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Physiotherapy > PHTY 142 Respiration > Flashcards

PHTY 142 Respiration Flashcards

1
Q

anatomical position of the lung

A

diaphragm to clavicles

lie against ribs anteriorly and posteriorly

base is concave and fits over the convex diaphragm

Apex is upwards above the 1st rib and into floor of the neck

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2
Q

What is the hilum

A

Medial surface of each lung

bronchi, blood and lymphatic vessels , nerves enter or exit

Held together by pleura and connective tissue

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3
Q

Cardiac notch

A

Located in the left lung medially

Where the apex of the heart lies

Due to heart - left lung is 10% smaller than right

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4
Q

Differences between the right and left lung

A

right - 3 lobes
Left - 2 lobes

Right - 2 bronchi
Left - 1 bronchus

Right - heavier

Right - shorter and wider
Left - long and narrow

Right provides space for liver
Left provides space for the heart

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5
Q

How to fissures separate lobes

A

Both lungs have oblique fissures
They extend inferiorly to anteriorly

Left - Separates inferior and superior lobe

Right has Horizontal fissure

Right - Oblique fissure superiorly separates inferior lobe from superior lobe
Inferiorly the oblique fissure separates inferior lobe form the middle lobe
Middle lobe is bordered superiorly by the horizontal fissure

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6
Q

Lobes in right and left lung

A

Right:
Superior, inferior and middle

Left:
Superior and inferior

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7
Q

Airways that supply lobes

A

Each has lobar bronchus

Right - 3, the superior, inferior, middle lobar bronchus

Left - 2, The superior and inferior lobar bronchus

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8
Q

Segments in the lung

A

There are 10 Segmental (tertiary) bronchi in each lung

Each portion of tissue that the segmental bronchi supplies is called Bronchopulmonary segments

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9
Q

What does the Hilum consist of

A

Bronchi
Pulmonary artery and vein
Nerves
Lymph nodes and lymphatic vessels
Pulmonary ligament

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10
Q

The 2 pleura

A

Parietal pleura
Superficial layer
Lines wall of thoracic cavity

Visceral pleura
Deeper layer
Covers lungs

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11
Q

What is the pleural cavity

A

Space between pleura

Contains lubricating fluid

Reduces friction between membranes allowing the membranes to slide over each other

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12
Q

Muscles involved in quiet inspiration

A

Diaphragm - flattens increases thoracic volume and lowering pressure. 75% of the energy

Abdominal wall relaxes - abdominal contents displaced

Intercostals are involved - forward movement of sternum and upward&outward movement of ribs

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13
Q

Muscles involved in quiet expiration

A

No direct muscle action

During inspiration lungs expand against elastic recoil which is sufficient to drive air out

Expiration : Controlled relaxation of intercostal muscles and diaphragm

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14
Q

Muscles involved in forced expiration

A

diaphragm
Scalene muscles and sternocleidomastoids (accessory muscles) raise ribs

Intercostal muscles

quadratus lumborum - force downward movement of diaphragm

Erector spinae

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15
Q

Muscles for Forced expiration

A

muscles of abdominal wall to move diaphragm

Quadratus lumborum

intercostal muscles prevent deformation of tissue

Use of accessory muscles – respiratory distress

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16
Q

Surface anatomy of the lung

A

Apex - medial third of the clavicles

lower borders - T6, T8, T10

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17
Q

Tidal Volume

A

Volume of air breathed in and out in a single breath

0.5L

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18
Q

Inspiratory reserve volume
Expiratory reserve volume

A

Volume of air breathed in by maximum inspiration at end of normal inspiration

Volume of air that can be expelled by a maximum effort at the end of normal expiration

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19
Q

Residual Volume

A

Volume of air remaining in lungs at the end of maximum expiration

Not measured using spirometry

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20
Q

Inspiratory capacity

A

Volume of air breathed in by maximum inspiration at the end of normal expiration

Tidal Volume + Inspiratory reserve volume

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21
Q

Functional residual capacity

A

Volume of air remaining in the lungs at the end of normal expiration.

Expiratory reserve volume + residual volume

Not measured using spirometry

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22
Q

Vital Capacity

A

Volume of air that can be breathed in by maximum inspiration following maximum expiration

Inspiratory reserve volume + Tidal volume + Expiratory reserve volume

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23
Q

Total Lung capacity

A

Only a fraction of TLC is used in normal breathing

VC + RV

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24
Q

Functional significance of residual volume

A

A fully deflated lung requires a lot more energy to inflate

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25
Obstructive disorder
obstruction of normal air flow caused by airway narrowing Residual volume is increased as gas cannot leave the lung RV: TLC ratio increases Severe: Vital capacity can decrease Example : COPD
26
Restrictive disorder
Stiffer lungs so cannot expand to normal volumes subdivisions of volume are decreased RV:TLC would be normal or increased Example: Idiopathic pulmonary Fibrosis
27
FEV1
Forced expiratory volume in 1 second Volume of air expelled in the first second of forced expiration starting from full inspiration
28
FVC
Forced Vital Capacity A measure of total lung volume exhaled with maximal effort after full expiration
29
FEV1/FVC ratio
FEV1 is 80% of FVC in normal measure of airway limitation and allows us to differentiate between obstructive and restrictive lung disease Restrictive: Both FEV1 and FVC are decreased , often in proportion to each other Obstructive: FEV1 is reduced much more than FVC so the FEV1/FVC ratio is reduced
30
Respiratory pathway
Mouth/nose Pharyx Larynx Trachea Bronchi (main, lobar, segmental) Bronchioles Lungs Alveoli
31
nose
Has external nose and nasal cavities separated by the nasal septum Lateral wall of nasal cavity: Bony ridges called conchae providing large surface area Nose - humidifies and warms inspired air Mucus secreting goblet cells with microvilli propels mucus to the pharynx where it is swallowed
32
Pharynx
Base of skull to inferior border of cricoid cartilage Divided into 3 parts: nasopharynx, oropharynx and laryngopharynx
33
Trachea
Cartilaginous and membranous tube 10cm in length and Extends from larynx to carina Supported by c shaped rings of hyaline cartilage Epithelium sits on basement membrane separating it from lamina propria Lamina propria lies a loose submucosa Relations: Thyroid gland, carotoid arteries, oesophagus
34
Bronchus
divided into left and right at the carina right - shorter and more vertical Primary bronchi within each lung is divided into secondary or lobar Fewer goblet cells than the trachea
35
Bronchiole
no cartilage and rely on parenchymal tissue for support Surrounded by smooth muscle and have few alveoli so is a site for gaseous exchange divide up to 20 or more generations before meeting the terminal bronchiole Terminal bronchiole supplies the end respiratory unit
36
Alveoli and alveolar duct
Ducts: Rings of smooth muscle, collagen and elastic fibres Open into 2 or 3 alveolar sacs Alveoli: Blind ended terminal sac where gaseous exchange occurs Lined with type 1 and type 2 pneumocytes
37
Type 1 and 2 pneumocytes
Type 1 : Cover 95% of the internal surface of each alveoli. They share a basement membrane with pulmonary capillary to form a blood brain barrier Type 2 : Synthesising cells of the alveolar surfactant. It maintains alveolar and airway stability by reducing surface tension
38
Pore of Kohn
epithelial lined opening s between adjacent alveoli Usually contain fluid an usually only open in response to high pressure gradient Between 13-21 pores in each alveolus
39
Channel of lambert
Communications from respiratory bronchioles to alveolar ducts Have muscular wall with possible regional airflow control
40
Channel of Martin
Diameter of 30um found between respiratory bronchioles and terminal bronchioles
41
Alveolar macrophage
Most numerous of cells in the lungs They clear up dust debris through phagocytosis They are found in the mucociliary escalator
42
The mucociliary escalator
Deals with large particles trapped in bronchi and bronchioles brought up by alveolar macrophages Has mucus film which is divided into 2 layers Periciliary fluid layer about 6um deep -- this reduces viscosity and allows movement of cilia Superficial gel layer about 5-10um deep -- viscous layer forming a sticky blanket which traps particles Superficial gel layer with trapped particles can be continually transported upwards towards the mouth
43
pathway of MCE
Connective tissue Cartilage submucosa lamina propria Basement membrane Cilia Mucus blanket
44
How can MCE clearance be inhibited
Smoking cold air Drugs like general anaesthetics Sulphur oxides Nitrogen oxides
45
Cough reflex arc
Initiated by cough receptors which send information to afferent nerves. These receptors are found in the trachea, carina, pharynx Sensory information to NTS of the medulla Motor neurons to effector muscles Respiratory muscles contract to allowing cough reflex Diaphragm flatterns Laryngeal muscles close vocal cords E intercostals contract Rectus abdominus contracts to depress ribcage
46
3 main phases of the cough reflex
Inspiratory phase Irritation of cough receptors Compression phase epiglottis and Vocal cords close Expiratory phase internal intercostals contract to depress thoracic cavity Vocal cords relax and epiglottis opens
47
physical defences
Preventing entry filtering of nose Prevention of aspiration while swallowing Cough reflex mucocililary clearance Alveolar macrophages
48
Humoral defences
Antimicrobial peptides Surfactant Immunoglobulins Compliment Antiproteases
49
Cellular defence
Alveolar macrophages neutrophils
50
Process of gaseous exchange
O2 diffuses from alveolar air at 105mmHg to capillaries where PO2 is 40mmHg O2 diffuses from alveolar air to capillaries CO2 is diffusing in the opposite direction from 45mmHg to 40mmHG Exhalation keeps CO2 at 40mmHg in alveolar
51
What influences rate of gas exchange
Partial pressure of gases Surface area available Diffusion distance Molecular weight and solubility of the gases O2 has lower weight than CO2 but solubility of CO2 is greater. Outward of CO2 faster than O2 in
52
Oxygen binding to heamoglobin
only 1.5% of O2 inhaled is dissolved in blood plasma 98.5% is bound to heamoglobin Each RBC contains a heam group with 4 irons 4 molecules of oxygen and bind
53
Haemoglobin and oxygen partial pressure
The higher the PO2 the more O2 that binds When reduced heamoglobin is completely converted it is said to be fully saturated Hb and Hb-O2 mix is partially saturated
54
How CO2 is transported
Dissolved CO2 - 7% dissolved in blood plasma Carbamino compounds - 23% combines with amino groups. The main CO2 binding site are terminal amino acids in the two alpha and beta globin chains of haemoglobin Bicarbonate ions - 70%. As CO2 diffuses into capillaries it reacts with water in the presence of CA enzyme to form carbonic acid
55
Oxygen dissociation curve
Where PO2 is high like in pulmonary capillaries oxygen saturation is high. High affinity Where PO2 is low like in tissue capillaries, unloading happens and saturation is less. Low affinity
56
Factors that influence affinity of Hb for oxygen
pH - Low PH the less saturation as acidity increases unloading Partial pressure of CO2 - As it rises O2 is released more readily as more carbonic acid so more H+. More acidity means less affinity Temperature - Heat produces more acids BPG - produced from break down of glucose. Decreases affinity
57
Bohr effect
PH decreases Curve shifts to right Increase in H+ - more acidity - more unloading Contrastingly increases affinity increases and curve shifts to left
58
Normal range valves for arterial blood gases
pH: 7.35-7.45 pO2: 10-14kPa pCO2: 4.5-6kPa Base excess: -2-2mmol/l HCO3: 22 - 26mmol/l
59
Respiratory control
Sensors (chemoreceptors and mechanoreceptors) Respiratory control centre (medulla and pons) Effectors (respiratory muscles and diaphragm)
60
Chemoreceptor
Responds to chemical compounds Oxygen receptors - peripheral NS Carbon dioxide - peripherally and centrally
61
Stretch receptor
Respond to stretch of muscles sending impulses to CNS
62
Where is the medulla and pons
Part of the brain stem
63
pneumotaxic centre
Upper aspect of the pons Controls fine tuning of respiratory rate and depth Sends signals to influence the VRG and DRG
64
Apneustic centre
Lower aspect of the pons Controls prolonged breathing Sneds signals to VRG and DRG to trigger inspiration
65
Dorsal respiratory group
DRG Medially in aspect within the medulla Receives peripheral stimulus from stretch receptors, proprioceptors and juxtacapillary receptors Sends signals to external intercostals and diaphragm for inspiration
66
Ventral respiratory group
VRG Anterior aspect of medulla Controls expiration via sending expiratory signals
67
Central chemoreceptors
when inactivated respiration ceases Located in brainstem on ventrolateral surface of the medulla Respond to hydrogen ion concentration and low partial pressure of oxygen when carbonic acid increases Chemoreceptors promote increased ventilation
68
Peripheral chemoreceptors
Located in cartoid sinus and aortic arch sensitive to PaO2 PaCO2 pH Blood flow Temperature
69
Factors affecting rate and depth of breathing
Increase: Voluntary hyperventilation Increase in PCO2 above 40mmHg Decrease in PO2 from 105mmHg to 50mmHg Increased proprioreceptor activity Increase in body temperature Prolonged pain Decrease in blood pressure Stretching of anal sphincter Decrease Voluntary hypoventilation decrease in PCO2 below Decrease in PO2 below 50mmHg Decrease Proprioreceptor activity Decrease body temperature Severe pain Increase in blood pressure Irritation of pharynx or larynx
70
Normal ranges for body components
Temperature 37 degrees c Heart rate 60-99 per minute Blood pressure 120/80 mmHg Respiratory rate 12-16 breaths per minute Oxygen saturation 95%-100% pH 7.3-7.5
71
what is auscultation
Technique to listen to internal sounds of the body Heart: Aortic area Pulmonic Area ERB's point Tricuspid area Mitral area Lung Check bronchial, bronchovesicular, vesicular Abnormal sounds Bronchial - loud, high pitched Bronchovesicular - medium pitched Vesicular - soft, low pitched sounds Diminished lung sounds, adventitious breath sounds
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Physiotherapy (8 decks)

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