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Cardiopulmonary > gas exchange- cole and karius > Flashcards

gas exchange- cole and karius Flashcards

1
Q

Purpose of the cilia

A

Move mucus and particles towards pharynx

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2
Q

Common airway diseases are characterized by ___ or ___

A

Excessive mucus

Deficient clearance of particles trapped in mucus

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3
Q

3 cell types that make airway mucus

A

Goblet cells

Clara cells of terminal bronchiles

Serous cells of submucosal glands

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4
Q

3 main contents of airway mucus

A

Mucins (MUC5AC, 5B)

Antimicrobial molecules (Ig, lysozyme, etc.)

Immunomodulatory molecules (cytokines, etc.)

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5
Q

Normal mucus is _% solids (non-water)

A

3%

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6
Q

Which 2 cell types rest on the basal membrane of airways but do NOT reach the lumen?

Which of these can often be cancerous? Name of condition?

A

Basal cells

Neuroendocrine cells

NE cells - bronchial carcinoid tumors

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7
Q

Describe smoker’s respiratory epithelium

Increased what?
Decreased what?

A

Change to stratified squamous (less ciliated columnar) for better protection

Increased goblet cells but decreased movement of mucus

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8
Q

Smoker’s melanosis

A

Benign pigmentations of oral mucosa (black-ish) in mouth

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9
Q

So, typical “respiratory epithelium” consists of what?

A

Ciliated pseudostratified columnar epithelium w/ goblet cells

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10
Q

How many C-shaped rings of ___ are in the trachea?

A

Hyaline cartilage

15-20

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11
Q

Where is the trachealis muscle?

Purpose?

A

In the trachea, between the lumen and the esophagus

Smooth muscle that narrows during cough reflex, thus air velocity increases

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12
Q

What is the fibroelastic ligament?

A

Near the trachealis muscle

Collagen and elastic fibers that prevent over-distention of lumen

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13
Q

As bronchi divide, what happens to the hyaline cartilage rings?

A

Become intermittent cartilage plates dispersed behind the mucosa and smooth muscle bundles

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14
Q

What is BALT?

Seen where?

A

Bronchial-associated lymphoid tissue

Aggregates of lymphoid tissue in the wall of intrapulmonary bronchi

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15
Q

From inside to outside, list these (respiratory wall)?

Mucosa, cilia, adventitia, sub-mucosa

A

Cilia, mucosa, sub-mucosa, adventitia

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16
Q

Put these in order from inside to outside (respiratory mucosa):

Basement membrane
Elastic fibers
Respiratory epithelium

A

Epithelium
BM
Elastic fibers

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17
Q

What layer are the cartilage rings/plates in?

A

Inner part of adventitia (outermost layer)

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18
Q

Primary vs. secondary (lobar) bronchi wall

A

Primary - cartilage rings

Secondary - cartilage plates (islands)

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19
Q

Respiratory epithelium in terminal bronchioles

A

No goblet cells, simple ciliated columnar

Goblet cells replaced by clara cells

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20
Q

Asthma - responses to trigger? (2)

A

Bronchoconstriction of smooth muscle bundles around bronchiolar lumen

Mucus hypersecretion by goblet cells

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21
Q

What is a pulmonary lobule?

A

Terminal bronchiole and the associated tissue region it supplies

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22
Q

What is a pulmonary acinus?

A

Respiratory bronchiole and its associated alveoli and alveolar ducts

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23
Q

What is alveolar bronchiolization?

A

Clara cells proliferate and migrate to replenish alveolar epithelial cells following airway injury

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24
Q

Cystic fibrosis

A

Abnormally thick mucus by respiratory/GI glands due to defective Cl- transport out and increased Na+ absorption (H2O follows)

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25
Q

Airflow through the conducting airway is affected by ___, which is affected by ___

A

Resistance

Radius

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26
Q

Equation for resistance of an airway

So how is airflow controlled?

A

R = 8(visc.)L / r4

Changing radius via smooth muscle contraction, thus changing resistance to FOURTH POWER

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27
Q

Why would we want to change the airway resistance?

A

Send air to the alveoli that have good blood supply

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28
Q

How to calculate approximate amount of anatomical dead space in any person?

A

Weight in pounds = dead space in mL’s

150 lbs = 150 mL dead space

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29
Q

2 types of dead space (w/ definitions)

A

Anatomical - conducting tubes

Alveolar - alveoli w/o gas exchange b/c no blood flow or ventilation

30
Q

Physiologic dead space

A

Anatomic + alveolar

31
Q

Alveolar ventilation definition

If per minute, called what?

Average adult value?

A

Volume of air reaching the alveoli

VA (dot)

4 L/min

32
Q

How to calculate alveolar ventilation (per minute)?

Units?

A

(Tidal volume - dead space) x respiratory rate

mL air / min

33
Q

Perfusion definition

Average value?

A

Blood pumped passed alveoli per minute

5 L/min

34
Q

How to calculate perfusion (Q)?

A

= cardiac output = SV x HR

35
Q

Variables that affect diffusion rate (mL/min) of any gas between alveoli and capillaries

A

Surface area

Diffusion coefficient for the gas

Pressure different across the alveolar membrane

Diffusion distance (alveolar barrier thickness)

36
Q

Equation for diffusion rate (J) of a given gas

A

J = (SA x D x (P1 - P2)) / distance

D = coefficient
SA = surface area
37
Q

Normal diffusion rate values (J) for O2 and CO2

A

O2 - 250 ml/min

CO2 - 200 ml/min

38
Q

What does it mean that the diffusion rates of O2 and CO2 are different?

A

They are INDEPENDENT of one another

39
Q

Which variables for diffusion rate (J) depend on alveolar structure?

A

SA and distance (barrier thickness)

40
Q

Typical diameter of an alveolar wall

A

0.2 mm

41
Q

Components of the interalveolar septum

A

2 simple squamous layers w/ an interstitium (capillaries, elastic tissue) in between

42
Q

2 types of alveolar epithelial cells (w/ percentages of cells vs. surface area)

Location of type 2 cells?

A

Type 1 - 40% of cells, 90% of surface

Type 2 - 60% of cells, 10% of surface (angles of adjacent alveolar septa)

43
Q

Function of type 2 alveolar cells

A

Produce surfactant

44
Q

Explain acute respiratory distress syndrome steps (6)

A
  1. Low/no alveolar surfactant
  2. Alveolar surface tension increases
  3. Hypoventilation causes low oxygen, so surfactant production further reduced
  4. Pulmonary hypoperfusion of gases
  5. Endothelial cell damage
  6. Fibrin and other proteins form hyaline membrane, which leads to CO2 retention
45
Q

Alveolar macrophages

Other name?

A

Macrophages in alveolar surface that remove debris that escaped the mucus and cilia of conducting system

Dust cells

46
Q

What are alveolar macrophages called in CHF?

Why?

A

Heart failure cells

Left ventricle can’t keep up w/ venous return from lungs, so lungs back up, so RBCs pass into alveoli and are phagocytosed

47
Q

What is surface area in the diffusion rate equation related to?

A

Number of alveoli in lungs and open pulmonary capillaries

48
Q

Emphysema

A

Destruction of elastic tissue in alveoli/respiratory bronchioles leads to enlarged alveoli, decreased fresh gas exchange

49
Q

How is the elastic tissue destroyed in emphysema?

What normally prevents this?

A

Elastase (released by neutrophils) breaks it down

Serum alpha-1-antitrypsin neutralizes elastase

50
Q

What would deficient alpha-1-antitrypsin cause?

A

Emphysema, since elastase from neutrophils can’t be neutrolized, so elastic tissue of alveoli is destroyed

51
Q

What is the blood-air barrier?

3 contents?

A

The shortest diffusion path oxygen can cross to reach the blood

  1. Cytoplasm of squamous epithelial cells
  2. Fused basal lamina of type 1 alveolar and capillary epithelial cells
  3. Cytoplasm of capillary endothelial cells
52
Q

Which part of the diffusion rate (J) equation is affected by the blood-air barrier?

A

Distance (denominator)

53
Q

What happens to that distance in ARDS?

A

The damage to the alveolar epithelial lining due to hypoperfusion (lack of oxygen causes this) results in increased hydrostatic pressure of capillaries, thus fluid accumulates in the lungs, so the lungs stiffen and hypoxemia can occur

54
Q

What does the diffusion coefficient for a given gas depend on?

Is that of O2 or CO2 higher? Why?

A

Solubility of the gas in water (more is better)

Molecular weight of the gas (less is better)

CO2 is 20x higher, because its severely higher solubility in water far outweighs its heavier molecular weight

55
Q

Which has a larger pressure gradient in the lungs: O2 or CO2?

A

Oxygen

56
Q

How long does an RBC spend in a pulmonary capillary?

How long does O2 need to reach equilibrium across the barrier?

How does this change in exercise?

A
  1. 75 sec
  2. 25 sec

During exercise, an RBC spends only 0.25 sec, so there is much less extra time for gas exchange

57
Q

What is the clinical significance of the time an RBC spends in a pulmonary capillary during exercise compared to rest?

A

No free time, so person w/ respiratory problems will notice the problem upon exertion

58
Q

Normal diffusion capacity of the lung for oxygen (DLO2)

A

21 ml O2/min/mm Hg

mm Hg = average gradient along capillary

59
Q

Is the diffusion capacity of O2 greater or less than that of CO2?

Value of CO2? Why so?

A

MUCH less

CO2 = 400 (compared to 21)

Equilibrium is almost immediate (small gradient AND passes much faster through b/c of solubility in H20)

60
Q

Clinical significance of the difference in diffusion capacity between O2 and CO2

A

CO2 is much higher, so it would take a MUCH worse lung disease to have problems w/ CO2 retention

61
Q

Why is alveolar surfactant (type 2 cells) so important?

A

Alveoli are different sizes, so the pressure in them will be different based on radius

W/o surfactant, air would flow from high to low pressure (small to large alveoli), so small alveoli would get smaller and vice versa, which would reduce surface area

62
Q

Equation for pressure in an alveolus

Name of it?

A

P = 2T/r

T = tension
r = radius

LaPlace’s Law

63
Q

Use LaPlace’s Law to describe why alveolar surfactant is important?

A

Combats the smaller radius of smaller alveoli by decreasing surface tension, so pressure remains the same as that w/in larger alveoli

64
Q

SO, would you expect to see more surfactant produced in a large or small alveolus? Why?

A

Small - to reduce surface tension to combat the smaller radius (keep pressure constant to prevent alveolar collapse and thus decreased surface area)

65
Q

Components of the conducting part of the respiratory system

A 
Nasal cavity
Nasopharynx
Larynx
Trachea
Bronchi
Bronchioles
66
Q

The respiratory portion of the nasal cavity is lined by what epithelium?

A

Pseudostratified columnar ciliated epithelium (Respiratory epithelium)

67
Q

What else is within the respiratory epithelium? (4)

A

Goblet cells, lamina propria, seromucous glands, superficial venous plexus

68
Q

What happens to air in the nasal cavity?

A

Warmed by blood in venous plexus

Moistened by secretions of seromucous glands/goblet cells

69
Q

How is all air rubbed up against the epithelium for warming and moistening?

A

Conchae create turbulence to help move the air around

70
Q

Paranasal sinuses are lined by what epithelium?

A

Pseudostratified columnar ciliated, few goblet cells

71
Q

What is the lamina propria of the respiratory wall made of? (5)

A

CT, seromucous glands, elastic fibers, bone/cartilage, smooth muscle

72
Q

Where along the respiratory tract does the epithelial cell population taper off?

A

Terminal bronchioles

Cardiopulmonary (8 decks)

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