Intro to Respiratory Clinial Cases Flashcards
obstructive lung diseases
emphysema
chronic bronchitis
asthma
emphysema
alveolar wall destruction
overinflation
chronic bronchitis
productive cough
airway inflammation
asthma
reversible obstruction
bronchial hyperresponsiveness
COPD
emphysema and chronic bronchitis
can exist together
emphysematous lung?
enlargement of air spaces
-loss of alveolar sacs
chronic bronchitis?
plugging with mucus and inflammation of airways
albuterol
beta-2 receptor agonist
-bronchodilation
idiopathic pulmonary fibrosis
restrictive disease
left sided heart failure
pulmonary edema and hypertension
pulmonary edema
fluid in alveolar space
-affects gas exchange
pulmonary embolism
impaired perfusion in lungs
respiration
gaseous exchange by cells and tissues
types of respiration
cellular and external
cellular respiration
gaseous exchange within cells
external respiration
at level of blood cells
-rid CO2 and recharge with O2
3 components of respiratory system?
conducting - carries air into lungs respiratory - air exchange ventilatory mechanism (diaphragm and rib cage)
central airways?
greater than 2mm diameter
*bronchi
peripheral airways?
less than 2mm diameter
*bronchiolar
conducting portion
dead air space
-nasal cavity, nasopharynx, larynx, trachea, bronchi, bronchioles
function of conducting portion?
conduct air
removal of particulates
warming, cooling, humidifying air
dry and wet air?
air humidified as it move through respiratory passages
**pay attention when doing calculations
why is it important to warm inhaled air?
solubility of oxygen drops at higher temperatures
also, don’t want to destroy cilia
trachea?
lined by respiratory epithelium -ciliated pseudostratified columnar epithelium lamina propria (glands) smooth muscle elastic fibers cartilage
as you move down cartilage?
cilia, glands, cartilage gradually disappear
smooth muscle increases
epithelium becomes cuboidal
cell classification of trachea epithelium?
pseudostratified columnar epithelium
- rests on thick basement membrane
- cilia - moves mucus up
with goblet cells
terminal bronchioles?
last section that is purely conducting
lamina propria
thin fibrous layer
elastic fibers are dense
forms elastic membrane** - bottom of lamina propria
submucosa
beneath elastic membrane
-contains seromucous glands
tracheal cartilage?
C-shaped
posterior aspect has smooth muscle (trachealis)
-allows passage of food bolus down esophagus
hyaline cartilage
carina
horseshoe shaped cartilage
bronchiole
no cartilage**
bronchus
has cartilage**
pulmonary artery
travel with bronchus
-carry deoxygenated blood
at the terminal bronchioles
transition from pseudostratified columnar to simple columnar epithelium
terminal bronchiole columnar cells?
two types
ciliated
club cells
club cells
non-ciliated secretory cells
-formerly clara cells
secrete product that protects bronchiolar epithelium
- CCSP - club cell secretory protein
- similar to surfactant
engulfs and breaks down toxins via cytochrome P-450
progenitor population to regenerate ciliated epithelial cells
particulates in lung?
greater than 10 micrometers - tonsils and adenoids
2-10 micrometers - mucus and coughing
less than 2 micrometers - alveolar macrophages
respiratory region of lung?
respiratory bronchiole
alveolar duct
alveolar sac
alveoli
alveolar duct
elongated branch of respiratory bronchiole
atrium
space between alveolar duct and alveolarsac
alveolar sac
end of alveolar duct
-single outpocket - alveolus
alveoli
walls are delicate and contain elastic fibers
-thin-walled polyhedral structures
alveolar pore**
small slit-like openings that allow air to flow between alveoli
allows equalization of pressure** stop collapse of alveoli due to pressure also allow spread of infection can prevent atelectasis allow alternate pathway for ventilation
atelactasis
collapsed lung
alveolar wall
five different types of cells
-surface cells
1 type I alveolar cells
2 type II alveolar cells
-intramural cells
3 endothelial cells
4 fibroblasts
5 smooth muscle cells
surface cells
epithelial cells
-on outer surface
alveolar macrophage
not part of wall, but very important
type I alveolar cells
cover surface of alveolus (90%)
-stretches in long extensions
type II alveolar cells
cover 5-10% of surface
- more cuboidal in nature
- sits in wall of alveolus
- secrete surfactant* better air exchange*
full of lamellar bodies (that contain surfactant)
surfactant
surface tension reducing agent
-prevents collapse of alveolus during expiration
capillary endothelial cells
intramural cell
interspace for air exchange
alveolar macrophages
aka dust cells
-lots of these into lung during heart attack
free of alveolar wall
aka heart failure cells
known derivation is monocytic
alveolar membrane
O2 exchange - passive transport
multilayered barrier
-attenuated cytoplasm type I cell
-BM between type I cell and endothelium
attenuated cytoplasm of endothelium
henry’s law
concentration of dissolved gas is proportional to partial pressure in gas phase
fick’s law
flow proportional to concentration difference across a barrier
surfactant
dipolar (amphipathic)
-reduce surface tension
pulmonary arteries
carry deoxygenated blood to lung
large elastic arteries
enter lung at hilum
follow bronchial tree
bronchial arteries
carry oxygen/nutrient rich blood to lung
medium muscular arteries
distribute to lung
follow bronchial tree
pulmonary veins
tend to run within parenchyma
large veins approach bronchial tree
run away from the airways
mean pulmonary artery pressure
15 mmHg (very low)
mean systemic pressure
100 mmHg
shunt
transfer of deoxygenated blood from venous circulation to arterial circulation
start on HISTO slide
126**
in lamina propria
seromucous glands
elastic membrane
underlies lamina propria
submucosa layer?
beyond elastic membrane
cartilage collagen type?
type II
bronchial artery
smaller vessel close to the bronchi
dark brown crap cell in alveolar space?
macrophage
type II alveolar cell?
in wall
larger round nucleus
secretes surfactant** which has lipid
infants before 32-34 weeks?
low surfactant production
-not good exchange of O2
