Lecture 3/4 - Pulmonary Flashcards
Test 2
T/F: your FRC will always decrease when going in the supine position
F
There is a bars standard deviation of +/- 1L which overlaps with the upright position. Meaning that FRC doesn’t always decrease when going into the supine position.
but does always decrease in the actual supine position
Just not when doing the motion to go into supine
Your FRC _______ when sitting
decreases
What is spirometer?
An instrument that measures how long volumes changes during breathing
Spirometry is incapable of measuring anything with the component of ____. What does this include? Why
RV
Includes: TLC
FRC
This is because we can’t get that air out of lungs so the spirometer can’t measure it
IRV is _____ than ERV
larger
VC =
IRV + ERV + VT
What advanced spirometer good for measuring?
Lung volumes/capacities that INCLUDE components of RV
-TLC & FRC
What is needed for advanced spirometry?
Inert gas
Gas meter
CO2 scavanger
O2 source
Why do we use inert gases for advance spirometry?
will not react wth anything in the lungs
Most common Indicator gas for advance spirometry is _____
Helium (He)
O2 is fed in at ________ rate that CO2 is scavanged in advance spirometry
the same
How are we able to find FRC from advance spirometry?
We know starting volume/concentration of He –> He goes into lungs during breathing –> He concentration diluted with air and lungs –> can figure out volume in pts lungs by figuring out what the end concentration is in the lungs with the gas meter.
FRC (V2) =
((V1 x (C1 - C2)) / C2
This is when not given spirometer volume
FRC =
((C1 - V1) / C2) - V2
This is when given spirometer volume
what group is your inert gases? What are they used in? What is this called? List them all.
Group 18
Advanced spirometry
Noble gases
Helium (He)
Neon (Ne)
Argon (Ar)
Krypton (Kr)
Xenon (Xe)
Radon (Rn)
Ununoctium (Uuo)
Which gas that’s found in the ground in basements is the 2nd leading cause of lung cancer?
Radon (Rn)
Increase PTP = ________ lung volume
increase
What is normal vital capacity?
4.5 L
If vital capacity deceases from normal (4.5 L), what type of lung disease is this? Increases?
Restrictive lung disease
Obstructive lung disease
What is an example of restrictive lung disease?
Fibrosis
What is an example of obstructive lung disease?
Emphysema
COPD
Bronchitis
Emphysema is a loss of ________. The lungs are _____ to stretch and _____ to fill.
Elastic tissue
Easier
Easier.
In emphysema the lungs are _______ compliant. Why?
More compliant
Easier to fill with air bc lungs/alveoli have low resistance dt loss of elastic tissue
In emphysema the lungs are ______ to get air out of. Why?
hard
Loss of elastic tissue = loss of recoil to push air out
Restrictive lung disease is an increase in ________. The lungs are _____ to fill.
Scar tissue
hard
With restrictive lung disease, the lungs have a ________ compliance. Why?
Decreased
Because lungs are harder to fill dt the extra scar tissue
Overall, lung volumes/ capacities are generally higher in __________ and lower in __________
Obstructive lung diseases
Restrictive lung diseases
What is the approximate max vital capacity for fibrosis and emphysema?
Normal: 4.5 L
Fibrosis: 3 L
Emphysema: 6 L
Expiration is ________ compliant than inspiration
more
What word describes the difference between the behavior of the lungs with inspiration and expiration in regards to compliance?
Hysteresis
The lungs are _______ compliant with saline. How does this affect inspiration/expiration?
more
Behavior w/ inspiration/expiration narrows ALOT –> hysteresis is smaller
behavior of inspiration/expiration almost becomes the same
_______ contributes to hysteresis in the lungs and makes them ______ compliant
air
less
T/F: All alveoli have a thin layer of fluid
T
With inspiration there is a delay in volume entering the lungs. What causes this?
The lungs need to reach a transpulmonary pressure of 8 cmH2O during inspiration before they start accepting volume
What is the pressure needed during inspiration before the lungs start to accept volume?
PTP 8cmH2O
Describe compliance in a saline filled lung.
Compliance is increased
Small amount of pressure –> large amount of volume accepted
Increase surface tension = _____ to put air into lungs
hard
Decrease surface tension = ______ to put air into lung
easy
What causes the delay in inspiration/decreased compliance in inspiration?
Surface tension
T/F: surface tension is a big contributor to compliance of the lungs
T
Alveoli has an air-water interface. What is this for? What can happen here?
This is where the thin layer of alveolar fluid meets the air –> cruicial area for gas exchange
Water molecules can aggregate here
What does surfactant do?
Decreases surface tension
Prevents water molecules from aggregating
Increasing surfactant = ______ to put air in lungs
easier
What are the 2 components of surfactant? What are they?
- Phospholipids
Dipalmitoylphosphatidylcholine
Phosphatidylcholine - Surfactant proteins
SP-A
SP-D
SP-B
SP-C
What does amphipathic mean?
To have portions that are both soluble & insoluble in water
What molecoles are amphipathic? Describe these molecules.
Dipalmitoylphosphatidylcholine
Phosphatidylcholine
Surfactant
These are Phospholipds: Long fatty tail (insoluble) w/ charge head (soluble)
What percentage do the phospholipids make up of surfactant? Proteins?
phospholipids: 90% total
The cholines: 31% EACH –> 62% total (ot about 1/3 each)
proteins: 10%
Which surfactant proteins are hydrophilic (or lipophobic)?
SP-A
SP-D
Which surfactant proteins are hydrophobic (or lipophilic)?
SP-B
SP-C
What do club cells and type II cells produce?
Phospholipids and proteins needed to make surfactant
What do goblet cells produce?
Mostly mucuous
Small amount of surfactant/compounds
Goblet cells are in the ______ airway. Are they in the alveoli?
Upper
NO!!! They are not in the alveoli!!!!
What are the most important cells for surfactant? (2)
Club cells
Type II cells
If type 2 cells stop releasing surfactant or tubular myelin doesn’t release the surfactant, what will happen?
What’s already in the lung will fall apart –> they wont be replaced –> decreased surfactant –> increased surface tension –> hard to get air in lungs
How many alveoli do we have as a young healthy 20yo? What affects this number?
500 million
Aging beyond 20
Deteriorating Health/lung health
Lung removal
T/F: We dont produce new alveoli
F
We do produce new ones just very slowly like cardiac cells
What will happen if you remove a lung?
The other remaining lung will start to increase in number of alveoli slowly
How many capillaries does each alveoli have?
About 1000
How much surface area is available for gas exchange in a healthy 20yo? What is this approximately the size of?
70 m2
Tennis court
What is the last name of the scientist who discovered the surfactant secreting cells? Describe him.
Clara
Nazi, who did a lot of bad stuff in WWII –> reason why they changed the name to “club cell”
Where is the club cell located? What does it do?
deeper airway; lines lower airway
BUT NOT IN THE ALVEOLI!!!!
Produces surfactant/compounds
Type II cells make up _______ % of gas exchange surface area and type I makes up ______%
5 - 10%
90 - 95%
Where are type II cells located?
In between type I cells IN WALLS OF THE ALVEOLI
There are ___x as many type II cells then type I. type I cells take up _____ space than type II cells
2
more
Describe the shape of type II cells versus type I
Type II: cube shaped –> need to fit things in to produce/release surfactant –> not good for gas exchange (not used for gas exchange)
Type I: thin –> very good for gas exchange
What is the major gas exchange cell?
Type I cell
T/F: Type I & Type II cells are only found in the alveoli
T
The process of releasing surfactant from type II cells into the alveoli is called ___________
Exocytosis
What are the components inside of a type two cell that are needed for the creation/excretion of surfactant? (4)
Nucleus
Golgi apparatus
Lamellar body
Endoplasmic reticulum (ER)
What is 1 word that describes macrophages?
Scavangers
What is the process that surfactant goes through w/ type II cells?
Released thru exocytosis –> attaches to tubular myelin –> surfactant knocked off netting –> surfactant float to alveolar air-water interface –> surfactant becomes active –> surfactant falls apart –> digested by macrophages –> reuptaken by type II cells –> more surfactant produced
What is the storage area for surfactant after exocytosis with type II cells? Where is this?
Tubular myelin
INSIDE THE ALVEOLI (Not in the walls)
Surfactant has to be replaced at ________ rate than decay. What cell is mostly resposible for this?
the same rate
Type II
What are things that knock the surfactant off the tubular myelin?
PA = -1 cmH2O during inspiration
Alveolar stretch dt increase volume
How does being on a ventilator affect surfactant?
You wont have that negative alveolar pressure during inspiration anymore.
decreased surfactant knocked off tubular myelin –> breathing wont be normal
(There will still be some knocked off from alveolar stretch but just decreased in general)
What is a mast cell? What does it release?
Inflammatory mediatory in the lung
secretory cell –> releases histamine
What effects can histamine have in the airways?
irritates airways
airway smooth muscle constriction
What would happen to surfactant if there was an upper airway obstruction OR there was a collapse area of the lung (not inflating/deflating)?
No air into lung or to that area –> no (-) PA, increase lung volume, or alveolar stretch –> surfactant won’t fall off tubular meylin –> will run out of surfactant in that lung/area
T/F: it’s easy to fill a lung back up once it’s been collapse over a while
F
Decrease surfactant –> increase surface tension –> very hard to re-recruit alveoli after a long time
How do you re-recruit alveoli that have been collapsed for a short period of time vs a long period of time? Why is the Tx different?
Long: Fully fill alveoli that are already open –> then air will flow to other places (100% FIO2 for a little bit)
Short: increase inspiratory pressure
If the lung just collapsed, that means there will be a significant amount of surfactant there, but if it’s been a day or so, there may not be enough surfactant there and surface tension will have increased enough to where just increasing pressure won’t help.
Describe regular surface tension in the lungs
It’s regulated
-doesn’t impede getting air into the lungs
T/F: Alveoli want to recoil on themselves
T
What are the elastic recoil pressure components consist of?
1/3 spring/stretchy tissue
2/3 surface tension
Increase surface tension = ______ PER. What does this cause?
Increase
Causes air to be pushed out of the lungs
Where are the recoil tissues present?
small airway
alveoli
The property of water to want to be around other water molecules versus air is called _________
Surface tension
Restrictive lung diseases have ______ layers of recoil tissue. What affects does this have.
More (3)
Harder to fill with air –> holds less volume
Obstructive lung diseases have ______ layers of recoil tissue. What affects does this have.
less
Easier to fill –> causes them to be larger –> holds more volume
What does all lung diseases have in common?
Surfactant deficiency
Who does water like to hang out with? What is this called?
Water
Surface tension
How is surfactant oriented at the air-water interface?
Polar head is in the water
fatty tail is in the air (O2 is more LIPOPHILIC!!!)
How does surfactant work in the lungs?
inserts itself in-between water molecules –> prevents water molecule aggregation –> decreases surface tension –> more compliant lung
What is added to dish washer detergent to prevent water spots?
surfactant
It spreads the water molecules out & if theres Ca+/minerals —> spreads them out so you cant see them
What are important uses for surfactant in the lungs? How?
Helps keeps the lungs dry (prevents water from aggregating)
Helps put air into lungs (decrease surface tension = easier for air to come into lungs)
Helps with gas exchange (thinner layer of water = easier for gas exchange)
Does these things by decreasing surface tension
Increased lung volume = ________ airway diameter. How does this affect resistance and speed of respiration?
increased
DECREASES resistance
INCREASES speed
Decreased lung volume = _________ airway diameter. How does this affect resistance and speed of respiration?
Decreased
INCREASES resistance
DECREASES speed
What are the larger airways held open by?
Pleural pressure of -5
What is traction in the airways upper airway?
physical pull airways from (-) pleural presure –> other airways are linked to each other –> they pull each other open
