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circulation and breathing > influence of disease on respiratory function > Flashcards

influence of disease on respiratory function Flashcards

1
Q

how can restricitve diseases be divided and what are some examples for each

A
  • intrinsic restrictive diseases= lung fibrosis, pulmonary oedema
  • extrinsic restrictive diseases= pneumothorax, pleural effusion, obesity, chest wall deformity, respiratory muscle weakness, neuromuscular abnormalities (myasthenia graves)
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2
Q

what are some examples of obstructive conditions

A
  • COPD (emphysema and chronic bronchitis)
  • asthma
  • bronchiectasis
  • cystic fibrosis
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3
Q

what are the hallmarks/characterstics for obstructive and restrictive diseases

A
  • obstructive diseases has normal/high lung volume but poor/low flow, obstructive conditions are more about the airways and the resistance to flow
  • restrictive conditions have normal flow but low lung volume and is characterised by low lung compliance and expanding the actual lung not necessarily about the airways
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4
Q

what would you notice about the frc, rv and lung volume for obstructive and restrictive diseases

A
  • obstructive would be either normal or increased (severe)
  • restrictive low/ decreased
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5
Q

how does radius impact airflow

A
  • halting the radius decreases flow but a factor of 16 and increases resistance by a factor of 16
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6
Q

what can we use a peak flow meter to measure

A
  • peak expiratory flow which would be lower in obstructive conditions
  • found in gps
  • easy to use
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7
Q

what can we use a pneumotachograph for

A
  • to measure Fev1 and fvc values
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8
Q

what are the features of a flow-volume loop

A
  • consists of two sides/loops one for inhalation and one for exhalation
  • inhalation loop is more round compared to exhalation
  • measures peak expiratory flow
  • FEV1 value
  • volume in lung and the changes in volume during inhalation and exhalation
  • flow in lungs and how it changes
  • spirometry is an effort dependant test
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9
Q

how would the flow volume loop be different for obstructive patients

A
  • the exhalation loop would be move concave
  • peak expiratory flow would be lower
  • lung volume would be greater or normal due to air trapping and hyperinflation
  • fev1 would decrease
  • fev1/fvc would decrease
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10
Q

how would the flow volume loop be different for restrictive patients

A
  • tall and narrow
  • volume smaller
  • peak expiratory flow would be normal or slightly reduced
  • fev1 would be reduced but proportional to lung volume
  • fev1/fvc ratio high
  • convex
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11
Q

what is the fev1/fvc ratio for obstructive and restrictive conditions

A

obstructive= below 70%
restrictive= above 80%

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12
Q

what happens in asthma

A
  • bronchoconstriction
  • wall inflamed and thickened
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13
Q

what happens in COPD

A
  • emphysema damaged alveolar wall this can make it hard for gas exchange and the alveoli expanding and recoiling causing air trapping
  • chronic bronchitis- inflammation and secretion of excess mucus causing airway obstruction
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14
Q

what is the associating with smoking and fev1

A

as age increases naturally fev1 decreases however in smokers this decrease is much larger and more significant and can decrease all the way to 12.5%

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15
Q

what is the equal pressure point

A
  • the point along the airways where the intraluminal pressure is equal to the intrapleural pressure
  • in healthy individuals it usually is in larger airways such as trachea but in patients who have conditions like COPD this point can be much earlier in the airways specifically in smaller airways
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16
Q

can you describe the changes in intraplueral and intraluminal pressures during inhalation, exhalation and forced exhalation and at rest

A
  1. during rest the intrapleural pressure is -5 (negative pressure) this keeps the alveoli open and the intraluminal pressure is zero.
  2. during inhalation the diaphragm and external intercostal muscles contract causing the thoracic cavity to increase in volume and therefore the pleural increase in volume, this decreases the intrapleural pressure from -5 to -8 and this causes the alveoli to further expand increasing the alveoli volume and decreasing alveolar pressure to -2
  3. during normal expiration the decrease in thoracic volume causes pleural volume to decrease and pressure to increase to resting intrapleural pressure of -5, the elastic recoil of the alveoli decrease alveoli volume and increase alveoli pressure causing air to move out
  4. during forced exhalation the contraction of accessory muscles further decrease thoracic volume and pleural volume this causes intrapleural pressure to increase and become positive, this causes the alveoli pressure to also increase more significantly than in normal exhalation creating this bigger pressure difference of inside the lung and outside the lung so more air is exhaled
17
Q

what happens if the intrapleural pressure exceeds the intraluminal/ alveolar pressure

A

causes the airways to collapse, this reduces airflow and thus leads to air trapping which can lead to hyperinflation

18
Q

what is the expiratory flow limitation

A
  • the point where increasing your exhalation force would have no effect of exhalation air flow
  • this happens when the airways collapse which result from the intrapleural pressure exceeding the intraluminal pressure and further increasing the force of your exhalation wouldn’t have an impact on your airflow as the airways have already collapsed/compressed
  • in healthy people the expiratory flow limitation happens during forced exhalation but in patients with COPD this can happen in normal breathing
19
Q

why does COPD patients have their expiratory flow limitation in normal breathing or mild forced exhalation

A
  • COPD patients have decreased elastic recoil, thickened airways/obstructed airways this means there’s a greater resistance to flow
  • moreover copd patients due to the destrucgted alveoli their alveoli pressure would not increase as much as normal patients due to the impaired elastic recoil and therefore the equal pressure point would happen earlier along the airways and therefore airway collapsing happens earlier resulting in an expiratory flow limitation in mild forced exhalation
20
Q

what is dynamic hyperinflation what is it caused by

A
  • caused by air trapping and it is when the lungs are hyper inflated
  • present in patients with more severe COPD where air flow is massively reduced/restricted resulting in air not being exhaled and therefore air being trapped
21
Q

what is pulmonary fibrosis

A
  • formation of excess fibrous connective tissue in lungs, making the lungs hardened, small lung with thickened alveolar capillary membrane effecting gas exchange and oxygen uptake
  • also increases work of breathing as your inflating something which is stiffer= low compliance
  • restrictive lung condition
  • cause type 1 respiratory failure due to difficulty of gas exchange due to thickened walls of alveoli and capillaries
22
Q

what is lung compliance

A
  • how well the lung can change its size/expansion with changes in volume/pressure
  • compliance greatest at normal lung volume
  • lowest at very small or large lung volume
23
Q

what is the two compliance and meaning

A
  • dynamic compliance= lung compliance and flow
  • static compliance= lung compliance no flow
24
Q

compare and contract lung compliance In emphysema and pulmonary fibrosis

A
  • emphysema= loss of elastic recoil, increased compliance
  • pulmonary fibrosis- stiffer lungs, reduced compliance
25
Q

what is the equation for minute ventilation and alveolar ventilation

A

minute= tidal volume x frequency
alveolar = (tidal volume-dead space) x frequency

26
Q

what are some conditons which can cause a high v/q mismatch

A
  • pulmonary embolism (blood clot so poor perfusion, good ventilation)
  • anaemia
  • emphysema (gas exchange doesn’t happen due to destructed alveoli)
  • pulmonary fibrosis (gas exchange doesn’t happened due to thickened wall affecting diffusion distance)
27
Q

what conditions cause a low v/q ratio

A
  • asthma
  • pulmonary oedema
  • pneumonia
  • COPD can be both high v/q or low (high- deadspace and air trapping, low- mucus plugging air not getting in)
28
Q

what is type 1 respiratory failure

A
  • hypoxemic hypoxia
  • oxygen levels below 8 kPa
  • impairment with gas exchange and uptake of oxygen rather than ventilation and clearance of carbon dioxide
  • so when thinking about conditions think about conditions which impair gas exhchange and not necessarily ventilation
  • normal carbon dioxide levels
  • caused primarily by v/q mismatch
29
Q

what is causes of type 1 respiratory failure

A
  • v/q mismatch
  • anaemia
  • pneumonia
  • pulmonary oedema
  • moderate asthma
  • reduced inspired oxygen
  • right to left cardiac shunt
  • ARDS
  • pulmonary fibrosis
30
Q

what is type 2 respiratory failure

A
  • hypercapnia
  • carbon dioxide levels above 6kPa
  • usually also hypoxia
  • usually problem with the actual lungs and ventilation than diffusion
31
Q

causes of type 2 respiratory failure

A
  • obesity
  • neuromuscular disease e.g. myasthenia graves
  • medication which cause hypoventilation
  • chest wall deformities
  • severe asthma
  • copd (as its chronic)
32
Q
A

circulation and breathing (26 decks)

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