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Physiology Module > Module 7: Respiratory System > Flashcards

Module 7: Respiratory System Flashcards

1
Q

Respiratory System

A

UPPER AIRWAYS - Nose, Sinuses, Larynx

LOWER AIRWAYS - Trachea, Airways, Alveoli

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2
Q

Nose: FUNCTIONS

A

warm (cold dry air damages the respiratory epithelium),
humidify (add water droplets to the air going in,
filter (prevent large particles from going in),
smell (olfactory neurons,only neurons capable for reproduction, are found in upper part of the nose),
defense

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3
Q
  • air filled spaces that lightens the skull
  • composed of frontal sinuses, maxillary sinus, sphenoid sinus, ethmoid sinus
  • Surround nasal passageways
A

Sinuses

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4
Q

Functions of Sinuses

A
  1. Lighten skull

2. Offer resonance to voice (improves the speech)

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5
Q
  • last part of the upper airway
  • voicebox
  • MAJOR STRUCTURES
  • Vocal Cords
  • Epiglottis, Arytenoids
A

Larynx

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6
Q
  • Covers the vocal cords during swallowing

- cover the entrance to the trachea during swallowing

A

Epiglottis, Arytenoids

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7
Q
  • part of the lower airway; airway that leads to the bronchus
  • In the trachea, C-shaped cartilages are found
A

Trachea

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8
Q

Trachea, Bronchi, Bronchioles

A

Trachea&raquo_space; Main Stem Bronchi&raquo_space; Lobar Bronchi&raquo_space; Segmental Bronchi&raquo_space; Terminal bronchioles&raquo_space; Respiratory bronchiole Alveoli

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9
Q

BRONCHI

A

Right vs Left: Right bronchi is wider, shorter and more vertical
Implication: will be common for aspiration on the RIGHT bronchi

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10
Q

BRONCHIOLE

A

Terminal Bronchiole vs Respiratory Bronchiole:

Terminal bronchiole - the distal part of the airway that has no alveoli or alveolar sacs; last part that has no gas exchange

Respiratory Bronchiole is capable of Gas Exchange

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11
Q
  • give rise to bronchopulmonary segment
A

Segmental Bronchi

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12
Q
  • consists of 8-10 per lung

- will have its own blood and nerve supply

A

Bronchopulmonary segments

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13
Q

3 Areas capable of gas exchange

A
  1. Respiratory Bronchioles
  2. Alveolar Ducts
  3. Alveoli
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14
Q
  • (+) presence of Respiratory Epithelium (pseudostratified ciliated columnar epithelium with goblet cells
  • Maintains periciliary fluid so that cilia may function
  • GOBLET CELLS, SUBMUCOSAL GLANDS
  • CLARA CELLS (CLUB CELLS)
A

Trachea, Bronchi, Bronchioles

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15
Q
  • Produces Mucus for lubrication

- Hyperplasia, Hypertrophy seen in chronic smokers

A

GOBLET CELLS, SUBMUCOSAL GLANDS

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16
Q
  • Controversial
  • nonciliated cells found in the respiratory epithelium
  • May play a role in EPITHELIAL REGENERATION after injury
A

CLARA CELLS (CLUB CELLS)

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17
Q
  • moves the dust debris towards the mouth

- has a unidirectional movement

A

Cilia

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18
Q

COUGH REFLEX

A
  1. 2.5 L of air rapidly inspired
  2. Epiglottis closes
  3. Abdominal muscles contract
  4. Epiglottis opens
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19
Q
  • Similar to cough reflex but applied to nasal passageways (upper respiratory passageways)
  • with depression of the uvula to force air to go to the nose
  • removes the irritating factor
A

SNEEZE REFLEX

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20
Q
  • Weighs 1kg
  • 60% lung tissue
  • 40% blood
  • Alveolar Spaces
  • Gas Exchange Area: 70 -80 m2
A

Lungs

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21
Q
  • Responsible for most of lung’s volume

- Divided by lung interstitium (tissue in between alveolar spaces)

A

Alveolar Spaces

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22
Q

Lungs

A

RIGHT LUNG

  • 3 Lobes (Upper, Middle, Lower)
  • Oblique Fissure, Horizontal Fissure

LEFT LUNG

  • 2 Lobes (Upper, Lower)
  • has lingula
  • Oblique Fissure
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23
Q
  • VISCERAL PLEURA - closely attach to the lungs
  • PARIETAL PLEURA - closely attach to the chest wall
  • PLEURAL FLUID
A

Lungs

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24
Q
  • Found in potential space between the two pleura
  • Keeps the 2 pleura together (allows them to slide)
  • Has negative pressure
A

PLEURAL FLUID

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25
Q
  • air inside the pleural space that cause the lungs to expand limitedly during inspiration
A

Pneumothorax

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26
Q
  • water inside the pleural space
A

Pleural Effusion

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27
Q
  • pus collection in the pleural space secondary to infection
A

Empyema

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28
Q
  • 5 x 108 alveoli
  • Made up of 2 Cells in a 1:1 ratio
  • TYPE I Pneumocytes
  • TYPE II Pneumocytes
A

Alveoli

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29
Q
  • 96-98% of surface area

- For Gas Exchange

A

TYPE I PNEUMOCYTE

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30
Q
  • 2-4% of surface area
  • Small, cuboidal, found at corners of alveoli
  • May turn into Type I if needed
  • For surfactant production (Decreases surface tension)
A

TYPE II PNEUMOCYTE

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31
Q
  • Force caused by water molecules at the air-liquid interface that tends to minimize surface area
A

Surface Tension

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32
Q

(Surface Tension of the Alveoli)

P=2T/r
(P=Collapsing Pressure on alveolus, T=Surface Tension, r=radius of alveolus)

  • Smaller alveoli would likely collapse if not for surfactant
A

LAPLACE LAW

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33
Q

Laplace Law

A
  • Collapsing Pressure is directly proportional to the surface tension
  • Collapsing Pressure is indirectly proportional to the radius
  • The higher the surface tension, the higher the collapsing pressure
  • The smaller the radius, the higher the collapsing pressure
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34
Q
  • Synthesized by Type II alveolar cells
  • Made up of DPPC (Dipalmitoylphosphatidylcholine),
    phosphatidylglycerol, surface apoproteins, calcium ions
  • reduces surface tension (to 5-30 dynes/ cm) and increases compliance
  • It also reduces capillary filtration forces (Reduces the possibility of pulmonary edema)
A

Pulmonary Surfactant

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35
Q

Causes of Respiratory Distress of the Newborn (Preterm)

A
  1. Immature surfactant

2. Smaller Alveoli (which means small radius)

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36
Q
  • active component of surfactant
  • act as a detergent which decrease surface tension
  • also known as Lecithin
A

Dipalmitoylphosphatidylcholine

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37
Q

Which blood vessels are involved in hemoptysis?

A

Bronchi Blood vessels

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38
Q
  • Also contributes to alveoli stability
  • One alveoli exerts traction on surrounding alveoli prevents collapse (alveolar collapse)
  • has 2 structures that prevents it: Pores of Kohn and Canals of Lambert
A

Interdependence

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39
Q

Connects alveoli to adjacent alveoli

A

PORES OF KOHN

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40
Q

Connects terminal airway to adjacent alveoli

A

CANALS OF LAMBERT

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41
Q

(Lung Interstitium)

  • Secretes Collagen (limits Lung Distensibility)
  • Secretes Elastin (contributes to Elastic Recoil of lung)
A

FIBROBLASTS

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42
Q

(Lung Interstitium)

  • Supports conducting airways
A

CARTILAGE

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43
Q

(Lung Interstitium)

  • Dilate or constrict airways
A

SPIRAL SMOOTH MUSCLES

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44
Q

(Lung Interstitium)

  • Secrete dopamine, serotonin
A

KULCHITSKY CELLS, NEUROENDOCRINE CELLS

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45
Q

(Pulmonary Circulation)

  • very thin and distensible
  • carries deoxygenated blood
A

PULMONARY ARTERIES

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46
Q

(Pulmonary Circulation)

  • same as the systemic veins
  • most oxygenated area; 100% of oxygenated blood
A

PULMONARY VEINS

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47
Q

(Pulmonary Circulation)

DUAL BLOOD SUPPLY OF THE LUNGS

A
  1. PULMONARY CIRCULATION

2. BRONCHIAL CIRCULATION

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48
Q
  • role is to pick up oxygen for the nonpulmonary parts of the body
  • Carries DEOXYGENATED BLOOD to the lungs
  • “Sheet” of capillaries in the alveoli
  • Pulmonary Veins returns to L atrium
A

PULMONARY CIRCULATION

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49
Q
  • gives up oxygen
  • Carries OXYGENATED BLOOD to the lungs
  • 1-2% of cardiac output
  • 1/3 returns to Right atrium via bronchial veins, 2/3 goes to the Left atrium via pulmonary veins
A

BRONCHIAL CIRCULATION

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50
Q

Pulmonary Circulation: Lymphatic Vessels of the Pulmonary System

A
  • start from the terminal bronchioles
  • drains into the RIGHT LYMPHATIC DUCT
  • Removes particulate matter and plasma proteins
  • Creates negative pressure in the pleural space
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51
Q

(Pulmonary Circulation Pressures)

RIGHT VENTRICULAR PRESSURE

A

25/0 mmHg

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52
Q

(Pulmonary Circulation Pressures)

PULMONARY ARTERY PRESSURE

A

25/8 mmHg

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53
Q

(Pulmonary Circulation Pressures)

PULMONARY CAPILLARY PRESSURE

A

7 mmHg

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54
Q

(Pulmonary Circulation Pressures)

LEFT ATRIAL AND PULMONARY VEIN PRESSURE

A

1-5 mmHg

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55
Q
  • used to estimate Left atrial pressure

- whatever pressure that is in here it’s 2-3 mmHg higher that the Left atrial pressure

A

PULMONARY CAPILLARY WEDGE PRESSURE (PCWP)

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56
Q

Clinical Significance of measuring Pulmonary Capillary Wedge Pressure

A

Enables us to differentiate between diseases like Cardiogenic Pulmonary Edema and Acute Respiratory Distress Syndrome in Adult

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57
Q

Cardiogenic Pulmonary Edema vs Acute Respiratory Distress Syndrome in Adult

A

Cardiogenic Pulmonary Edema&raquo_space; Increase PCWP due to increase atrial pressure (involves the heart)

Acute Respiratory Distress Syndrome in Adult&raquo_space; Decrease PCWP (involves the lungs)

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58
Q

Blood Volume, Blood Flow in the lungs

A
  • Blood Volume of the lungs: 450 mL
  • Hypoxia in the lungs causes Vasoconstriction
  • All other organs: hypoxia causes Vasodilation
  • Blood flow in the lungs is divided into theoretical 3 Zones
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59
Q

All arterioles in the body their response to Hypoxia is __

A

VASODILATION (to provide more oxygen to go to the organ like muscles)

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60
Q

Pulmonary arterioles response to Hypoxia is __

A

VASOCONSTRICTION (to shunt blood among areas for better oxygenation)

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61
Q

Lungs are not uniformly oxygenated

A

Base receive more oxygen or air more on the Apex

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62
Q

Lung Zones (Scenarios)

A

Zone 1
Zone 2
Zone 3

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63
Q
  • No Blood flow

- local alveolar capillary pressure

A

Zone 1

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64
Q
  • Intermittent Blood Flow (Blood flow during systole; No Blood flow during diastole)
  • local alveolar capillary systolic pressure > alveolar air pressure but less than that during diastole
A

Zone 2

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65
Q
  • Continuous Blood Flow

- local alveolar capillary pressure > alveolar air pressure throughout the cycle

A

Zone 3

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66
Q

Lung Zone during Sitting upright

A

Upper third of the Lungs - Zone 2/3

Middle and Lower third of the Lungs - Zone 3 exclusive

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67
Q

Lung Zone during Exercise

A

The entire lung is in Zone 3 (Continuous)

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68
Q

Lung Zone during Supine Position

A

The entire lung is in Zone 3 (Continuous)

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69
Q

Innervation

A

LUNGS

  • Under Autonomic Nervous System (ANS) Control
  • No pain fibers (Pain fibers are found only in the pleura)

MUSCLES OF RESPIRATION
Under Somatic Control

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70
Q

(ANS Control of the Lungs): SYMPATHETIC

A
  • bronchodilation (Beta 2&raquo_space; Relax smooth muscle&raquo_space; will cause BRONCHODILATION)
  • Airway relaxation, blood vessel constriction, inhibition of glandular secretion
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71
Q

(ANS Control of the Lungs): PARASYMPATHETIC

A
  • Bronchoconstriction (Muscarinic(acetylcholine)&raquo_space; Bronchial smooth muscle to contract&raquo_space; BRONCHOCONSTRICTION)
  • Airway constriction, blood vessel dilation, increased glandular secretion
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72
Q

Muscles Involved in Pulmonary Ventilation: INSPIRATION

A

NORMAL INSPIRATION: Active Process (Diaphragm)

FORCED INSPIRATION (happens during exercise): External Intercostals, SCM, Anterior Serrati, Scalene, Alae Nasi, Genioglossus, Arytenoid

*Accessory muscle + External intercostal

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73
Q

Muscles Involved in Pulmonary Ventilation: EXPIRATION

A

NORMAL ESPIRATION: Passive Process

FORCED EXPIRATION: rectus abdominis, Internal and External Oblique, Transversus Abdominis, Internal Intercostals

*Abdominal muscles + Internal Intercostal

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74
Q

How do the lungs contract and expand?

A

Diaphragmatic upward and downward movement&raquo_space; Chest cavity lengthening and shortening

Rib upward and downward rotation&raquo_space; Increase and decrease thoracic AP diameter

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75
Q

Elastic Forces of the Lungs and Thorax

A

LUNGS - inwardly directed elastic recoil; tendency is to collapse

CHEST WALL - outwardly directed elastic recoil; tendency is to expand

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76
Q

Elastic Forces of the Lungs and Thorax

A

Before Inspiration/After Expiration
- At Functional Residual Capacity, Recoil forces from lungs and thorax are equal and opposite (pressure in the alveoli is the same the pressure in the air in the atmosphere = no air will go in and out)

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77
Q

Pressures in the Pulmonary System: PLEURAL PRESSURE (pressure inside the pleural cavity)

A

Start of inspiration: -5cm H2O

End of inspiration: -7.5cm H20

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78
Q

Pressures in the Pulmonary System: ALVEOLAR PRESSURE

A

Start of Inspiration: 0cm H20

End of Inspiration: -1cm H20

79
Q
  • (Alveolar Pressure – Pleural Pressure)

- Measure of Recoil Pressure

A

TRANSPULMONARY PRESSURE

80
Q
  • Extent to which lungs will expand for each unit increase in transpulmonary pressure
  • Normal Value = 200 ml or air/cm of water transpulmonary pressure
  • Determined by Lung Elasticity
A

Lung Compliance

81
Q

TOTAL LUNG ELASTICITY

A
  • 1/3 due to Tissue Lung Elasticity

- 2/3 due to Fluid-Air Surface Tension Forces in the Alveoli

82
Q
  • Determined by properties of the lung parencyma and interaction between the lungs and chest wall
  • 4 Basic Lung Volumes
A

LUNG VOLUMES

83
Q
  • Sum of 2 or more lung volumes
A

LUNG CAPACITIES

84
Q

LUNG VOLUMES

A
  • Inspiratory Reserve Volume (IRV)
  • Tidal Volume (TV)
  • Expiratory Reserve Volume (ERV)
  • Residual Volume (RV)
85
Q

Sum of

  • Inspiratory Reserve Volume (IRV)
  • Tidal Volume (TV)
  • Expiratory Reserve Volume (ERV)
A

Vital Capacity

86
Q

Sum of

  • Inspiratory Reserve Volume (IRV)
  • Tidal Volume (TV)
A

Inspiratory Capacity

87
Q

Sum of

  • Expiratory Reserve Volume (ERV)
  • Residual Volume (RV)
A

Functional Residua Capacity

88
Q

What’s the difference in Lung Volumes and Capacities between males and females?

A

Females; 20-25% lower in females

89
Q
  • the amount of air that we normally inhale or exhale
  • 500ml
  • Normal Quiet Breathing Volume
A

Tidal Volume

90
Q
  • is the volume of air remaining in the lungs after the most forceful expiration
  • 1200 ml
  • Left in Lungs after maximal expiration
  • function: maintain oxygenation of blood in between breaths and breath holding
A

Residual Volume (RV)

91
Q
  • extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force
  • 3000 ml
  • Above Tidal volume w/max inspiration
A

Inspiratory Reserve Volume (IRV)

92
Q
  • is the maximum extra volume of air that can be expired by forceful expiration after the end of a normal tidal expiration
  • 1100 ml
  • Forcefully expired at Tidal volume end
A

Expiratory Reserve Volume (ERV)

93
Q
  • this capacity is the amount of air a person can breathe in, beginning at the normal expiratory level and distending the lungs to the maximum amount
  • 3500ml
  • From normal expiratory level up to max voume. lung can be distended
  • VT+IRV
A

Inspiratory Capacity (IC)

94
Q
  • 2300 ml
  • happens before you inhale or after you exhale (or before tidal volume inspiration or tidal volume expiration)
  • Remains in lungs at end of normal expiration
  • ERV+RV
A

Functional Residual Capacity (FRC)

95
Q
  • 4600 ml
  • maximum amount of air that you can inhale or exhale
  • Max that can be expelled after max inspiration then max expiration
  • IRV+VT+ERV or IC+ERV
A

Vital Capacity (VC)

96
Q
  • 5800 ml or approx 6L
  • maximum volume to which the lung can be expanded with the greatest possible effort
  • Maximum volume that lungs can hold at a given time
  • VC+RV or FRC+IC
A

Total Lung Capacity (TLC)

97
Q
  • marker for lung function
  • if its decrease, you already have a lung failure
  • alveolar pressure = atmospheric pressure (no air is coming in and out of the lungs)
  • also known as equilibrium volume
A

Functional Residual Capacity (FRC)

98
Q

Spirometry

A
  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in 1 second (FEV1)
  • FEV1/FVC
  • Average midmaximal expiratory flow rate (FEF25-75)
99
Q
  • is the total volume of air that can be forcibly expired

after a maximal inspiration

A

Forced vital capacity (FVC)

100
Q

The volume of air that can be forcibly expired in the

first second is called __.

A

Forced Expiratory Volume in 1 second (FEV1)

101
Q
  • measure severity of certain lung condition

- used to differentiate Obstructive Pulmonary Disease and Restrictive Pulmonary disease

A

Spirometry

102
Q

Obstructive Pulmonary Disease vs Restrictive Pulmonary disease

A

Obstructive Pulmonary Disease
- problems with expiration; can cause expiratory wheezing; COPD, Asthma

Restrictive Pulmonary disease
- problems with inspiration; Interstitial Lung Disease like fibrosis

103
Q

In a normal person, __ is approximately 0.8, meaning that 80% of the vital capacity can be expired in the
first second of forced expiration

A

FEV1/FVC

104
Q

In a patient with an __, both FVC and FEV1 are decreased, but FEV1 is decreased more than FVC is. Thus, FEV1/FVC is also decreased, which is typical of airway obstruction with increased resistance to expiratory airflow

A

obstructive lung disease

105
Q

In a patient with a __, both FVC and FEV1 are decreased but FEV1 is decreased less than FVC is. Thus, in fibrosis, FEV1/FVC is actually increased

A

restrictive lung disease

106
Q

obstructive lung disease

A

FEV1: Decreased More
FVC: Decreased
FEV1/FVC: Decreased

107
Q

restrictive lung disease

A

FEV1: Decreased
FVC: Decreased More
FEV1/FVC: Normal or Increased

108
Q

Total amount of new air moved into the respiratory passages per minute

A

Minute Respiratory Volume

109
Q

Minute Respiratory Volume (MRV)

A

Minute Respiratory Volume (MRV) = Tidal Volume x Respiratory Rate

  • Normal MRV = 0.5L x 12 bpm = 6L/min
  • Max MRV = 4.6L x 50 bpm = 230L/min
110
Q
  • Rate at which new air reaches the alveoli

- One of the major factors in determining the concentration of Oxygen and Carbon Dioxide in the Alveoli

A

Alveolar Ventilation

111
Q

Areas where there is no gas exchange is referred to as __

A

Dead Space

112
Q
  • Normal and physiologic
  • Air in normal non-conducting areas (from nose to terminal bronchiole)
  • Normal value: 150 ml
A

Anatomic Dead Space Volume

113
Q
  • Amount of air in the alveoli that are not capable of gas exchange
  • Air in abnormal non-conducting alveoli
  • Normal value: 0 ml
A

Alveolar Dead Space Volume

114
Q
  • Sum of Anatomic Dead Space Volume + Alveolar Dead Space Volume
A

Physiologic Dead Space Volume

115
Q

Alveolar Ventilation

A

VA = RR x (Tidal Volume – Physiologic Dead Space Volume)

116
Q
  • Air flows through the airways when pressure difference is present between the two ends
  • Air only flow from high pressure to low pressure
A

Airflow in Airways

117
Q

Determinants of Air Flow Rate

A
  1. Pattern of Gas flow

2. Resistance to airflow by airways

118
Q

Pattern of Gas flow

A
  1. Laminar Flow

2. Turbulent Flow

119
Q
  • Parallel to walls (fastest at the center; slowest at the edges
  • Present at low flow rates
  • Described by Poiseuille’s Equation
A

Laminar Air Flow

120
Q
  • random, disorderly, disorganized air flow
A

Turbulent Air Flow

121
Q

Airway Resistance

A

Major site of resistance: large bronchi

Approximately 1 cm H20/L/ sec

122
Q

Airway Resistance: FACTORS

A
  1. Lung volume
    - Decreased by airway mucus, edema and bronchiolar constriction
  2. Density and viscosity of inspired gas
    - E.g. inc density of gases in scuba diving
123
Q
  • Caused by the constant impact of moving molecules against a surface
  • directly proportional to the concentration of the gas molecules
A

PRESSURE

124
Q
  • In a mixture of different gases, it is the pressure caused by each gas alone
A

PARTIAL PRESSURE

125
Q

DALTON’S LAW OF PARTIAL PRESSURE’S

A

Partial Pressure = Total pressure x Fractional gas concentration

126
Q

Physics of Diffusion and Partial Pressures: EXAMPLE

A

Atmospheric pressure = 760mmHg
Oxygen =21% of atmosphere
Nitrogen = 79% of atmosphere

Partial Pressure of Oxygen(PO2) in the Atmosphere
760x.21 = 159.6

Partial Pressure of Nitrogen (PN2) in the Atmosphere
760x.79 = 600.4

127
Q

HENRY’S LAW

A

Partial Pressure = Concentration of Dissolved Gas/Solubility Coefficient

128
Q

SOLUBILITY COEFFIECIENT

A 
CO2  = 0.57 (has a higher solubility coefficient)
O2 = 0.024
CO = 0.018
Nitrogen =0.012
Helium = 0.008
129
Q

Fick’s Law of Gas Diffusion

A

D = Delta P x A x S
——————–
d x √MW

Where: 
D = Diffusion Rate
Delta P  = Partial Pressure Difference between two ends
A = Cross-Sectional Area
S = Solubility of Gas
d = distance of diffusion
MW = Molecular weight
130
Q

(Fick’s Law of Gas Diffusion)

Diffusion is directly proportional to

A
  1. Partial pressure difference between two ends
  2. Cross-sectional area (the larger the cross sec area, the greater the diffusion)
  3. Solubility of Gas (the greater the solubility, the greater the diffusion)
131
Q

(Fick’s Law of Gas Diffusion)

Diffusion is inversely proportional to

A
  1. Distance of diffusion (the longer the distance, the slower the diffusion rate)
  2. Molecular weight (the larger the MW, the slower the diffusion)
132
Q

DIFFUSION COEFFICENT

A

DIFFUSION COEFFICENT = S/√MW

D = Delta P x A x Diffusion Coeff
———————
d

133
Q

Rate at Which Alveolar Air is Renewed by Atmospheric Air

A
  • Only 350ml on new air is brought to the alveoli
  • FRC = 2300ml
  • It will take more than 16 breaths to replace most of the alveolar air
  • Prevents sudden changes in gas concentrations in the blood
134
Q

Factors Affecting Diffusion in the Respiratory Membrane

A
  1. Thickness of the membrane - affected by Edema, Fibrosis
  2. Membrane surface area - affected by Emphysema
  3. Diffusion coefficient of the gas - depends on the gas’ SOLUBILITY in the membrane and inversely on the square root of the gas’ molecular weight
    CO2 > O2 > N2
  4. Pressure difference of a gas
135
Q
  • the ability to exchange gas
  • ability of the respiratory membrane to exchange gas between the alveoli and the pulmonary blood
  • Volume of gas that will diffuse through the membrane each minute for a pressure difference of 1 mmHg
A

Diffusing Capacity

136
Q

DIFFUSING CAPACITY (O2)

A

O2– normal is 21 ml/min/mmHg, if exercising, 65 ml/min/mmHg

*during exercise, the diffusing capacity will increase three times the normal value

137
Q

DIFFUSING CAPACITY (CO2)

A

CO2 – normal is 400-450 ml/min/mmHg, if exercising, 1200-1300 ml/min/mmHg

  • higher than Oxygen because CO2 is more soluble
  • during exercise, the diffusing capacity will increase three times the normal value
138
Q

Factors that increase Diffusing Capacity during Exercise:

A
  1. Opening of dormant capillaries

2. Greater V/Q ratio

139
Q

Another condition in which the diffusing capacity will increase three times the normal value

A

High Altitude

140
Q

V/Q Ratio and Alveolar Gas Concentration

A
  • The lung areas are NOT made equal

- Different areas have different ventilation, different perfusion

141
Q

Site of Highest Ventilation (V):

A

BASE

142
Q

Site of Highest Perfusion (Q):

A

BASE (because of gravity)

143
Q

Site of Highest Ventilation-Perfusion Ratio (V/Q):

A

APEX

144
Q

Normal Ventilation-Perfusion Ratio

A

80% or .8

145
Q

(V/Q Ratio and Alveolar Gas Concentration)

If VA/Q = 0

A
  • VA = 0
  • occurs during mucus plug; no air flow
  • Air in the alveoli equilibrates with blood O2 and CO2
  • termed for Physiologic Shunt (shunted towards better ventilated area)
146
Q

(V/Q Ratio and Alveolar Gas Concentration)

If VA/Q = infinity

A
  • Perfusion = 0
  • happen in Pulmonary Embolism; no blood flow =no gas exchange
  • Air in the alveoli equilibrates with humidified inspired air
  • Physiologic Dead Space (no gas exchange)
147
Q

Abnormalities of V/Q Ratio: UPRIGHT POSITION

A

Top of the lung: moderate degree of physiologic dead space (low perfusion)

Bottom of the lung: moderate degree of physiologic shunt (low ventilation)

148
Q
  • Has areas with both serious physiologic dead space (inadequate flow in some areas) and serious physiologic shunt (obstructed small bronchioles)
A

Chronic Obstructive Pulmonary Disease (COPD)

149
Q

(Oxygen Transport in the Blood)

O2 is transported as:

A
  1. Freely-dissolved O2 in the plasma (2%)

2. Bound to Hemoglobin (98%)

150
Q

Oxygen Transport in the Blood

A

Oxyhemoglobin: with bound O2
Deoxyhemoglobin: without bound O2

151
Q

Hemoglobin is ideal for transport of O2 and CO2

A
  1. Positive cooperativity happens for Oxygen

2. CO2 participates in the Haldane effect and Bohr Effect

152
Q

Total amount of O2 carried in blood including bound and dissolved O2

A

O2 Content of Blood

153
Q

O2 Content of Blood

A

O2 content = (hemoglobin concentration x O2 binding capacity x % saturation) + dissolved O2

154
Q

Enable to pick up oxygen easily especially when there is high level of oxygen like in the lungs

A

Positive cooperativity

155
Q
  • Sigmoidal in shape (rapid pick up of oxygen in high oxygen area)
  • PO2 of 25 mmHg: 50% saturated (P50)
  • PO2 of 40 mmHg: 75% saturated (mixed venous blood)
  • PO2 of 100 mmHg: almost 100% saturated (arterial blood)
  • Exhibits Positive Cooperativity
  • Binding of first O2 molecule increases affinity for second O2 molecule and so forth O2-HgB Dissociation Curve
A

O2-HgB Dissociation Curve

156
Q

(O2-HgB Dissociation Curve)

Shift to the RIGHT

A

“CABET, do the RIGHT thing, LET GO”

CO2
Acidosis 
2,3 BPG
Exercise 
Temperature
157
Q
  • For a given partial pressure of oxygen, mas mababa ang saturation
  • Increase unloading of oxygen that’s why the saturation is low
  • Decrease binding of oxygen to hemoglobin
  • faster unloading of oxygen = will go to the starving tissues that needs oxygen
  • happen during HYPOXIA
A

Shift to the RIGHT

158
Q
  • For a given partial pressure of oxygen, the higher the saturation; increase binding of oxygen to hemoglobin
  • eg Fetal Hemoglobin; Carbon Monoxide Poisoning
A

Shift to the LEFT

159
Q

pH of 7.4 to 7.2

A

Shift to the Right

160
Q

Decrease CO

A

Shift to the RIGHT

161
Q

Decrease CO2

A

Shift to the LEFT

162
Q

Increase pH

A

Shift to the LEFT

163
Q

Increase CO

A

Shift to the LEFT

164
Q

Increase CO2

A

Shift to the RIGHT

165
Q

Increase Acidity/Low pH

A

Shift to the RIGHT

166
Q

Increase in Alkalinity

A

Shift to the LEFT

167
Q

Decrease in Alkalinity

A

Shift to the RIGHT

168
Q

pH 7.4 to 7.6

A

Shift to the LEFT

169
Q

Fever

A

Shift to the RIGHT

170
Q

Hyperventilation

A

Shift to the LEFT due to less carbon dioxide

171
Q

CO2 is transported in the blood in 3 ways:

A
  1. As HCO3- (90%)
    CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3-
  2. Freely-dissolved in plasma (5%)
  3. CarbaminoHemoglobin (3%)
172
Q
  • Increased CO2/H+ causes UNLOADING OF OXYGEN from Hemoglobin (shift to the R of the O2-HgB dissociation curve)
  • Occurs in Body Tissues
A

BOHR EFFECT

173
Q
  • Increased O2 causes UNLOADING OF CARBON DIOXIDE from Hemoglobin (shift to the R of the CO2-HgB dissociation curve)
  • Occurs in the Lungs
A

HALDANE EFFECT

174
Q

Components for Control of Breathing

A
  • Cerebral Cortex
  • Control Centers in the Midbrain and Pons
  • Central and Peripheral Chemoreceptors
  • Mechanoreceptors
  • Respiratory Muscles
175
Q
  • Can override the autonomic brainstem centers
  • Voluntary Hyperventilation
  • Dec PaCO2 increases pH LOC
  • Voluntary Hypoventilation (breath-holding)
  • Dec PaO2, Inc PaCO2 decreases pH LOC
  • period of prior hyperventilation can prolong the duration of breath-holding
A

Cerebral Cortex

176
Q
  • Creates the Basic Respiratory Rhythm

- contains the Dorsal Respiratory Group (DRG), Ventral Respiratory Group (VRG) and Central Chemoreceptors

A

Medulla

177
Q
  • Modify the output of the Respiratory center
  • Modifies the Basic Respiratory Rhythm
  • contains the Apneustic and Pneumotaxic centers
A

Pons

178
Q
  • Inspiratory Center; Control Basic Rhythm; For Normal Inspiration; can be modified by apneustic and pneumotaxic centers
A

Dorsal Respiratory Group (DRG)

179
Q
  • Override Mechanism during exercise; for Forced Inspiration and Respiration
A

Ventral Respiratory Group (VRG)

180
Q
  • Found in the Lower Pons

- prolongs the duration of inspiration&raquo_space; decrease Respiratory Rate

A

Apneustic Center

181
Q
  • Found in the Upper Pons

- Decreases the duration of the inspiration&raquo_space; increases the Respiratory Rate

A

Pneumotaxic centers

182
Q
  • Found in the ventral medulla

- Respond directly to CSF H+ (increases RR)

A

Central Chemoreceptors

183
Q
  • Responds MAINLY to PaO2
A

Peripheral Chemoreceptors

184
Q

Chemoreceptors

A

Central Chemoreceptors = CSH H+

Peripheral Chemoreceptors = Pang Low Oxygen (O2)

185
Q
  • Diseases that will decrease the RR: causes __
  • accumulation of Oxygen in the blood
    (e. g. sedative overdose)
A

Respiratory Acidosis

186
Q
  • Diseases that will increase the RR: causes __
  • less carbonic acid in the blood and associated with hypocalcemia
    (e. g.panic attacks)
A

Respiratory Alkalosis

187
Q

In metabolic acidosis, the compensation is __

A

Tachypnea

188
Q

In metabolic alkalosis, the compensation is __

A

Bradypnea

189
Q

(Mechanoreceptors)

  • Stimulated by Lung Distension
  • Initiates Hering-Breuer Reflex that decreases Respiratory Rate by prolonging expiratory time
A

Lung Stretch Receptors

190
Q

(Mechanoreceptors)

  • Stimulated by Limb Movement
  • Causes anticipatory increase in Respiratory Rate during Exercise
  • the moment you move your limbs, you Respiratory Rate will immediately go up
A

Joint and Muscle Receptors

191
Q

Protection reflex that prevents the overinflation of the lungs

A

Hering-Breuer Reflex

192
Q

(Mechanoreceptors)

  • Stimulated by Noxious chemicals
  • Causes bronchocontriction and increases the Respiratory Rate
A

Irritant Receptors

193
Q

(Mechanoreceptors)

  • Found in “juxtacapillary” areas
  • Stimulated by pulmonary capillary engorgement
  • Causes rapid shallow breathing and responsible for the feeling of dyspnea (e.g. in L-sided heart failure)
A

J Receptors

Physiology Module (8 decks)

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