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Block 2 week 7 > Pulmonary circulation > Flashcards

Pulmonary circulation Flashcards

1
Q

(blank) enter each lung at the hilum, they

travels adjacent to, and branches with each airway generation, to respiratory bronchiole

A

pulmonary arteries

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2
Q

(blank) carry oxygenated blood from the lungs to the left atrium.
(blank) pulmonary veins pass behind the right atrium and superior vena cava
(blank) pulmonary veins pass in front of descending thoracic aorta

A

pulmonary veins
Right
left

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3
Q

(blank) are the primary site of gas exchange

directly opposed to the alveoli and 0.6 microns thick

A

pulmonary capillaries

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4
Q

blood pressure varies with the (blank) of lung. What is it at the apex? What is it at the base?

A

height

(24 mm Hg at FRC) apex = 12 mm Hg, base = 36 mm Hg

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5
Q

Normal Pulmonary Artery Pressure (PPA) is (blank) (PA systolic 15/PA diastolic 8 mm Hg). Where is this value measured?

A

15 mm Hg

at main pulmonary artery

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6
Q

Pulmonary circulation is a (blank)-pressure circuit. 35-45%of pulmonary vascular resistance (PVR) is at the level of the (blank)

A

capillaries

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7
Q

low pre-capillary arterial resistance results in (blank) motion in the microvascular bed. When is this motion lost?

A

pulsatile

In severe pulmonary arterial hypertension (PAH)

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8
Q

How long is the transit time across the microcirculation and what does this amount of time allow for?

A

.5-1 second and allows for enough to for O2 and CO2 tensions in alveoli (partial pressure) to equilibrate

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9
Q

The pulmonary vascular resistance is (blank) of the systemic vascular resistance.

A

1/10th

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10
Q

What is the equation for pulmonary vascular resistance?

A

change in pressure divided by pulmonary blood flow

PPA(arterial) - PPV(venous) / Pulmonary Blood Flow

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11
Q

Pulmonary vascular resistance depends on capillary resistance, the change in pressure and blood flow and on (blank) pressures.

A

left atrial pressures

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12
Q

As Left atrial pressure (PLA) increases, pulmonary vascular resistance will (blank), because the vascular bed is (blank).

A

stop decreasing

nearly fully distended

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13
Q

The capillaries are near (blank) pressure because of surfactant.

A

atmospheric

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14
Q

If alveolar pressure is greater than capillary pressure, then capillaries (blank).

A

collapse

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15
Q

When the lungs expand (inspiration), what happens to pressure?

A

your pressure decreases causing radial traction

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16
Q

What does radial traction do?

A

it pulls open vessels, and reduces pressure

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17
Q

What are the three things that reduce pulmonary vascular resistance?

A

recruitment (opening of closed capillaries)
Distention (increase caliber of already open capillaries)
Expansion of lung volume

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18
Q

What is the typical distribution of blood flow?

When is this not true?

A

basal blood flow is greater than apical blood flow

If a human is upside down (it is opposite)

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19
Q

What is the reason for regional blood flow differences?

A

hydrostatic pressure

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20
Q

At the apex of the lung (zone 1), what is happening with it?What are happening to the capillaries at the apex of the lung?

A
  • > the apex is ventilated but not perfused
  • > dead space and you have increased CO2 here. ->collapse of vessel before it crosses alveolus; no forward flow; doesn’t exist in normal lungs – might occur if person has hemorrhaged (BP, intravascular volume are low)
  • > capillaries are flattened due to increase Palveolar, except for extra-alveolar capillaries which are patent
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21
Q

What kind of zone will you have if you are hemmoraging?

A

Zone 1-> capillaries collapse due to increase alveolar pressure
PALV >PPA>PPV

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22
Q

At the middle of the lung (zone 2), how is blood flow determined?

A

it is the difference between Palveolar & Parterial. Arterial is greater, causing great distension and increased blood flow.

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23
Q

What has the highest pressure at midlung (zone 2), the PPA, PALV or PPV?

A

PPA > PALV > PPV

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24
Q

Which zone has the waterfall effect?

A

Zone 2 (midlung)

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25
Q

What is a pulmonary artery wedge pressure?

A

utilizes swan-ganz catheter inserted into pulmonary circulation to measure static fluid pressure and reflects left atrial pressure and estimates total body fluid balance.

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26
Q

What is this and what is it’s normal value?
Swan-Ganz catheter inserted into pulmonary circulation measures static fluid pressure in pulmonary circuit reflects left atrial pressure and estimates total body fluid balance

A

Pulmonary Artery Wedge Pressure

8-12 mm Hg

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27
Q

Which part of the lung gets less blood flow, the apex or base?

A

apex

28
Q

The pressure in the arterial is always going to be higher than the pressure in what?

A

the vein

29
Q

If you are in the supine position what happens to your blood flow?

A

increased apical blood flow

same basal blood flow

30
Q

If you are undergoing mild exercise what happens to your apical and basal blood flow?

A

increased apical and basal blood flow (decreased regional differences)

31
Q

What zone will you be in if you are exercising?

A

zone 2 (waterfall effect) PPA > PALV > PPV

32
Q

Where does zone 3 occur and what is it?

A

occurs basally, it is the blood flow determined by usual arterial-venous difference PPA > PPV > PALV

33
Q

What is hypoxic vasoconstriction?

A

when you get contraction of arteriolar smooth muscle walls in hypoxic region and directs blood to less hypoxic regions

34
Q

(blank) is an endothelial derived releasing factor that causes smooth muscle relaxation

A

NOx

35
Q

What is formed from L-Arginine via guanylate cyclase, forming cyclic GMP?

A

NOx

36
Q

Active control of circulation has the greatest responsiveness at a pO2 of what?

A

less than 70 mm Hg

37
Q

What is salvage therapy?

A

a last effort to reduce pulmonary hypoxic vasoconstriction via NOx

38
Q

High altitude generally causes (blank) and increased (blank)

A

vasoconstriction and increased arterial pressure

39
Q

A fetus has increased (blank) resulting in only 15% of Cardiac output to lungs. When they take their first breath, you will get decreased (blank) and increased pulmonary blood flow

A

Pulmonary vascular resistance (PVR)

PVR

40
Q

What are these:
carbon monoxide, increased PVR, hypothermia, acidosis and alkalosis, inhaled anesthetics, Ca blockers, postive end-expiratory pressure, high frequency ventilation, isproterenol, vasodilators

A

Factors that inhibit hypoxic vasoconstriction

41
Q

Pulmonary capillaries follow (blank) law

A

starlings’s

Net Fluid = K[(PC-Pi) - ∂ (∏C-∏P)]

42
Q

Fluid leakage from capillaries goes to (blank) of alveolar walls via perivascular and peribronchial lymph nodes

A

interstitium

43
Q

Fluid leakage from capillaries goes into the interstitium of alveolar walls via perivascular and peribronchial lymph nodes. This can cause (blank) because of the excess fluid in the hilar lymph nodes. When might this occur?

A

interstitial edema

CHF

44
Q

(blank) occurs when capacity of the lymphatics is exceeded and fluid pours into alveoli which interferes with gas exchange

A

alveolar edema

45
Q

(blank) causes an increase in intracranial pressure. This leads to an increase in pulmonary capillary pressure, this can cause trauma to capillaries and increased capillary permeability

A

neurogenic pulmonary edema

46
Q

What can be caused by increased sympathetic discharge resulting in increased pulmonary capillary pressure?

A

neurogenic pulmonary edema

47
Q

What type of edema causes hypoxia-induced vasoconstriction at pre-capillary sites but the mechanism for its cause is still unknown?

A

high-altitude pulmonary edema

48
Q

What causes this:
accumulation of proteinaceous fluid in the alveoli due to a number of causes
causes significant Ventilation-Perfusion (V-Q) mismatch

A

Adult Respiratory Distress Syndrome (ARDS)

49
Q

What are the causes of ARDS?

A

severe trauma, sepsis, pancreatitis, aspiration pneumonia, community-acquired pneumonia

50
Q

How do you treat ARDS?

A

with low tidal volume ventilation
(Don’t want too much volume or pressure-> will rupture alveoli and collapse them, may make a pneumothorax. SOOOO lets prevent this by making pnt have low tidal volume)

51
Q 
What does this describe?
60-70% mortality at 30-days
lower in trauma victims
tend to be younger and healthier
higher in alcohol abusers
A

ARDS

52
Q

What is Transfusion-Related Acute Lung Injury (TRALI)

A

Variant of ARDS, occurs with massive blood transfusion (mostly with fresh plasma)

53
Q

What causes TRALI?

A

Granulocytes from a blood transfusion will cause an inflammation reaction in pulmonary capillaries where your antibodies attack the new blood you just got. (not too bad,just lasts a few days)

54
Q 
What does this describe?
develops within 1-2 hours of transfusion
fever, tachycardia, tachypnea
development of pink, frothy sputum
patients usually extubated within 48h
A

TRALI

55
Q

What are two interesting functions of the pulmonary circulation?

A

reservoir for blood due to low PVR

Filtration (small thrombi, and WBC’s)

56
Q

The lung functions metabolically by activating (blank)

A

angiotensin I to angiotensin II via ACE

57
Q

Where is ace found?

A

small pits of capillary endothelial cells of lung

58
Q

What does the lung inactivate?

A 
bradykinin (via ACE, up to 80% of it)
Serotonin (via uptake and storage)
Prostaglandin (E1 /E2/F2∝ (removed)
Norepinephrine (up to 30%)
Arachidonic acid
59
Q

When does the lung release serotonin?

A

during anaphylaxis, to transfer to platelets in lung

60
Q

What does the lung do to arachidonic acid?

A

converts it to leukotrienes (via lipoxygenase)

and to prostaglandins (via cyclooxygenase)

61
Q

What does prostaglandin E2 do?

A

relaxes patent ductus arteriosus in fetus

62
Q

What do all prostaglandins cause?

A

platelet aggregation and bronchoconstriction in asthma

63
Q

What does the lung synthesize?

A

surfactant
proteins
mucopolysaccharides (bronchial mucus)

64
Q

What kind of proteins does the lung synthesize?

A

collagen and elastic of lung framework (broken down by protease)

65
Q

What blocks protease?

A

antitrypsin : )

66
Q

What is transmural pressure?

A

inside of vessel minus outside of vessel (why the capillaries collapse due to large Palveolar)

67
Q

What regulates blood flow and resistance in the pulmonary circuit?!?!?!

A

CAPILLARIES

Block 2 week 7 (9 decks)

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