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PT Pulmonary Pathology, Diagnosis and Management > Pulmonary Anatomy And Physiology > Flashcards

Pulmonary Anatomy And Physiology Flashcards

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1
Q

Pulmonary Anatomy and Physiology

Ventilation ≠ Respiration

A
  • Ventilation: movement of AIR into and outside the body.
  • Respiration: process by which we take in O2 and throw off CO2.
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2
Q

Pulmonary Anatomy and Physiology

Functional movement of the thorax:

A
  • Pump handle: anterior and superior motion of the sternum and upper rib cage.
  • Bucket handle: lateral and superior motion of the ribs.
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3
Q

Pulmonary Anatomy and Physiology

Principal muscles of inspiration:

A
  • DIAPHRAGM: primary muscle of inspiration.
  • INTERCOSTALS: ext & int
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4
Q

Pulmonary Anatomy and Physiology

What are the 2 main purposes of the thorax?

A
  1. Attachment for mm of ventilation.
  2. Houses lungs and mediastinum
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5
Q

Pulmonary Anatomy and Physiology

the thorax is made up of:

A
  • 12 thoracic Vertebrae: provide stability
  • Sternum:
    • Manubrium: ribs 1 and 2
    • Body: ribs 3-7
    • Sternal angle: leveled with the carina and about the 5th thoracic vertebrae.
  • 12 Ribs: Attachment for muscles, protection of organs.
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6
Q

Pulmonary Anatomy and Physiology

Movement of the thorax increases where?

A

Inferiorly and anteriorly, so it is more stable posteriorly and superiorly

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7
Q

Pulmonary Anatomy and Physiology

What is the sequence of normal breathing?

A
  1. Diaphragm: rises the abdomen.
  2. Abdominals: allow lateral costal expansion of the lower chest.
  3. Intercostals: gentle rise of the of the upper rib cage sup and ant.
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8
Q

Pulmonary Anatomy and Physiology

Principal muscles of INSPIRATION:

A
  • Diaphragm: flattens over the abd cavity. Causes chest to expand laterally and lower ribs to elevate. Depends on abdominal and intercostals for optimal diaphragmatic breathing.
  • Intercostals:
    • Internal: lower the ribs, decrease pressure.
    • External: elevate the ribs, increase pressure.
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9
Q

Pulmonary Anatomy and Physiology

When internal and external intercostals contract:

A

Elevate the ribs

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10
Q

Pulmonary Anatomy and Physiology

Upward movement of upper ribs increases _________________ diameter of chest.

A

anterior and posterior

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11
Q

Pulmonary Anatomy and Physiology

Elevation of lower ribs increases ________ diameter of the chest.

A

longitudinal (transverse)

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12
Q

Pulmonary Anatomy and Physiology

This principal muscle of inspiration flattens over abd contents, and decreases intrathoracic cavity pressure:

A

DIAPHRAGM

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13
Q

Pulmonary Anatomy and Physiology

What is the amount percentage of the diaphragm’s work in breathing?
How much of the tidal volume does it provide?

A

60 - 70% Of the work providing 2/3 - 3/4 of the tidal volume

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14
Q

Pulmonary Anatomy and Physiology

3 origins of the diaphragm:

A
  • Posterior xiphoid.
  • Ant lumbar vertebrae & arcuate ligaments.
  • Inner surface of costal cartilage 6 to 12.
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15
Q

Pulmonary Anatomy and Physiology

How does the diaphragm level changes in relation to positioning?

A
  • Supine: higher in thorax, larger inspiratory excursion, but harder to get a deep breath.
  • Sitting: lower, easier to get a deep breath.
  • Sidelying: lower side is higher.
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16
Q

Pulmonary Anatomy and Physiology

Muscles of exhalation:

A
  • Exhalation is passive.
  • Forceful exhalation uses abdominal muscles to depress the ribs and compress abdominal contents,
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17
Q

Pulmonary Anatomy and Physiology

Innervation of the diaphragm:

A

Phrenic nerve C3 to C5

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18
Q

Pulmonary Anatomy and Physiology

What happens during a concentric diaphragmatic contraction?

A

Quiet forceful inhalation.

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19
Q

Pulmonary Anatomy and Physiology

What happens during a eccentric diaphragmatic contraction?

A

Controlled exhalation and speech.

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20
Q

Pulmonary Anatomy and Physiology

Function of the intercostal muscles:

A

Stabilize rib cage during inhalation and prevent chest wall from moving inward toward the negative pressure.

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21
Q

Pulmonary Anatomy and Physiology

Innervation of the intercostals muscles:

A

T1 to T12

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22
Q

Pulmonary Anatomy and Physiology

Upper chest intercostals expand the chest in which direction?

A

Superior and anterior

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23
Q

Pulmonary Anatomy and Physiology

Lower chest intercostals expand the chest in which direction?

A

Lateral and superior

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24
Q

Pulmonary Anatomy and Physiology

Eccentric contraction of the intercostals is needed for what?

A
  • Controlled exhalation and speech:
    • Vocal folds control exhalation speed.
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25
# Pulmonary Anatomy and Physiology What structure controls the **speed** of exhalation?
* **Vocal folds** * Eccentric contraction of intercostals and diaphragm
26
# Pulmonary Anatomy and Physiology What are the functions of the abdominal muscles from a pulmonary perspective?
* Stabilize rib cage and provide visceral support. * Provide positive pressure to help stabilize diaphragm. Prevent abdominal cavity from pushing out when diaphragm is pressing down. * Allow for effective cough, venous return, bowel movement.
27
# Pulmonary Anatomy and Physiology Innervation of the abdominal muscles:
* T6 - L1 * T4 injury? Can get a breath in, but what if they need to cough?
28
# Pulmonary Anatomy and Physiology Paradoxical breathing:
* Inward abdominal or chest wall movement with inspiration and outward movement with exhalation. * Weakness of diaphragm.
29
# Pulmonary Anatomy and Physiology ACCESSORY **INSPIRATORY** MUSCLES:
1. **Erector Spinae (T1 - S3):** stabilize thorax posteriorly. 2. **Pectoralis (C5 - C7):** stabilize ribs; assists with ant and lat chest expansion; forced exhalation when chest moves into flx. 3. **Serratus Anterior (C5 - C7):** only inspiration muscle paired with trunk flexion; posterior expansion with fixed UE. 4. **Scalenes (C3 -C8):** sup and ant expansion; elevate and fix upper ribs. 5. **SCM (C2, C3, CN XI):** sup and ant expansion; elevates the sternum. 6. **Trapezius (C2 - C4, CN XI):** superior expansion; least energy efficient accessory muscle.
30
# Pulmonary Anatomy and Physiology Only inspiration **muscle** paired with trunk flexion; posterior expansion with fixed UE.
**Serratus Anterior (C5 - C7)**
31
# Pulmonary Anatomy and Physiology Most significant stage of normal chest development:
6-12 MO, all breathing mm available
32
# Pulmonary Anatomy and Physiology What is the **shape** of the chest wall in a newborn baby?
Triangular
33
# Pulmonary Anatomy and Physiology How does a newborn breathes?
**Diaphragmatic** breather
34
# Pulmonary Anatomy and Physiology According to the the body’s “aluminum can” concept, the diaphragm...
is a major pressure regulator
35
# Pulmonary Anatomy and Physiology According to the body's "aluminum soda can" concept, **intra-abdominal pressure** always
**positive** flluctuates w/breathing: - Increase w/inhalatioN - Decrease w/exhalation
36
# Pulmonary Anatomy and Physiology According to the body's "aluminum soda can" concept, **intra-thoracic pressure** is...
Lower to draw air in (inhalation) and higher with exhalation
37
# Pulmonary Anatomy and Physiology **Function** of the conducting airways:
**filter**, **warm**, and **conduct** air to the respiratory units
38
# Pulmonary Anatomy and Physiology Upper airways pathway:
* From nasal and oral orificies to the false vocal cords in the larynx: * Nose * Nasal cavity * Pharynx * Nasoparynx * Oropharynx * Laryngopharynx * Larynx: acts as a valve and has pronating mechanism for voice production.
39
# Pulmonary Anatomy and Physiology acts as a valve and has pronating mechanism for voice production
**Larynx**
40
# Pulmonary Anatomy and Physiology Lower airways go from...
True vocal folds to the alveoli: * Trachea (ciliated) * Bronchi (ciliated) * Bronchioles (ciliated) * Terminal bronchioles **(non-ciliated)** * Terminal respiratory units
41
# Pulmonary Anatomy and Physiology Right main stem bronchus is more \_\_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_\_, and _______________ than left→clinical significance?
**Vertical**, **shorter**, and **wider:** **aspiration** (food particles more to the right).
42
# Pulmonary Anatomy and Physiology Where O2 gets from lung to the capillary
Alveolar capillary septum (membrane)
43
# Pulmonary Anatomy and Physiology Carina:
* Located in in the trachea, where it divides into right and left main stem bronchi * right main stem bronchi is **shorter**, **wider**, and more **vertical** than left
44
# Pulmonary Anatomy and Physiology Number of orders of branching from trachea to alveolar duct
**23-25**
45
# Pulmonary Anatomy and Physiology two or more alveoli sharing a common opening.
Alveolar sac
46
# Pulmonary Anatomy and Physiology Function of **type I alveolar cells**:
main site for gas exchange
47
# Pulmonary Anatomy and Physiology Function of **type II alveolar cells**:
Secrete **surfactant**
48
# Pulmonary Anatomy and Physiology What are **goblet cells** and where are they located?
* Secrete mucous * Located in **bronchioles** (lower airways)
49
# Pulmonary Anatomy and Physiology How are inhaled particles removed in the terminal bronchioles?
May be removed by macrophages
50
# Pulmonary Anatomy and Physiology **Cilia** What it is and location?
* Move mucous at 1 cm/min * Use ATP * Located in upper airways (trachea), bronchioles and smaller bronchioles
51
# Pulmonary Anatomy and Physiology Contents of **lungs hilum/hilus:**
* Pulmonary vein and artery. * Principal bronchus. * Bronchial veins and arteries. * Pulmonary nerve plexus. * Lymph vessels.
52
# Pulmonary Anatomy and Physiology Blood supply to lungs:
left and right bronchial arteries and veins
53
# Pulmonary Anatomy and Physiology Innervation of the lungs
Sympathetic and parasympathetic nervous system
54
# Pulmonary Anatomy and Physiology In which lung is the **horizontal fissure**?
**R lung only**, separates R upper and R middle lobes
55
# Pulmonary Anatomy and Physiology Lung lobes:
* **Right lung**: 3 lobes, oblique and horizontal fissures. * Horizontal fissure separates RUL and RML. * **Left lung**: 2 lobes, lingula, oblique fissures.
56
# Pulmonary Anatomy and Physiology Number of bronchopulmonary segments:
**10** some text say 10 in the R and 8 on the L
57
# Pulmonary Anatomy and Physiology Thoracentesis:
is a procedure to remove fluid from the space between the lungs and the chest wall
58
# Pulmonary Anatomy and Physiology Visceral and parietal pleurae:
* **Visceral**: cover the lungs. * **Parietal**: attached to inner surface of thoracic cavity.
59
# Pulmonary Anatomy and Physiology Embryonic development of **lung buds** occurs when?
week 4
60
# Pulmonary Anatomy and Physiology Development of all major elements of the lung except the gas exchange units:
pseudoglandular period: weeks 5-17
61
# Pulmonary Anatomy and Physiology Embryonic week when alveolar cells begin to produce surfactant, but not enough for survival
week 20
62
# Pulmonary Anatomy and Physiology Prematurity more difficult before __ weeks due to production of surfactant,
28
63
# Pulmonary Anatomy and Physiology Complete development of mature alveoli:
**7 to 8 y/o**
64
# Pulmonary Anatomy and Physiology PULMONARY SYSTEM **FUNCTIONS**:
* Exchange O2 and CO2 between tissues, blood, and environment. * Regulates blood acid-base balance (PH). * Assist with temperature homeostasis. * Due to receiving all cardiac output: play a role in filtering and metabolizing toxic substances.
65
# Pulmonary Anatomy and Physiology Oxygen transport pathway:
1. **Inspired oxygen and quality of ambient air (FIO2).** 2. **Airways.** 3. **Lungs and Chest wall.** 4. **Diffusion.** 5. **Perfusion.** 6. Myocardial function. 7. Peripheral circulation. 8. Tissue extraction and use of oxygen. 9. Return of partially desaturated blood and CO2 to the lungs.
66
# Pulmonary Anatomy and Physiology What is **diffusion**:
passage of O2 and CO2 across the **capillary alveoli membrane**
67
# Pulmonary Anatomy and Physiology Perfusion
transport dissolved and bound gases to/from lungs and cells in blood (=how much of the blood perfused in the lungs is getting into our system)
68
# Pulmonary Anatomy and Physiology Respiration:
02 consumption and the cell level and production of CO2 in use of metabolic substrates.
69
# Pulmonary Anatomy and Physiology Inhalation account for what percentage of inspiration?
75%
70
# Pulmonary Anatomy and Physiology 2 circulatory systems of the lungs:
* **Pulmonary circulation:** (Oxygen to the body) receiving deoxygenated blood from the heart and returning oxygenated to the heart. * **Bronchial circulation:** (oxygen to lungs) receiving oxygenated blood via bronchial arteries from aorta.
71
# Pulmonary Anatomy and Physiology **Bronchial circulation** accounts for what percentage of the cardiac output?
1 to 2%
72
# Pulmonary Anatomy and Physiology An area of **low V/Q** will have...
lower oxygen saturation after passing the alveoli (High perfusion of blood but low ventilation)
73
# Pulmonary Anatomy and Physiology An area of high V/Q will have...
low blood perfusion but high ventilation = highly oxygen saturated blood
74
# Pulmonary Anatomy and Physiology What is the **anatomic dead space**?
Anatomic dead space is the total volume of the conducting airways from the nose or mouth down to the level of the terminal bronchioles, and is about 150 ml on the average in humans. The anatomic dead space fills with inspired air at the end of each inspiration, but this air is exhaled unchanged.
75
# Pulmonary Anatomy and Physiology Exchange of oxygen and carbon dioxide b/t the lungs and blood takes place by _________ across alveolar and capillary walls. Where does this occur?
* **Diffusion:** * Movement of gas from and area of higher concentration to an area of lower concentration * **Occurs in the respiratory membrane:** * Alveolar wall
76
# Pulmonary Anatomy and Physiology Normal V/Q ratio =
0.8 to 1
77
# Pulmonary Anatomy and Physiology V/Q ratio properties:
* Optimal gas exchange occurs with the greatest ventilation AND perfusion. * **Alveolar ventilation follows the direction of least resistance.** * **Pulmonary perfusion is position dependent (gravity).** * V/Q mismatch leads to physiologic dead space: * Normal V/Q = 0.8 to 1 * Shunt = poor ventilation * Physiologic dead space = poor perfusion.
78
# Pulmonary Anatomy and Physiology The pressure exerted by each component of a gas mixture
partial pressure
79
# Pulmonary Anatomy and Physiology What is the **atmospheric concentration** of oxygen? Nitrogen? CO2?
* Nitrogen 78.6% * Oxygen 20.8 % * Carbon Dioxide 0.04%
80
# Pulmonary Anatomy and Physiology Causes of increased CO2 production:
* Fever * Muscle exertion * Shivering * Metabolic processes resulting in the formation of metabolic acids
81
# Pulmonary Anatomy and Physiology Causes of decreased CO2 production:
hyperventilation
82
# Pulmonary Anatomy and Physiology What is the function of the **pneumotaxic** area in the pons?
* Maintains normal patterns of respiration. * Inhibitory impulses shortens inhalation, increases RR.
83
# Pulmonary Anatomy and Physiology What is the function of the **apneustic** area in the pons?
* Impulses prolong inspiration ## Footnote *During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are (patency), there may or may not be a flow of gas between the lungs and the environment; gas exchange within the lungs and cellular respiration is not affected.*
84
# Pulmonary Anatomy and Physiology What is the **primary control** of the respiratory center stimulation? Tip: CO2 can diffuse through the blood-brain barrier.
**CSF pH**
85
# Pulmonary Anatomy and Physiology What is the **Hering-Breuer Reflex**?
The Hering–Breuer inflation reflex, named for Josef Breuer and Ewald Hering, is a reflex triggered to **prevent over-inflation of the lung**. Pulmonary stretch receptors present in the smooth muscle of the airways (bronchi and bronchioles) respond to excessive stretching of the lung during large inspirations
86
# Pulmonary Anatomy and Physiology At birth, ventilation is initiated quickly due to ...
**hypoxia** and **hypercapnia** (to much CO2)
87
# Pulmonary Anatomy and Physiology Tidal volume (VT):
normally inhaled and exhaled air during quiet breathing, 4-7l.
88
# Pulmonary Anatomy and Physiology Inspiratory Reserve Volume (IRV):
additional volume of air that can be taken beyond VT, 2+L
89
# Pulmonary Anatomy and Physiology Expiratory Reserve Volume (ERV):
additional volume of air that can be let out beyond VT, 0.5-1 L
90
# Pulmonary Anatomy and Physiology Residual Volume (RV):
air that remains in the lungs after a **forceful** exhalation, 1-2 L.
91
# Pulmonary Anatomy and Physiology Minute Ventilation:
VE = VT x RR. amount of air moved in and out in 1 min.
92
# Pulmonary Anatomy and Physiology Average lung can hold around
5 liters of air
93
# Pulmonary Anatomy and Physiology Total Lung Capacity (TLC):
max volume to which lungs can be expanded = sum of all volumes.
94
# Pulmonary Anatomy and Physiology Inspiratory Capacity (IC):
sum of VT and IRV.
95
# Pulmonary Anatomy and Physiology Functional Residual Capacity (FRC):
sum of ERV and RV. "Relaxation Volume."
96
# Pulmonary Anatomy and Physiology Vital Capacity (VC):
IRV + TV + ERV, max amount of air that can be expelled following max inhalation.
97
# Pulmonary Anatomy and Physiology Inspiratory Vital Capacity (IVC):
max amount of air inhaled from point of max exhalation.
98
# Pulmonary Anatomy and Physiology Difference in pressure between alveolar and atmospheric pressure divided by airflow
**Resistance to Gas Flow**, a mechanical property of the lung Increases in the lower airways. Slow breathing = less resistance Fast breathing = more resistance
99
# Pulmonary Anatomy and Physiology Do we use ALL the air we breathe in?
no: * Anatomic Dead Space: air in the upper airways * Physiologic Dead Space: volume of air which is inhaled that does not take part in the gas exchange, either because it (1) remains in the conducting airways, or (2) reaches alveoli that are not perfused or poorly perfuse
100
# Pulmonary Anatomy and Physiology What does the X axis represents in the Oxyhemoglobin Dissociation Curve?
Oxygen Partial Pressure (mmHg)
101
# Pulmonary Anatomy and Physiology What will cause a shift to the **right** in the Oxyhemoglobin Dissociation Curve?
* Exercise * Temperature * PH decrease
102
# Pulmonary Anatomy and Physiology What will cause a shift to the **left** in the Oxyhemoglobin Dissociation Curve?
103
# Pulmonary Anatomy and Physiology ABG includes:
(Arterial Blood Gas) * pH * PaCO2 * PaO2, * HCO3-, BE * Respiratory Control of pH
104
# Pulmonary Anatomy and Physiology CARBON DIOXIDE TRANSPORT:
* **Dissolved in plasma.** * **Bound to proteins.** * **Bicarbonate.** * Carried by venous blood to the lungs. * Has the biggest effect in blood PH.
105
# Pulmonary Anatomy and Physiology OXYGEN TRANSPORT:
* Diffusion * O2 dissolved in plasma * O2 bound to hemoglobin
106
# Pulmonary Anatomy and Physiology Optimal gas exchange occurs with the ________ ventilation AND perfusion.
greatest
107
# Pulmonary Anatomy and Physiology Alveolar ventilation follows the direction of...
least resistance.
108
# Pulmonary Anatomy and Physiology Pulmonary perfusion is _________ dependent (gravity).
position
109
# Pulmonary Anatomy and Physiology Shunt =
poor ventilation
110
# Pulmonary Anatomy and Physiology Normal V/Q is:
* 8 -1.0 * Poor ventilation – shunt * Poor perfusion – physiologic dead space​
111
# Pulmonary Anatomy and Physiology Inhibitory impulses to the pneumotaxic area _______ inhalation, __________ RR.
1. shortens 2. Increases
112
# Pulmonary Anatomy and Physiology Alveolar **Hypoventilation:**
* Occurs when less O2 is supplied and less CO2 removed from blood * PaO2 DECREASES and PaCo2 INCREASES (excess CO2 in blood) * Alveolar hypoventilation will cause an excess of CO2 in the blood stream resulting in Hypercapnia

PT Pulmonary Pathology, Diagnosis and Management (10 decks)

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