains (higher affinity for O2)
Glycosylated Hb
Caused by high blood sugar especially in diabetes can be used as a marker for uncontrolled diabetes
What determines Hb saturation
PaO2
Time for saturation of Hb to take place
0.25s (total contact time is 0.75s)
Until where is Hb 90% saturated
60mmHg
Myoglobin
Higher affinity for O2 even than HbF
Anaemia
A condition where the oxygen carrying capacity of the blood is compromised
Factors increasing Hb affinity for O2
Increase in pH, decrease in PCO2, decrease in temperature, decrease in DPHG (produces when RBC working hard eg high altitude or heart/lung diseases). They will be less likely to let go of oxygen.
Factors decreasing Hb affinity for oxygen
Decreasing pH, increasing PCO2, increasing temperature, increasing DPG. Oxygen more likely to get to tissues
How can alkalosis or acidosis be compensated for
Hypo or hyperventilating
CO + Hb
Carboxyhaemoglobin
Affinity of Hb for CO
250x more than O2
Concentration of CO needed to form carboxyhaemoglobin (in mmHg)
0.4mmHg
Symptoms of carbon monoxide poisoning
Hypoxia and anaemia, nausea and headaches, cherry red skin. Normal resp rate as PCO2 is normal. Can cause potential brain damage and death.
5 causes of hypoxia
Hypoxaemic, anaemic, stagnant, histotoxic, metabolic
Hypoxaemic hypoxia
Most common, less O2 diffusion at lungs due to low atmospheric O2 or tissue pathology
Anaemic hypoxia
Blood can’t carry O2
Stagnant hypoxia
Inefficient pumping of blood to lungs and body due to heart disease
Histotoxic hypoxia
Cells are poisoned by CO or cyanide etc and can’t use oxygen
Metabolic hypoxia
Oxygen delivery to tissues doesn’t meet an increased demand
CO2 transport in blood
7% dissolved in plasma and erythrocytes, 23% combines with deoxyheamoglobin to form carbamino compounds, 70% forms carbonic acid in erythrocytes to yield hco3 and H ions which chlorine shift into blood mostly.
Hypoventilation on CO2
Retention and acidosis
Hyperventilation on CO2
Getting rid of more CO2 and alkalosis