Pulmonary Phys theme 1 Flashcards
Name the vascular lung disorders
Pulmonary embolism
Pulmonary edema
Pulmonary hypertension
Congenital malformation
Name the restrictive-like lung disorders
Interstitial pulmonary fibrosis sacrcoidosis environmental factors hypersensitivity pneumonitis certain cancers pleural effusions & thickening Pneumothorax scoliosis ankylosing spondylitis obesity neuromuscular disorers pulmonary edema
Changes seen in a PFT for a person with obstructive lung disorder?
lower FEV1 leading to a lower FEV1/FVC (norm value 80%)
changes seen in a person with restrictive like lung disorder
dec FVC leading to and inc in FEV1/FVC ratio (norm value 80% you’ll see ~90% here)
what creates the subatmoshperic Ppl?
It is created by the tension between the chest wall expanding force, and the lungs collapsing force
How does the diaphragm contracting begin inspiration?
it inc the pleural space-> makes the pleural pressure more negative -> lungs expand-> cause negative alveolar pressure-> causing a gradient btw alveoli and atmosphere-> air flows in
be able to describe the respiratory cycle
1.06 slide 9-14
whats the biggest factor in Airway Resistance?
size of radius
the bigger the radius = less resistance
How does adding branches lower airway resistance?
the branches are added in a parallel circuit fashion, which lowers the resistance of the system
What does radial traction do for airways?
its mechianically tethered
it inc the diameter which will lower the resistance
What happens if you lower the radius of of airways?
you inc the airway resistance making it more difficult to push air out(dec FEV1), takes a higher press gradient. This is what you see in an obstructive lung disorder (like asthma)
Why do you get an occulsion in emphysema during forced expiration?
in emphysema you have a reduce alevolar elastic component so you have less recoil force. Has you go up the airway you lose some of your pressure due to airway resistance. You can get to a point that the pleural pressure is actually greater than the airway pressure which is what causes the occulsion
What/How do we overcome pulmonary surface tension?
surfactant, which is produce by type 2 pnemocytes, which only cover a small fraction of the alveolar surface area. This is why they have a greater effect on small alveoli from collapsing
what is surfactant?
mixture of lipids and proteins sim to phospholipids of the membrane. They interpose themselves between water molecules to reduce surface tension.
whats the importance of reducing surface tension with surfactant?
based on size pressure laws air would flow to just bigger alveoli bc of reduced surface tension. Surfactant reduces surface tension of smaller alveoli, kind of evening out the ball field, so air goes into both small and big alveoli
Why does a person with restricted lung disease inc their breath freq?
resistricted lung disease inc the work of breath during inspiration. People want to breath at the lowest work needed to breath, so to compensate the inc workload to do normal breath, someone will just inc their breath rate instead of working harder to inflate to normal capacity
How does obstructive lung disorder effect ones work of breathing?
it inc the work of breathing during expiration
What happens when Pulmonary Pressure goes up?
vascular resistance goes down-> pulmonary blood flow goes up
What can cause lace of function to ciliated epithelium in the Respiratory tract?
infection (big player) chemical (alcohol & smoking) congentital (situs inversus) increases pneumonias (Klebsiella pneumoniae) toxins from bacteria -> paralysis
Defects in immunity increases incidence of upper respiratory tract infections by what?
encapsulated organsisms, especially:
streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Defects impact oropharyngeal area causing increase in infection by?
Haemophilus meningitidis and Neisseria influenzae
Infection of the upper respiratory tract that cause inflammation?
sinusitis (bacterial), otitis media (fungal), pharyngitis (viral)
infection of the lower respiratory?
pneumonia
Describe the TLR signaling pathway?
TLRs recognize PAMPs -> MyD88 activates NFKappaB-> induces the transcription of cytokines
What are the cytokines NFKappaB induces the transcription of?
IL-1
IL-2
THF alpha (it is a type 1 interferon seen with viral infect) + IL-6 {fever}
IL-8 (neutrophil inflammation)
TLRs look for extracellular and intracellular organisms. What is a intracellular TLRs looking for?
dsRNA
ssRNA
basically viral genome
What does TNF-alpha do?
fever, endothelial permeabiltiy, (hypovolemia) (effusion), coagulation
used in viral infections
What does IL-1 do
fever, vasodilation, adhesion factors
What does IL-8 do? aka cdc8
neutrophil infiltration and activator=PUS
also causes bands in neutrophils
what does IL-6 do?
fever, acute inflammatory protein synthesis, B-cell growth, and segue to granuloma formation
What does IL-2 do?
initiate T-cell activation , its the bridge between innate and adaptive immune response
What causes a left shift in WBC diffentions?
IL-8, it will start off as an innate response and then more than likely switch over to a TH17 response, if switch to a TH1 it will have a spike in neutrophils at the beginning and then lower the count
You have an intracellular pathogen
Describe the process of Phagocytosis and what it does after digestion?
microbes bind to phagocyte -> membrane enclose forming phagosome-> it fuses with a lysosome-> digest the microbe by ROS, NO, and lysosomal enzymes (in the phagolysosome) -> the broken down peptides are sent to the membrane of cell as MHC2 antigen-> the APC go to lymph tissue to activate CD 4 + T cells
What is pus in the lungs called?
empyema- some you leave alone other you evacuate
formed by innate and TH17 responses
What activates a Classical Pathway TH1 response?
IFN-gamma….. fights microbials (bacteria)
What activates the alternate pathway TH2?
IL-4 & IL-13…… fights parasiteds
What activates a TH17 response and what does it attack?
TGF-beta, IL-6, IL-23
it attacks extracellular bacteria and fungi
Describe the TH2 airway inflammation pathway?
APC-T-cell and IL-4 (from basophil) start the process. TH2 release IL-5, IL-4, IL-13. IL-5 cause make and release of eosinophils. IL-4 cause b cell isotype switch to make IgE-> binds to mast cells causing the release of cytokines. IL-5 also cause degranulation of eosinphill in the tissue. IL-13 cause smm hyper reactivity, goblet cell hyperplasia & mucus transcript and translation and chemokine production
what does histamine (in mast cells) do?
cause bronchoconstriction, and vasodilation
What do leukotrienes in mast cells do?
inc microvascular permeability, stimulate secretion of mucus, contraction of airway smooth muscle
What cause CD4 /TH1 and CD4/ TH17 responses
atypical pneumonias, tuberculosis, emphyzema granulomas, and fungal
How does chronic TH17 response lead to emphysema?
chronic recruitment of neutrophils to the lungs-> prd elastace and metabulite proteases-> loss elastisity of the lung-> leads to emphysema
When do you see a CD 8+ response?
viral infection and certain cancers
What do inhaled corticosteroids do? and what do they work on?
They reduce inflammation by inhibiting transcription of pro-inflammatory gene transcription
affects helper CD4+ t-cells and in asthma TH2 cells
easiest way to distinguish between Asthma and COPD?
PFT post brochodilator
If asthma the FEV1 will need to improve by 12%
If COPD the bronchodilator won’t have any improvement in FEV1. The FEV1/FVC will be
why are these test ran in COPD patents? Xray Lung Vol and diffusion capacity Oximetry and ABG Alpha-1 antitrypis def screening
to see if have cancer
the severity of COPD
evaluate patents O2 sat to see if need to be put on supplemental O2
On caucasian decent under 45, bc can give them a drug to boost alpha-1 antitrypsin to build up in alveoli
What is the therapeutic treatments for COPD?
Bronchodilators, as needed to prevent or reduce symptoms beta2 agonist (long or short term), anticholinergics, theophylline or a combination of them
inhaled corticosteroids are also used to treat COPD. What are the big side effects?
an inc risk of pneumonia
also withdrawal from this treatment may lead to exacerbation in some patents
What is a form of surgery shown to improve COPD?
Lung volume reduction surgery. It only really helps upper-lobe predominant emphysema and low exercise capacity
Name the obstructive lung disorders
Asparate something COPD (emphysema, chronic bronchitis) Ashtma Anaphylaxis Pulmonary edema Cystic fibrosis Pneumonia Neoplasm peribronchial edema
