Lecture 1-EXAM 4 (respiratory) Flashcards
what are the reasons why we breath? (3)
O2 goes to electron transport chain to make ATP
In a normal person, what are the volumes of tidal volume, dead space and alveolar ventilation?
- TV: 500ml
- Dead: 150 ml (no gas exchange)
- Alv: 350ml (where gas exchange happens)
What are the factors that affects gas exchange? (3)
- Surface area: alveoli has a lot of SA that is important for exchange
- Respiratory membrane
- Blood supply
Notice: There is a short diffusion distance
As we move down the resp. trees in the lungs, what happens to the diameter, cilia, goblet cells, cartilage and smooth muscle?
Going down the lung braches:
* Decreases in: Diameter (smallest being alveolar sac), cilia (for propeling dust/debris out), cartilage, goblet cells
* Increases in: Smooth muscle (the most being in bronchioles and terminal brochioles)
* Smooth muscle replaces cartilage
What is the size of bronchioles?
0.5-1mm
What muscles are for normal (eupneic) inspiration and expiration?
- Inspiration: External intercostals (elevates ribs 2-12 widen thoracic cavity) and diaphragm (descends and increases depth of thoracic cavity)
- Expiration: no muslces, just the recoil back
What muscles are for FORCED inspiration and expiration?
- Inspiration (SIPS): SCM (elevates sternum), Scalenes (fix or elevate ribs 1-2), pectoralis minor (elevates ribs 3-5), Internal internals, intercartiagionous part (aid in elevating ribs)
- Expiration: Intercostals, interosseous part (depress ribs 1-11 narrow thoracic cavity), Rectus abdominis (depresses lower ribs, pushes diaphragm upward by compressing abdominal organs), external abdominal oblique (same effects as rectus abdominis)
How do to the ribs move in expiration and inspiration?
What are the sequence of events for inspiration?
You need to increase volume to decrease pressure (think about molecules in a small and large container)
What are the sequence of events for expiration?
Increase pressure by decreasing volume
What are the three most important gases in the air? What are their percentages in air?
Nitrogen, O2, CO2
What is the pO2 and pN2?
- pO2: 760mmHg * 21%= 160mmHg
- pN2: 760mmHg * 79% =600mmHg
What are the partial pressures of Po2 and Pco2 when entering alveolar capillaries, alveoli, and leaving alveolar capillaries?
What is the way you can change the air pressures?
Altitudes:
* Higher heights: has less pressure so less Po2
* Lower: more pressure so more Po2
What is the approximate percentage for inhaled and exhaled (N2, CO2, O2, H2O) ?
Nitrogen stays the same because it comes from digestion and not from vent.
O2 decreases in exhalation
CO2: increase in exhalation
Fill in
What prevents the lung and airways to not collapse?
Negative intrapleual pressure
Pressures:
* Atmospheric:
* Intrapleual pressure:
* Intra-alveolar pressure:
* Transpulmonary pressure:
- Atmospheric: 760 mmHg (or 0mmHg)
- Intrapleual pressure: 756 mmHg (or -4 mmHg)
- Intra-alveolar pressure: 760 mmHg (or 0 mmHg)
- Transpulmonary pressure: Palv-Pip = 4 mmHg
What causes the pelural sac negative pressure?
Lungs want to recoil in and chest wall wants to recoil out therefore causing the negative intrapleural pressure (ALLOWS the chest wall and lungs to move together)
If we do not have this, then the lungs will win and cause the lungs to collapse.
What is a pneumothorax? What events lead to this?
Pneumothorax: presence of air in pleual cavity
* Thoracic wall is punctured
* Inspiration sucks air through the wound into the pleural cavity
* Potential space becomes an air-filled cavity
* Loss of negative intrapleural pressure allows lungs to recol and collapse
Atelectasis
Explain the changes in alveolar pressure move air in and out of the lungs
What is the time difference betweeen inspiratory time and expiratory time? What does this difference cause?
- The inspiratory time (TI) is 2 seconds and is less than the expiratory time (TE) of 3 seconds.
- This difference is a result of, in part, a higher airflow resistance during expiration, as is reflected by a higher alveolar pressure (PA) change during expiration (1.2 cm H2O) than during inspiration (0.8 cm H2O
An increase in airway resistance will cause what?
decrease the inspiratory time/expiratory time ratio
T/F: Only a small pressure change between the mouth and alveoli is required for a normal tidal volume
True
What ventation values cannot be determined directly by spirometry?
Residual lung volume, FRC, and TLC (since you need RV)
What is pul. emphysema?
What happens when lung recoli forces decreases?
- Pulmonary emphysema is characterized by a destruction of elastic tissue in the lung, which causes a lower lung recoil force.
- When lung recoil forces decrease, as in emphysema, chest wall expansion forces predominate, the chest wall expands outward pulling the lung with it.
- A new equilibrium occurs at increased lung volume so what increases?
- The RV is increased in emphysema because why?
- When a person with emphysema tries to exhale completely, what happens?
- Increased FRC = _ ; Increased RV = _
- A new equilibrium occurs at increased lung volume so the FRC is increased.
- The RV is increased in emphysema because the VC is decreased because of small airway obstruction.
- When a person with emphysema tries to exhale completely, his or her bronchioles collapse, trapping air in the lungs.
- Increased FRC = hyperinflation; Increased RV = air trapping.
*
What is the minute ventilation equation?
What happens when not all of the inspired air reaches the alveloi? Give examples
not all of the inspired air reaches the alveloi will become wasted air
* Some of the air in the tidal volume does not participate in gas exchange.The volume of air in the conducting airways does not participate in gas exchange and constitutes dead space volume (VD)
* Total wasted air in the lungs is computed from the physiologic dead space volume. Dead space volume occurs in the conducting airways and in alveoli with poor capillary circulation. For A, There is no blood flow to an alveolar region. For B, There is reduced blood flow. In both cases, a portion of alveolar air does not participate in gas exchange and constitutes alveolar dead space volume.
What is the alveolar ventilation per minute equation?
How is alveolar ventilation determined?
By measuring the patient’s volume of expired CO2
If alv. ventilation is halved, the PCO2 is what? This is called what?
- If alv. vent is halved, arterial PCO2 will double (assuming a steady-state and constant carbon dioxide production)
- This decrease in alv vent below normal is called hypoventilation
What happens with PaCO2 when you increase ventilation? What is this called?
- If alv. vent is increased, arterial PCO2 will fall (assuming a steady-state and constant carbon dioxide production)
- This increase in alv vent below normal is called hyperventilation
What is the difference in hypernea and hyperventation?
- hypernea: by metabolic processes
- hyperventation: not metabolic
- What directly affects inflation and deflation of the lungs?
- What is distensibility?
- What is elatic recoil?
- Elastic recoil of lungs
- Distensibility - ease with which the lungs can be stretched or inflated.
- Elastic recoil - ability of a stretched or inflated lung to return to its resting volume (FRC).
- What does lung compliance measure? (provide equation)
- What happens with increase and decrease compliance?
How does obstructive and restrictive diseases alter lung compliance?
- Blue line: obstructive
- Doted black: restrictive
Difference in regional lung compliance causes what? Explain
Causes uneven ventilation
* look at picture to understand the difference of apex and base with ventilation
- As a result of gravity, where is ventilation higher? (when standing)
- Why?
- As a result of gravity, ventilation is higher at the base of the lung
- Alveoli are smaller at the base of the upright lung than at the apex dt the weight of the lung compressing alveoli at the base.
- When the lung is at FRC, the smaller alveoli at the base of the lung have optimal compliance and are more easily ventilated; alveoli at the apex have a high resting volume and are more difficult to ventilate due to lower compliance.
- Basal alveoli also have a larger range of volume through which they can expand during inspiration.
What does surfactant do?
Lowers surface tension and stabilizes alveoli at low lung volumes
Where is surfactant more concentrated? What happens when there is no surfactant in alveoli?
- Surfactant lowers surface tension proportionately more in the smaller alveolus. As a result, pressures in the two alveoli are equal, and alveoli of different diameters can coexist
- Pressure in the smaller alveolus is greater than that in the larger alveolus, which causes air from the smaller alveolus to empty into the larger alveolus. At low lung volumes, the smaller alveoli tend to collapse, a phenomenon known as atelectasis.
What happens when you increase surfactant?
- Increased surfactant = compliance
- Increased compliance = increased volume at a given pressure
- What allows for distribution of pressure in alveoli?
- What cell reduce surface tension?
- What cell is the squamous epithelial cell?
- Alveolar pores
- Type 2
- Type 1
- The height of the column of mercury that is supported by air pressure decreases with altitude, which is a result of a fall in barometric pressure (PB).
- Because the fractional concentration of inspired O2 (FIO2) does not change with altitude, the decrease in PO2 with altitude is caused entirely by a decrease in PB.