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Lungs 2 Flashcards

1
Q

gas exchange

A

-simple diffusion
-driven by partial pressure of difference of gas (not concentration)
-driving force = difference in pressure
-also depends of diffusion coefficient
-CO2 has a much higher diffusion coefficient -> diffuses faster than O2

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2
Q

diffusion capacity- ficks law

A

-1. diffusion coefficient of the gas
-2. surface area of the membrane
-3. thickness of the membrane
-CO (carbon monoxide) measures this bc diffusion of CO is limited only by diffusion -> rate of disappearance of CO is proportional to diffusion capacity
-diffusion limited during exercise

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3
Q

emphysema

A

-reduced surface area
-decreases diffusion capacity

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4
Q

fibrosis or pulmonary edema

A

-membrane is thicker
-diffusing lung capacity decreases

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5
Q

exercise

A

-increase amount of blood flow to lungs -> increase SA for gas exchange
-increase diffusing lung capacity

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6
Q

Henry’s law- dissolved gas

A

-henrys law- concentration dissolved gas in a solution is proportional to PP of O2
-at a given partial pressure -> higher solubility of gas -> higher concentration of gas in solution
-total gas concentration = dissolved gas + bound gas + chemically modified gas
-only dissolved gas contributes to PP
-dissolved gas- nitrogen is only dissolved molecule
-bound gas- gas is bound to protein (ex. O2 bound to hemoglobin)
-chemically modified gas- CO2 -> bicarbonate in the blood

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7
Q

gas exchange in lungs

A

-O2 leaves alveolar air -> into pulmonary capillary blood
-CO2 leaves pulmonary capillary blood -> into alveolar air
-O2 and CO2 transfer = consumption and production
-pulmonary mixed venous blood- PP of O2 is low (40) bc its been used; CO2 PP is high (46) bc tissues produce CO2 and add it into venous blood
-diffusion of O2 into pulmonary capillary is driven by low O2 pp in venous blood -> equilibrates to alveolar O2 pp

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8
Q

systemic arterial blood

A

-same pressure as alveolar air
-PP O2 is 100 and PP CO2 is 40
-goes to left heart

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9
Q

pressure in dry, humidified, tracheal, alveolar, and pulmonary capillary blood

A

-dry inspired air- O2 (160), CO2 (0)
-humidified tracheal air- O2 (150), CO2 (0)
-alveolar air- O2 (100), CO2 (40)
-mixed venous blood- O2 (40), CO2 (46)
-systemic arterial blood- O2 (100), CO2 (40)

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10
Q

high altitude

A

-barometric pressure reduced
-PP of O2 in alveolar gas will also be reduced
-decreases the gradient -> less drive for diffusion
-slower equilibration / diffusion -> pulmonary capillary does not equilibrate by the end of the capillary
-can impair tissue perfusion
-this is exaggerated in pts with fibrosis

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11
Q

forms O2 is carried and hemoglobin

A

-dissolved and bound to hemoglobin
-% saturation- precent of heme groups (4) that are bound
-iron must be in ferrous state to bind
-methomoglobin- when iron is in ferric state -> does not bind O2
-fetal hemoglobin (HbF) - higher affinity for O2 (2 beta chains and 2 gamma) -> O2 goes from mom to fetus -> replaced by HbA during life
-hemoglobin S- sickle cell shape (alpha subunits are normal and beta are abnormal) -> affinity for O2 decreases; also causes occlusion, pain

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12
Q

O2 hemoglobin dissociation curve

A

-% saturation increases steeply as O2 pressure increases from 0 to 40
-levels off between 50-100
-affinity increases as more O2 binds to the 4 heme groups -> positive cooperativity
-P50- O2 pressure where hmg is 50% saturated
-if P50 is increased- decrease affinity
-P50 is decreased- increase affinity
-hmg saturation is maintained from 60-100 -> we can tolerate these changes in alveolar O2 pressure without compromising tissue perfusion

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13
Q

pulse oximetry

A

-measure % saturation of arterial blood
-does NOT directly measure pressure of O2 in arterial blood
-% saturation can help you estimate O2 pressure from O2 hemoglobin dissociation curve though

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14
Q

decreased affinity of O2 on hmg

A

-right shift
-P50 increase- 50% saturation is achieved at higher than normal O2 pressure
-increase CO2 pressure
-decrease pH
-increase temperature
-increase 2,3 DPG
-unloading of O2 is good

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15
Q

increased affinity for O2 on hmg

A

-left shift
-decrease P50- 50% saturation occurs at lower than normal O2 pressure
-unloading of O2 is more difficult
-decrease CO2 PP
-increase pH
-decrease temp
-decrease 2,3 DPG
-hemoglobin F

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16
Q

carbon monoxide

A

-decreases O2 bound to hmg
-left shift
-binds to hmg with MUCH higher affinity compared to O2
-forms carboxyhemoglobin
-reduces O2 binding sites -> decrease O2 binding capacity
-sites that are open bind O2 more tightly than usually -> hard to drop it off to tissue

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17
Q

erythropoietin (EPO)

A

-glycoprotein
-stimulus for erythropoiesis -> RBC
-induced by kidneys in response to hypoxia
-chronic renal failure -> decrease EPO -> decrease production of RBC -> decrease in hmg concentration -> anemia :(
-treat with recombinant human EPO

18
Q

CO2 carried in blood

A

-3 forms:
-1. dissolved CO2
-2. carbaminohemoglobin (CO2 bound to hemoglobin)
-3. bicarbonate (HCO3-) - MOST important
-almost all CO2 carried is in chemically modified form HCO3- (90%)
-aerobic metabolism -> systemic capillary blood -> converted to HCO3- -> lungs -> converts back to CO2 -> expired

19
Q

henrys law in regards to CO2

A

-concentration of CO2 in blood is PP multiplied by solubility of CO2

20
Q

CO2 binding to hemoglobin

A

-binds at a different site than O2
-Bohr effect- CO2 binding reduces the affinity for O2 binding bc it causes a right shift of O2 hemoglobin dissociation curve
-haldane effect- when less O2 is bound to hemoglobin affinity for CO2 increases
-this makes sense bc as you are binding CO2, O2 is being dropped off to tissue and when you drop of CO2, O2 is being picked up

21
Q

pulmonary circulation

A

-pulmonary blood flow = CO of right heart = CO of left heart
-pulmonary circulation is MUCH lower pressure and resistance
-flow is regulated by resistance of arterioles via arteriolar smooth muscle
-regulated by local vasoactive substance -> mostly O2
-decrease Pa O2 -> vasoconstriction (hypoxic vasoconstriction)
-this seems wrong but vasoconstriction directs blood away from poorly ventilated areas and towards well ventilated areas -> better gas exchange
-this doesnt happen during exercise bc arterial O2 is not changed during exercise!!!

22
Q

fetal circulation

A

-global hypoxic vasoconstriction
-Pa O2 is low in fetus bc it does not breathe
-vasoconstriction in fetal lungs -> increases pulmonary vascular resistance -> reduce to 15% of CO
-first breath increase Pa O2 to 100 -> vasoconstriction reduced -> resistance reduces -> eventually equals CO

23
Q

pulmonary blood flow and gravity

A

-uneven distribution of blood flow in lungs
-sitting- blood flow highest at base and lowest at apex
-supine- nearly uniform distribution

24
Q

shunt

A

-portion of CO or blood flow that is diverted or rerouted
-physiological shunt- some blood (2%) bypasses alveoli to go to bronchial blood flow
-right to left shunt- ventral wall defect causes bypassing of lungs -> HYPOXEMIA ALWAYS bc large portion of CO (up to 50%) is not delivered for oxygenation
-left to right shunts- MC- patent ductus arteriosus or/and trauma -> oxygenated blood from left heart goes to right and causes pulmonary blood flow > systemic
-leaves lungs and goes to right heart -> P O2 on right side will be elevated
-left to right shunts- DOES NOT cause hypoxemia

25
ventilation/perfusion ratio
-ratio of alveolar ventilation to pulmonary blood flow -> matching -> ideal gas exchange -similar to blood distribution, V/Q is uneven due to gravity too -Zone 1- apex- lowest perfusion and ventilation -> Zone 3- base- highest perfusion and ventilation -perfusion varies MORE compared to ventilation due to gravity -V/Q ratio is highest at zone 1 and lowest at zone 3
26
4 components to control breathing system
-1. chemoreceptors for O2, CO2, and H+ -2. mechanoreceptors in lungs and joints -3. control centers in brain stem (medulla and pons) -4. respiratory muscles controlled by brain stem -voluntary control can also be done by cerebral cortex (breath holding, voluntary hyperventilation)
27
involuntary breathing
-controlled by 3 groups of neurons or brain stem centers: -medullary respiratory center -apneustic center -pneumotaxic center- turns off inspiration by limiting tidal volume
28
inspiratory center
-located in dorsal respiratory group (DRG) -controls basic rhythm by setting frequency for inspiration -sensory input from chemoreceptors in glossopharyngeal and vagus and from mechanoreceptors in lungs via vagus -motor output to diaphragm via phrenic
29
expiratory center
-located in ventral respiratory neuron -passive process -inactive during quiet breathing -during exercise -> expiration becomes active -> activated
30
apneusis
-abnormal breathing pattern -prolonged inspiratory gasps followed by brief expiratory movement
31
chemoreceptors
-sensory information sensed by chemoreceptors -> brain stem -> output to motor -> diaphragm via phrenic -senses Pa O2, Pa CO2, and arterial pH in carotid bodies -> DRG -decrease CSF pH -> hyperventilation -increase CSF pH -> hypoventilation
32
mechanoreceptors
-lung stretch receptors -in smooth muscle of airways -stimulated by distention -Hering Breuer reflex- stretch -> reflex -> decrease in breathing rate by prolonging expiratory time -joint and muscle receptors- early response to exercise detects movement and instructs inspiratory center to increase breathing rate
33
irritant receptors
-noxious chemicals and particles -located between epithelial cells lining airways -travel to medulla by vagus -> reflex constriction of bronchial smooth muscle -> increase breathing rate
34
J receptors
-juxtacapillary receptors -in the alveolar walls near capillaries -when pulmonary capillaries fill with blood and increases interstitial fluid volume -> active receptors -> increase breathing rate -ex. left sided heart failure- blood backs up in pulmonary circulation -> J receptors mediate breathing change -> rapid shallow breathing and dyspnea (difficulty breathing)
35
exercise O2 and CO2 levels
-demand for O2 increase -> ventilation rate increases -arterial P O2 and P CO2 DONT change -> excellent matching -P co2 of mixed venous blood MUST increase bc skeletal muscle is adding more CO2 to venous blood -> increase ventilation to rid of the excess CO2 in venous blood -> expire CO2 -> excess CO2 never reaches the systemic blood
36
exercise CO
-CO increases to meet demand for O2 -bc pulmonary flow = CO of left heart = CO of right heart -> increase in CO will increase pulmonary blood flow -decrease in pulmonary resistance -perfusion of more capillary beds -> improved gas exchange -blood flow becomes more evenly distributed -> V/Q ratio becomes more even -> decrease in physiologic dead space
37
exercise hemoglobin dissociation curve
-shifts to right -increased tissue P co2, decreased tissue pH, increased temperature -increase in P50 and decreased affinity of hemoglobin for O2 -allows for easy unloading of O2 in the exercising skeletal muscle
38
high altitude
-hypoxemia -decreased P O2 inspired and alveolar air -headache, fatigue, dizzy, nausea, palpitations, insomnia -> due to initial hypoxia and respiratory alkalosis -response: -1. hyperventilation -2. increase in RBC concentration (polycythemia) -> increase Hmg concentration -> increases O2 content of blood even though P O2 is less -polycythemia is good for O2 transport but bad for blood viscosity -3. increased synthesis of 2,3DPG by RBC -> O2 hemoglobin dissociation curve shifts to right -4. vasoconstriction of pulmonary vasculature (hypoxic vasoconstriction) -> increased resistance -> increase pulmonary arterial pressure -> right ventricle has to work harder -> hypertrophy of right ventricle -5. respiratory alkalosis
39
hypoxia
-decreased O2 delivery or utilization of O2 by tissues -caused by decreased CO or decreased O2 content of blood (O2-hemoglobin) -hypoxemia causes hypoxia (not the only cause)- decrease Pa O2 reduces % saturation of hmg -> decrease O2 content of blood -anemia- decreases hmg concentration -> decrease O2 in blood -CO poisoning- CO binds hmg and decreases O2 content of blood -cyanide poisoning- EXCEPTION- does not involve decreased CO or decreased O2 content -> interferes with O2 utilization of tissue
40
hypoxemia
-decrease in arterial P O2 -high altitude -hypoventilation- decreasing alveolar P O2 (less fresh inspired air into alveoli) -diffusion defects (fibrosis, pulmonary edema) - increases diffusion distance or decreasing SA for diffusion -V/Q defect- can be associated with dead space, high V/Q, low V/Q, shunt -right to left shunt- bypasses lungs
41
A-a gradient
-difference between P O2 of alveolar gas and P O2 of systemic arterial blood

Physiology (24 decks)

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