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AP2 > Lecture 2/25 - Pulmonary > Flashcards

Lecture 2/25 - Pulmonary Flashcards

Test 2

1
Q

What is zone 3 of the lung known as? Why?

A

The “dependent” area of the lung

Part of the lung that’s closest to the heart –> has the highest flow

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2
Q

Zone 2 has _______ flow and zone 3 has ______ flow

A

pulsatile

continuous

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3
Q

Increased wt of blood from gravity = _________ of vessel = ________ vascular resistance = _______ blood flow

A

distention

decreased

increased

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4
Q

Why does zone 4 exist?

A

dt the compression of the blood vessels in base of the lung

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5
Q

PER =

A

PTP

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6
Q

PA =

A

PIP + PER

or

PIP + PTP

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7
Q

What is another name for elastic recoil pressure?

A

Transpulmonary pressure

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8
Q

Increased lung stretch = _______ recoil

A

increased

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9
Q

Increased PTP = ________ lung volume

A

increased

(transpulmonary pressure)

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10
Q

What is PTP?

A

Transpulmonary pressure

Pressure thats available to fill the lung up with air

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11
Q

What are the balanced forces at the start of the respiratory cycle?

A

PA= 0 cmH2O
PIP= -5 cmH2O
PER= 5 cmH2O

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12
Q

What is the tendency of the alveoli? Why?

A

They want to recoil into a smaller container

They are made of elastic soft tissue.

elastic = recoil

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13
Q

What keeps air in the alveoli? Explain this in correlation to FRC

A

Negative pleural pressure

-5cmH2O pleural pressure keeps our 3L FRC in the lungs in between breaths

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14
Q

T/F: During inspiration the forces are balanced. What does this mean?

A

F

The forces are unbalanced.
PA= 0
PIP= -6
PER = 5

The pleural pressure has now dropped from -5 cmH2O to -6.

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15
Q

During inspiration, how are we able to suck air in?

A

Pleural pressure -6 –> forces unbalanced –> alveolar pressure -1

This creates a (delta)P with the outside environment and inside the alveoli –> able to suck air into lungs

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16
Q

How does the alveoli pressure get back to 0 after inspiration?

A

Inward recoil pressure has to be higher than it was before

PA= -1
PIP= -6
PER = 5

PER would need to increase to 6 cmH2O as a result of air coming in and alveoli being stretched out –> PA= 0

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17
Q

Increased volume = _______ recoil

A

increased

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18
Q

When you exhale, the diaphragm ________ and the lungs _________

A

relaxes

contract

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19
Q

During the relaxation of the diaphragm, how do we fix the out of balance forces?

A

We have excess recoil

PA= 0
PIP= -5
PER = 6

Alveoli pressure will become +1 –> we have a (delta)P –> able to push air out of lungs –> alveoli gets smaller & recoil pressure decreases

This would mark the end of expiration

Forces should be back balanced.

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20
Q

What are the 2 most important passive factors to PVR? Which has the biggest influence?

A

1. Gravity/body position <– biggest influnence

  1. Increase/decrease in lung volume
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21
Q

Lung volume refers to ______ volume

A

air

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22
Q

What medications can you put down an ETT that increase PVR? What type of influence is this?

A

NE/Epi

Active influence

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23
Q

How do active influences in the pulm vessels work?

A

similiar to systemic system –> constricting/dilating the pulm vessels

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24
Q

According to the PVR graph, At normal FRC, PVR is at its _______ point. What is the importance of this point?

A

lowest

Easiest for heart to pump blood & body spends most of its time near FRC.

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25
What happens to PVR if you increase or decrease lung volume from FRC?
PRV increases
26
What is the lowest possible lung volume we can be at?
RV = 1.5 L
27
What is the highest possible volume we can be at?
TLC = 6L
28
Why is the PVR graph skewed to the left?
It doesn't start at 0 And because IRV (2.5L) is larger than ERV (1.5L)
29
What is the difference between an extraalveolar and an alveolar blood vessel?
Extraalveolar: large pulmonary blood vessel alveolar blood vessel: smaller pulmonary capillary
30
At low lung volumes, describe extraalveolar PVR
It is very high dt higher pleural pressue
31
As lung volume increases, alveolar blood vessel PVR ______
increases
32
On the PVR graph, what is the blue line represent?
Total PRV: consist of equal sum of individual vascular resistances of both extraalveolar and alveolar
33
What are some pathology that will alter the FRC and change the PVR graph?
COPD: increases lung volume PEEP: increases pressure on vessels
34
What is another name for the alveolar blood vessels?
Pulmonary capillaries
35
T/F: gas exchange happens in the extraalveolar blood vessels
F Only in the alveolar blood vessels/pulmonary capillaries
36
What is considered the functional unit of the lungs?
alveoli
37
Decreasing pleural pressure = _________ in alveolar PVR
increase
38
How does more air in the alveoli affect the alveolar blood vessels? Less air?
More air: longer capillaries w/ smaller diameter --> increase in resistance Less air: shorter cap w/ larger diameter --> decrease in resistance
39
What 2 things affect alveolar blood vessel PVR?
1) Air volume in the alveoli 2) pleural pressure
40
What are the extraalveolar blood vessels PVR affected by?
Pleural pressure
41
When pleural pressure decreases during inspiration, PVR ________ in the extraalveolar blood vessels. Why?
decreases The lower pleural pressure in the chest pulls the vessesl and increases the diameter
42
Extraalveoli and alveolar blood vessels PVR has a _________ relationship
inverse
43
What is significant about extraalveolar and alveolar blood vessel PVR value at FRC?
They are low at this point causing that to be the lowest point
44
Describe the location of capillaries in relation to an alveoli
embedded in walls right next to where air --> good for gas exchange
45
_____ (2) causes problems with gas exchange
water excess tissue
46
How does increasing CO affect PVR?
Decreases it Distention: Increasing CO puts more blood thru vessels Recruitment: Also utilizes unused pathways --> **increases parallel pathways** These things decrease PVR
47
Do you use all your alveoli with each breath? Why?
No, there are large spotty areas of unused alveolis and IT IS NORMAL We dont want to use all of our alveoli all the time --> if breathing in toxins --> all alveoli exposed to that toxin Not using them all, all the time prevents things like this.
48
Increase/decrease in CO that affects PVR is considered a ________
Passive force
49
Increased Right heart CO = _________ PVR
Decreased
50
What can cause decreased right heart CO?
MI R heart failure
51
How can decreased R heart CO become a vicious cycle?
Decreased R heart CO increases PVR --> this will further decrease R heart CO --> vicious cycle
52
What passive influences decrease PVR? How? (6)
1. Gravity 2. Body Position -hydrostatic effects of recruitment/distention **Decreases in gravity dependent regions** ------------------------ 3. Increased LAP 4. Increased pulm blood volume 5. Increased CO 6. Increased PAP -Recruitment /distention
53
What passive influences increase PVR? How? (5)
1. Increase lung volume from FRC: lengthening/compression of alveolar vessels 2. Decrease lung volume from FRC: compression/less traction of extraalveolar vessels 3. Increased interstial pressure: compresses vessels close to alveoli 4. Increased blood viscosity: blood harder to get thru circuit 5. Positive-pressure ventilation (increased alveolar pressure/positive intrapleural pressure): compression/derecruitment of alveolar/extraalveolar vessels
54
What are ACTIVE influences that increase PVR? (12)
1. SNS inneration 2. NE/Epi 3. Alpha-adenergic agonist 4. PGF2A 5. PGE2 6. Throboxane 7. Endothelium 8. Angiotensin 9. Histamine 10. Alveolar hypoxia 11. Alveolar hypercapnia 12. Low pH
55
What are ACTIVE influences that decrease PVR?
1. PNS stimulation/decrease in SNS stimulation 2. ACH 3. Beta-adrenergic agonists 4. PGE1 5. Prostacyclin (PGI2) 6. Nitric Oxide 7. Bradykinin
56
Histamine is a veno_______ in the systemic circulation and a veno_______ in the pulmonary circuit
dilator constrictor
57
What 2 things do you need to get gasses into the body?
Gas Pressure
58
What is the complete make up of our DRY atmospheric gasses?
N2 (Nitrogen): 79% -- 600.3 mmHg O2 (Oxygen): 21% -- 159.0 mmHg CO2/trace gasses (Carbon dioxide/methane): 0.04% -- 0.3 mmHg
59
What is our total atmospheric pressure at sea level?
760 mmHg
60
T/F: Concentration of gasses changes at different altitudes
F The concentrations will always stay the same, but what changes is the atomspheric pressures --> which changes the partial pressures
61
Partial pressure =
Total pressure x [gas concentration percentage in decimal]
62
760 mmHg =
760 torr 1 atm
63
The lower you are = ________ atmospheric pressure
increased
64
The higher you are = ____________ atomospheric pressure
decreased
65
What changes with gas mixtures at extremely high altitudes? What is an example of this?
Total atmospheric pressures will decrease --> oxygen partial pressure will decrease!!! Ex) If you go on a plane and the door flies open --> high altitude --> wont have enough O2 bc decrease O2 partial pressure --> reason why masks fall down
66
What is the definition of inspired humified gas? What consideration to we have with inspired humidified gas?
Inspired gas at body temperature = 37.0 C & 100% water vapor saturated Considerations: Can only have 760 mmHg so OTHER GASSES ARE DISPLACED dt warmth & humidity
67
What gas is displaced the most with inspired humidifed gas? Why?
Nitrogen Because concentration is the highest (79%)
68
How do abbreviate gas concentrations?
[ ] <------ with these brackets or F
69
About how much does O2 partial pressure decrease from displacement with inspired humidifed gas?
10 mmHg
70
What is the partial pressure of water in inspired humified gas?
47 mmHg
71
How do you abbreviate inspired air?
subcript I Ex) PIO2> = Inspired O2 pressure
72
Inspired gas is _________ by water vapors
diluted
73
T/F: Volatile anesthetics are diluted by water vapors in inspired humidified gas
T
74
What is the the formula for inspired gas concentration?
(partial pressure) = (gas concentration)(Atomspheric pressure - partial pressure of water) Ex) 149 = (.29)(760 - 47)
75
T/F: Water vapor can be displaced during inspiration
F Water is BIG DADDY, it CANNOT be displace. It will always be 47.0 mmHg
76
Partial Pressure of water will ALWAYS be ______ and it will ______ change
47.0 mmHg NEVER CHANGE **IT WILL NEVER CHANGE**
77
What is the PO2 and PCO2 that is inhaled?
PIO2 = 149 mmHg PICO2 = 0.3 mmHg (or 0)
78
________ of air is lost in the _________ during inspiration
150 cc dead space
79
How much air makes it to the alveoli?
350 cc
80
What is the Pressure in the pulmonary arteries for O2 and CO2?
PaO2 = 40 mmHg PaCO2 = 45 mmHg
81
How would you describe pulmonary arterial blood?
Deoxygenated systemic venous blood going into the lung for gas exchange (to be oxygenated)
82
What is the average alveolar gas pressure? What is significant about this number/area?
PAO2 = 100 mmHg PACO2 = 40 mmHg This is where O2 is put into the circulation and CO2 is taken out of circulation
83
How much CO2 is offloaded from the pulomary arteries into the alveoli?
5 mmHg
84
How much O2 is put into the pulomary veins from the alveoli in addition to what was already in the pulmonary arteries??
60 mmHg
85
What are gas pressures in the pulmonary vein after gas exchange with the alveoli?
PvO2 = 100 mmHg PvCO2 = 40 mmHg
86
The average alveolar pressures has the same values as the ___________
pulmonary vein pressures
87
Pulmonary vein blood is considered _________
oxygenated
88
Inspired air will ________ CO2 which will ______ the concentration in the lungs
dilute decrease
89
Inspired air will ______ the O2 concentration in the lungs
increase
90
Explain how equilivant amounts of O2 and CO2 are exchanged with inspiration and expiration.
Although the pressure of CO2 in the pulm vein decreased by 5 mmHg and O2 increased by 60 mmHg equal amounts are exchanged. ✅ CO₂ has a lower pressure gradient but higher solubility, so it diffuses efficiently. ✅ O₂ has a higher pressure gradient but lower solubility, so it needs hemoglobin for transport. ✅ Despite different pressure changes, equal amounts of gas are exchanged due to differences in solubility and transport.
91
Alveolar pressures are the pressures ________ inspiration equilibrium
after (after gas exchange)
92
T/F: O2 absorption and unloading of CO2 is intermittent
F It is a continuous thing

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