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clinical medicine > Pathophysiology Pulmonary > Flashcards

Pathophysiology Pulmonary Flashcards

0
Q

Explain the larynx

A

Connects upper and lower respiratory tracts

Includes epiglottis, thyroid, cricoid cartilages, plus a few other small cartilages

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1
Q

What makes up the upper respiratory tract?

A 
Nasal cavity (mucosal lining warms and humidifies the air)
Pharynx (nasopharynx, oropharynx, and laryngopharynx)
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2
Q

What makes up the ACINUS? What occurs in the acinus?

A

respiratory bronchiole, alveolar ducts, alveoli

-gas exchange

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3
Q

What does the pulmonary tree (lower respiratory tract) divide into?

A

terminal bronchiole (conducting zone) and respiratory bronchioles (respiratory zone) –>acinus

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4
Q

What are the non-respiratory functions of the pulmonary system?

A 
Phonation
Acid-Base balance
Pulmonary defense mechanisms
Metabolic function of pulmonary system
Filtration and removal of particles/microorganisms
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5
Q

Describe acid-base balance

A

Participates in acid-base regulation & compensation by removing CO2 from the blood stream

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6
Q

Describe pulmonary defense mechanisms

A

Air conditioning: optimal air temp & humidity for the body
Ventilation: warms/humidifies colder ambient air
Mucosa of nasal and oral cavities rich blood supply to warm/humidify air as it passes through to tracheal tree
Olfaction: sniffling–allows olfactory nerves to detect dangerous gas/material without bringing air into the lungs

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7
Q

List metabolic examples of pulmonary system

A 
Prostaglandins (E and F) are removed
Leukotrines--removed
Serotonin--85-95% removed
Norepinephrine--30% removed
Epinephrine is not affeted
Bradykinin--80% inactivated
Angiotensin I--lungs produce ACE to converse Angio1-->AngioII
ATP and AMP--40-90% removed
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8
Q

What are two mechanisms of filtration and removal of particles/microorganisms from reaching distal end of tracheal tree?

A
  1. Particles are trapped in mucous sheath lining the tubules

2. Particles are removed by ciliary action and reflex mechanisms

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9
Q

List steps of ciliary action (mucociliary escalator)

A
  • tracheobronchial secretions and mucociliary transport
  • lining of respiratory tract produces mucous
  • mucous propelled AWAY from alveoli via cilia
  • particles become trapped in the mucous and are transported to pharynx
  • coughing forcefully propels mucous to pharynx
  • mucous removed via swallowing, blowing nose
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10
Q

What do irritant receptors do? (Located in the airways)

A 
produce SNEEZE (receptors = nasopharynx)
produce COUGH (receptors = trachea)
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11
Q

How are the airways FUNCTIONALLY DIVIDED?

A

Into 2 regions:
conducting zone
respiratory zone

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12
Q

What is the anatomy of the conducting airway zone?

A

Upper respiratory tract to terminal bronchioles
NO ALVEOLI here
First 16 generations of tracheal tree represent conducting zone

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13
Q

What is the function of the conducting zone?

A

Provide passage for air into and out of gas-exchange areas of the lung
gas exchange DOES NOT occur in conducting zone

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14
Q

What is DEAD SPACE?

A

Inspired air that does not reach gas exchange

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15
Q

Where is the dead space “located”?

A

conducting zone

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16
Q

Describe air flow in conducting zone

A

Initially–fast through trachea due to small cross section

-slows as air travels down divisions of tracheal tree (larger cross sectional area)

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17
Q

What are the three defensive mechanisms of the conducting zone?

A
  • Mucociliary escalator: mucous secreting cells create mucous blanket which traps foreign particles & cilia always moving mucous toward pharynx, blow or swallow nose for removal
  • cough via irritant receptors in the trachea & conducting airways to protect deeper structures of conducting zone
  • sneeze via irritant receptors in the nose–protect front end of conducting zone
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18
Q

What happens with particles bigger than 10 micrometers in diameter?

A
  • filtered and trapped by nasal hairs

- irritant receptors lining the nasal passages initiate the sneeze reflex for removal of particles

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19
Q

What happens with particles 2-10 micrometers in diameter?

A
  • mucociliary transport system lining the airways proximal to terminal bronchioles
  • irritant receptors in airway lining initiate cough for removal of particles
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20
Q

What happens to particles <2 micrometers in diameter?

A

My reach alveoli (RESPIRATORY ZONE)

  • -migrating phagocytic macrophages engulf foreign particles on alveolar surface and degrade them
  • -non-degradable particles with sharp profiles such as: silica dust and asbestos fibers injure alveolar epithelium and alveolar macrophages leading to inflammation and scar formation –> PULMONARY FIBROSIS
21
Q

What are the sections of the respiratory airway (zone)? What is this zone formed by?

A

Formed by respiratory bronchioles to alveolar sacs
Transitional section of respiratory zone–alveoli found from 17th-19th divisions
Respiratory section–alveoli completely line 20-22nd divisions
Alveolar sacs represent the 23rd generation

22
Q

What occurs in the respiratory bronchioles?

A

first site of gas exchange

23
Q

What are the PORES OF KOHN?

A

They allow adjacent alveoli to exchange air between each other

24
Q

What does the alveolar septa consist of?

A

Epithelial layer and basement membrane (thin elastic layer that allows gas exchange)

25
Q

What types of cells are in the epithelial layer of the alveolar septa?

A

Type I alveolar cells (provide physical structure of alveoli) and Type II alveolar cells (produce surfactant, a lipoprotein that coats the surface of the alveoli)

26
Q

What is the role of alveolar phagocytes?

A
  • Ingest and remove foreign particles/bacteria
  • Removal through lymphatics located in terminal bronchioles–phagocytes migrate up to terminal bronchiole
  • -NO COUGH REFLEX THIS DEEP
27
Q

What is the composition of the wall in the trachea?

A

Anterior/lateral: C shaped cartilage
Posterior: smooth muscle
Mucosa–ciliated pseudostratified columnar epithelium with goblet cells, basement membrane, lamina propria, elastic fibers
Submucosa–rich in blood vessels and glands (serous, mucous, mixed)
Cartilage in C-shape (smooth muscle completes the ring)
Adventitia–(C.T.; associated with blood vessels, nerves, and sometimes fat)

28
Q

What is the composition of the wall of the larger bronchi–smaller bronchi?

A

Cartilage continues but progressively diminishes into distal airways
Mucosa: ciliated pseudostratified columnar epithelium with goblet cells, tinner lamina propria in smaller bronchi, elastic fibers
Smooth muscle in spiral arrangement
Submucosa w/ glands
Cartilage plates
Adventitia

29
Q

What is the composition of the walls of the bronchioles?

A

No cartilage, no glands
Ciliated columnar cuboidal; goblet cells only in larger bronchioles, some CT
Smooth muscle bundles
Elastic fibers and collagen

30
Q

What part of the respiratory tract is NOT lined by mucous producing cells and ciliated cells?

A
  1. respiratory bronchioles
  2. anterior 1/3 of nose
  3. portions of pharynx
31
Q

What is the job of ciliated cells?

A

Beat 600-900 beats per minute to provide waves to provide physical movement for mucociliary escalator

32
Q

What are the mucous producing/secreting cells in the epithelial lining?

A
  • Single exocrine cells –secrete OUTSIDE body–located between ciliated cells
  • Found along airways: GOBLET CELLS (proximal to bronchioles) & CLARA CELLS (in terminal bronchus)
33
Q

What are the mucous glands in the epithelial lining?

A
  • -secrete mucous
  • -found deep in submucosa (3rd layer-connective tissue)
  • -located throughout respiratory tract
34
Q

What is chronic bronchitis?

A

hypertrophy of mucous producing cells produces too much mucous and obstructs airway

35
Q

What is intubation?

A

continues to produce mucous but removal mechanisms are impaired

36
Q

What is cystic fibrosis?

A

Genetic disease of many organs of body (sweat glands, GI/pancreas, lungs) causing excessive mucous, sweat and digestive juice production

pulmonary dysfunction occurs: mucous accumulation in lungs promotes infection

37
Q

What is pulmonary circulation?

A

un-oxygenated blood flow from right ventricle travels to pulmonary capillaries for gas exchange

38
Q

What is bronchial circulation?

A

oxygenated blood flow from left ventricle supplies structures of pulmonary system

39
Q

What are the functions of pulmonary circulation?

A
  • facilitates gas exchange
  • acts as a reservoir for left ventricle
  • acts as a filter system to remove particles/emboli (clots or air)
40
Q

What happens at alveolocapillary membrane?

A 
Gas exchange (ratio of blood to surface area)
100 ml of blood in the capillaries is spread across 70-100m2 of aveolocapillary membrane (1/10 of liter spread out over an area of 10m/10m)
41
Q

What kinds of damage can be done to alveolocapillary membrane?

A

Plasma/blood can leak into alveolar space

Impair gas exchange

42
Q

What is hypoxic vasoconstriction?

A

LUNGS only: if damage or partial pressure O2 drops, the arterioles direct blood away from site
OPPOSITE of systemic circulation

43
Q

What makes bronchial circulation unique?

A

It does not participate in gas exchange because it’s part of systemic circulation
Bronchial arteries supply structures of lungs (conducting system, pleura, etc)

44
Q

What is the function of bronchial circulation?

A

Supplies nutrients to structures of lungs

  • Some of bronchial veins create functional RIGHT TO LEFT shunt of blood flow
  • R->L shunt: un-oxygenated blood passing into oxygenated circulation
  • Bronchial capillaries (deoxygenated) drain into pulmonary veins (oxygenated)
45
Q

What is lymphatic drainage?

A

Drains structures of lungs–located throughout tracheal tree through the terminal bronchial
-NO lymphatic vessels located in respiratory bronchioles, alveoli ducts, alveoli; no lymphatic vessels in sites of gas exchange

46
Q

How do lymphatic vessels drain and protect the alveoli?

A

Accumulating fluid in the alveoli and the alveolar macrophages migrate up to the terminal bronchioles and then drain into lymphatic system at the level of terminal bronchioles

47
Q

What makes up the chest wall?

A

Ribs and intercostal musculature

48
Q

What makes up the pleura? (double folded serous membrane)

A

Visceral pleura: lines lungs

Parietal pleura: lines chest wall

49
Q

What is the pleural space/cavity?

A

potential space created between visceral and parietal layers

50
Q

What is in the pleural space?

A

Pleural fluid: secreted by pleura itself, normally thin layer within the pleural space, provides lubricant
Pressure in pleural space: low (negative or sub-atmospheric) -4 to -10 mmHg, allows lungs to expand and suck in outside air

51
Q

What is the job of the pneumothorax?

A

Air enters into pleural cavity–increases pressure in pleural cavity so compresses or collapses the lung

clinical medicine (12 decks)

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