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Lung Physiology Flashcards

1
Q

What are the 5 main features of inflammation

A
  1. Calor (hot)
  2. Rubor (red)
  3. Dolor (painful)
  4. Tumour (swollen)
  5. Functio leasa (loss of function)
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2
Q

Define acute inflammation

A

Innate, intermediate and response short term followed by tissue injury

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3
Q

What is the result of vasodilation

A

Enhances blood flow to nearby capillaries and tissues

Leads to exbation of plasma including antibodies

Higher blood flow = rubor and calor

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4
Q

Define calor

A

Hot

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5
Q

Define rubor

A

Red

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6
Q

Define dolor

A

Painful

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7
Q

Define tumour

A

Swollen

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8
Q

Define functio lessa

A

Loss of function

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9
Q

In acute inflammation what are the steps of the biochemical cascades

A

Initiated in tissues by epithelial production of hydrogen peroxide and release of extracellular components

Amplified by specialist macrophages

Respond to pathogens or to tissue by recognising PAMPs or DAMPs

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10
Q

Define the meaning double edged sword

A

People die from the inflammatory process

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11
Q

What are the figures of community acquired pneumonia

Number affected each year

How many of those affected are admitted to hospital

What is the mortality of those who are admitted

A

250,000 adults per annum

33% of those are admitted to hospital

Morality approx. 10% of those admitted

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12
Q

Define ARDs (acute respiratory distress syndrome)

A

Form of acute lung injury characterised by severe hypoxemia (low blood oxygen) in the absence of a cardiogenic cause

Occurs when inflammatory damage to alveoli leads to pulmonary oedema

Can be direct or indirect

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13
Q

Define PRRs (Pattern Recognition Receptors)

A

Not specific of individual pathogens but to a group of pathogens

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14
Q

Define Toll-like receptors

A

Main PRR

Recognise different pathogen associated molecular patterns (PAMPs)

Recognise conserved molecular patterns in pathogens

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15
Q

How many toll-like receptor types are there

A

11

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16
Q

What are the two types of PRRs

A

Toll-like receptors

Nod-like receptors

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17
Q

What is the role of a macrophage

A

Critical role in immune regulation and wound healing

Can respond to a variety of cellular signals and change their physiology in response to local cues

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18
Q

What are alveolar macrophages

A

Specialised resident phagocytes

First line of cellular defence in the lungs

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19
Q

What are vital roles of alveolar macrophages

A

Lung development
Surfactant homeostasis
Immune surveillance

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20
Q

Where are alveolar macrophages located

A

Inner epithelial surface of alveoli

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21
Q

How does the respiratory epithelium act as a host defence in the lung

A

Acts as a barrier to potential pathogens

Prevents tissue injury by action of mucocillary escalator

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22
Q

What are the chemical epithelial barriers

A

Produced by most epithelial cells

  • Antiproteases
  • Anti-fungal peptides
  • Anti-microbial peptides
  • Anti-viral proteins
  • Opsins
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23
Q

How does alveolar epithelium have host defence function

A

Epithelial cells produce physical barriers (mucus) and products of submucosal glands

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24
Q

What is the role of mucus in the lungs

A

Viscoelastic gel - contains carbohydrates, proteins and lipids

Protects epithelium from foreign material

Prevents fluid loss

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25
How does the mucocillary escalator work
Cilia beat in directional waves to move mucus up the airway
26
Define cough
Expulsive reflex that protects the lungs and respiratory passages from foreign bodies
27
What causes coughs
Irritants Disease conditions Infections Can be voluntary or reflexively As a defensive reflex has both afferent and efferent pathways
28
What are the afferent nerves of the cough relfex
Receptors - within the sensory of trigeminal, glossopharyngeal, superior laryngeal and Vagus nerves
29
What are the efferent nerves of the cough reflex
Recurrent laryngeal nerve and spinal nerves
30
Define sneeze
Involuntary expulsion of air containing irritants from nose
31
What are the causes of a sneeze
Irritation of nasal mucosa Excess fluid in airway
32
Define complete repair
Following injury of airway epithelium it can fully repair due to a level of funtioning plasticity
33
What are mucus plugs associated with
Severe disease
34
What is the requirements of the respiratory pump
To move 5L/min of inspired gas (match cardiac output 5L/min)
35
What are the nerves involved in respiratory pump
Sensory - Sensory receptors - C fibres - Afferent via Vagus nerve Autonomic - sympathetic, parasympathetic balance
36
Define compliant
Lungs ability to stretch and expand
37
What is the role of surface tension
Limits the compliance of the lungs Thin layer of water due to water interactions try to push air out which avoids the alveoli from collapsing
38
What is the total combined surface area for gas exchange
50 -100m2
39
How many alveoli are there per each lung
300,000,000
40
What is needed for gas exchange
Perfusion
41
What are the two factors which effect gas exchange
Ventilation Perfusion
42
Define dead space
Volume of air not contributing to ventilation Last bit of gas we breath in which does not contribute to gas exchange e.g. in the nasopharynx
43
What is the volume of anatomic dead space
150 mls
44
What is the volume of alveolar dead space
25 mls
45
What is the volume of physiological dead space
175 mls anatomic + alveolar
46
What is the artery supply to the lungs
Bronchial arteries (arise from the descending aorta)
47
What must both right and left ventricles have
Same cardiac output Prevent blood from building up in either systemic or pulmonary circulation
48
What does the right bronchial vein drain into
Azygous veins
49
What does the left bronchial vein drain into
Accessory hemizygous veins
50
Define pulmonary circulation
Carries deoxygenated blood away from the heart to the lungs' alveoli to undergo gas exchange and return oxygenated blood back to the heart
51
How many pulmonary veins are there
4 2 per lung
52
Define broncho-vascular bundle
Pulmonary artery and bronchus run in parallel
53
How many capillaries are there per alveolus
100
54
How many erythrocytes will come into contact alveoli
Multiple
55
At rest what % way through the capillary is the haemoglobin fully saturated
25%
56
What are the 3 things capillaries must have to promote efficient gas exchange
Large surface area available for gas exchange Short diffusion distance (combined 0.3 um) Hypoxic pulmonary vasoconstriction - Ventilation matching
57
What does perfusion of capillaries depend on
Pulmonary artery pressure Pulmonary venous pressure Alveolar pressure
58
What is the mean arterial pressure of the pulmonary circulation
5-15mmHg (Low)
59
What is the mean arterial pressure of the systemic circulation
93 mmHg
60
What features do pulmonary arteries have to allow them to carry more blood
Thin vascular walls High compliance
61
What is the optimal V/Q ratio
0.8-1
62
Define hypoxic pulmonary vasoconstriction
Small arteries constrict to redirect blood flow from poorly ventilated areas of the lung to better ventilated areas
63
What does recruiting of alveoli occur in
Exercise
64
What % capacity of cardiac output do pulmonary vessels have at rest
30%
65
Define spirometry
Method of measuring the volume of air that the patient is able to expel from lungs after maximal inspiration
66
Define FEV1 (Forced expiratory volume in one second)
Volume exhaled in the first second after deep inspiration and forced expiration
67
Define FVC (Forced vital capacity)
Total volume of air that a patient can forcibly exhale in one breath
68
What are FEV1 and FVC expressed as
% predicted normal of a person of the same age, sex and height
69
What does a peak flow give readings in
litres/minute (L/min)
70
What can expiratory procedures only measure
Vital capacity not residual volume
71
What methods can be used to measure residual volume
Gas dilution Body box (total body plethysmography)
72
What does gas dilutions measure
Measurement of all air in the lungs that communicates with the airways
73
What does helium dilutions measure
Measures the total lung capacity (only accurate if the lungs are not obstructed) Quite inspiration holds gas of known helium conc. Hold breath for 10 seconds (allows air to mix with lungs) Conc. of helium measured after expiration
74
What does nitrogen wash out measure
Calculates the serial/anatomical dead space in the conducting airways including terminal bronchioles (normally 150mL)
75
What does total body plethysmography measure
Lung volume, including gas trapped in bullae Patient pants, pressure is proportionate to air in the chest
76
How do you measure compliance of lungs
Change in volume per unit change in pressure gradient between the pleura and the alveoli (transpulmonary pressure) During breath hold - static compliance During regular breathing - dynamic compliance
77
What is static compliance a measure of
Distensibility
78
How would you measure dynamic compliance
Measured during tidal breathing at the end of inspiration and expiration when stationary
79
What are the three importance of respiration
1. Ensure haemoglobin is close to saturation of oxygen as possible 2. Efficient use of energy resource 3. Regulate PaCO2 carefully (impacts pH)
80
What is the major determinant of next breath
CO2
81
What is CO2 inversely proportional to
Alveolar ventilation
82
What are the three types of lung receptors
Stretch J Irritant
83
What are the roles of lung receptors
Assist with lung volumes and responses to noxious inhaled agents
84
What are the airway receptors in the nose, nasopharynx and larynx
Chemo and mechano receptors
85
What are the role of the airway receptors in the pharynx
Receptors appear to be activated by swallowing Respiratory activity stops during swallowing to protecting against the risk of aspiration of food or liquid
86
What is the normal PaCO2
4-6 KPa
87
If alveoli ventilation increase what happens to CO2
Decreases (Vice versa)
88
Define respiratory failure
Failure of gas exchange Low PaO2 (with or without a rise in PaCO2)
89
Define hypoxia vs hypoxemia
Tissue components vs ambient low-pressure environment
90
What is piO2 at sea level
21 KPa 100KPa x 0.21
91
Define PAO2
Alveolar
92
Define PaO2
Arterial
93
Define type 1 respiratory failure
PaO2 = low (hypoxia) PaCO2 = low/abnormal (hypocapnia/normal)
94
Define type 2 respiratory failure
PaO2 = low (hypoxia) PaCO2 = high (hypercapnia)

Respiratory (16 decks)

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