Pulmonary System Flashcards
Lungs
Right = 3 lobes
Left = 2 lobes (left lingular lobe = right middle lobe)
The apex of lung extends 4 cm above rib #1
Medial (hilar) surface:
1. pulmonary arteries veins
2. Bronchi
Pleura:
1. Visceral - adheres to lung
2. Parietal - adheres to thoracic cage
Pneumothorax is the loss of vacuum between the two.
Mediastinum
Anterior - Thymus gland
Middle - Heart and pericardium
Posterior - Esophagus, descending aorta, azygous veins, thoracic duct, sympathetic trunk
Superior - Aortic arch, brachiocephalic veins
How do we drain mucous out of the head?
CN1 - Olfactory - sensation
CN5 - Sensation
Sphenoid drains into ethmoid.
Both Frontal and ethmoid drain into the maxillary which then drains into the nasal cavity.
Tidal volume
Breathing in and out
Amount of air that moves in or out of the lungs with each respiratory cycle.
Inspiratory reserve volume
It is the amount of air that can be forcibly inhaled after a normal tidal volume.
Used during exercise.
Expiratory reserve volume
Your expiratory reserve volume is the amount of extra air — above-normal volume — exhaled during a forceful breath out
Residual volume
It is the volume that remains in the lungs after a maximal expiration
FEV 1
It is the volume that can be expired in 1 second after a maximal inspiration.
It is normally 80% of the forced vital capacity.
Good for checking COPDs
What does the phrenic nerve innervate?
The diaphragm
Medulla
respiration
Dorsal respiratory group
-Associated with inspiration
Ventral respiratory group
- Associated with expiration
- Only operates during active respiration as normal expiration is known to be passive.
Pons
respiration
Apneustic Center (lower pons) - Stimulates inspiration (gasp / Apneusis)
Pneumotaxic Center (upper pons) - Inhibits inspiration (regulates rate and volume)
Remember
Carbon dioxide CO2 creates an acidic environment.
Bicarbonate creates a base environment.
Remember
Most of carbon dioxide is put away in bicarbonate buffer.
Rhinitis
Rhin = nasal -itis = inflammation Inflammation of the nose runny nose (rhinorrhea), nasal itching, nasal congestion, and sneezing
Allergic rhinitis
Allergic rhinitis is inflammation of the nose caused by allergens such as hay, pollen, dust, animal hair, or mold spores. Type 1 hypersensitivity reaction. IgE mediated. There are lots of mast cells that were activated by B-cells (which were activated by T cells) around the nose and mouth because both are portals of entry for infections Symptoms: - red itchy swollen eyes. - nasal congestion. - frequent bouts of sneezing Treatment: - antihistamine - nasal irrigation
Upper respiratory tract infection
An upper respiratory tract infection is any infection that involves the nasal cavity, paranasal sinuses, pharynx, or larynx, and it’s most often caused by an invading pathogen like a virus.
What is the larynx?
Below the pharynx
Commonly called voice box or glottis.
Passage for air between the pharynx above and the trachea below.
Tonsils
Lymphoid tissue
Acts as q first line of defense
Main function is to trap germs (bacteria and viruses)
What produces mucus?
Goblet cells and submucosal gland
Pus
Can form in the area where pathogens have invaded
Pathogens + immune cells + dead tissue + cytokines.
These cytokines get to the brain making the body increase temperature
Rhinitis
Rhin = nose -itis = inflammation Infection of the nasal cavity Bacterial or viral Usually caused by viruses Common Cold Flu
VIRAL: Rhinovirus (common cold) Influenza virus Respiratory syncytial virus (RSV) Parainfluenza virus Adenovirus
BACTERIAL: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrahalis (causes otitis media in children) Staphylococcus aureus
Chronic rhinitis
Post-nasal drip
Laryngitis
Laryng = larynx -itis = inflammation Inflammation of the larynx Most common Especially affects children Chronic if it lasts more than 3 weeks
What does the pharynx split into?
Esophagus and larynx (and or trachea)
Acute laryngitis
Most common (usually due to upper respiratory tract infection) Usually due to viruses: - Rhinovirus - Coronavirus - Influenza virus - Respiratory syncytial (RSV) - Parainfluenza
Bacterial - Group A streptococcus - Streptococcus pneumonae - Haemophilus influenzae Super infection - bacterial infection with viral infection.
Goblet cells produce lots of mucus, immune cells migrate to the area (neutrophils and macrophages), they release chemicals that cause swelling and pain, vocal cords don’t vibrate smoothly, dysphonia occurs (hoarseness)
Symptoms:
3 D’s = Dysphonia, dyspnea, and dysphagia
Hoarse voice, cough, difficulty swallowing (dysphagia as the epiglottis may compress against the esophagus), SOB (in children due to smaller airways).
Epiglottis
Sits on top of the larynx (voice box)
Keeps food and liquid going towards the esophagus and not going into the trachea
Bacterial Epiglottitis
Inflammation of the epiglottis
Can be life-threatening as it can block the trachea not allowing for breathing
Mostly caused by Haemophilus influenzae
Group a streptococcus.
Pathogens get into the mouth or nose, deposit in the mucosa of the epiglottis, goblet cells produce mucus, immune cells migrate to that area and release cytokines which makes blood vessels more permeable to fluid, inflammation and swelling occurs, obstruction of airflow happens.
symptoms:
Fever, difficulty breathing, stridor
Lab:
Endoscope and x-ray
Nasal Polyp
Nasal polyps develop when epithelial cells that line the respiratory region simply overgrow - a process called hyperplasia.
Non-cancerous
Blocks airflow and mucus drainage making pathogens lingering which cause infection causing swelling.
Remember
Between the pulmonary and systemic circuit, if I am pumping into the aorta or systemic circuit I am pumping at 100 mmHg. I can not do this in the pulmonary circuit. We are going to have the same volume but lower pressure.
Ventilation
The mass movement of air in and out of the lungs
Perfusion
Movement of O2 and CO2 across the alveolar membrane
Remember
Cartilaginous rings in the trachea and bronchi are C rings because, in the back of the C ring, there is smooth muscle that connects the two ends together.
Beta 1 goes to the heart and Beta 2 goes to the lungs
Pulmonary Edema
Any factor that causes the pulmonary interstitial fluid pressure to rise from negative to positive
Causes:
Left heart disease
Pulmonary capillary membrane damage
Emphysema
Pink puffers
Normal pCO2 - due to compensatory mechanism/response
PCO is normal because, unlike chronic bronchitis patients, they are never having a break from their emphysema. Chronic stimulation of erythropoietin (which comes from kidneys), then goes to bone marrow saying we need more red blood cells.
Permanent dilation of part or all the acinus with eventual destruction of alveolar walls
Cigarette smoking or def. serum alpha 1 protease inhibitor in non-smokers.
Barre-chest, pursed lips, slow forced expiration
Chronic bronchitis
Increased pCO2
Persistent cough with sputum for at least 3 months in at least two consecutive years
Obese, corp pumonale, cyanotic
Do not retain hypercapnic drive to breathe
How much erythrocyte is in total blood volume?
45% of total blood volume is made up of erythrocytes.
What are erythrocytes?
What is the function of erythrocytes?
Red blood cells
Carry oxygen to tissues and carbon dioxide to lungs
What is hematocrit?
The hematocrit is the proportion, by volume, of the blood that consists of red blood cells. The hematocrit (hct) is expressed as a percentage.
What does hematopoietic stem rise give rise to?
It gives rise to red blood cells, white blood cells, and platelets.
Polycythemia vera
refers to an increase in the number of red blood cells in the body.
The extra blood cells in the blood cause the blood to be thicker, increasing the risk of other health issues, such as blood clots.
90% of individuals with polycythemia have a mutation of the Janus Kinase 2 (JAK2) gene found in the hematopoietic stem cell which is responsible for making red blood cells.
Symptoms: Fatigue Dizziness Increased sweating Redness in the face Blurred vision Itchiness
complications:
Stroke, heart attack, DVT, Budd-Chiari syndrome (which is when liver veins are blocked by blood clot).
What is erythropoietin?
It is a hormone that is produced predominantly by specialized cells in the kidney
What normally makes erythropoietin (hormone) to be released?
Low oxygen
Myelofibrosis
Secondary to polycythemia
Hematopoietic cells die out causes fibrosis within the bone.
Anemia, thrombocytopenia, and leukopenia are developed as the cells responsible for making RBCs, platelets, and WBCs die out.
Reactive polycythemia
Caused by emphysema
Pneumonia
Patchy area throughout the lung Working hard to breathe X-ray Dullness to percussion Tactile fremitus
Infection in the lungs is caused by microbes.
This infection brings fluid to the lungs making it harder to breathe.
It brings white blood cells, red blood cells, fluid, and proteins to the area of inflammation when microbes achieve colonization of an area(s) of the lung.
Symptoms:
Dyspnea, chest pain, productive cough
Caused by viruses, bacteria, and fungi
Most common viral cause:
Influenza (flue)
Most common bacterial cause:
Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus
Community-acquired pneumonia
Not in a hospital
Hospital-acquired pneumonia
More serious because patients have weakened immune system
Aspiration pneumonia
Occurs when something installs into the lungs from air tubes such as gastric juice, food, etc.
Lobar pneumonia
A whole lobe is affected
Streptoccocus pneumoniae
Stages:
1. Congestion - days 1 and 2
Blood vessels and alveoli fill with excess fluid
2. Red hepatization - days 3 and 4
Exudate (RBCs, neutrophils and fibrin) fill airspaces making them more solid. Liver-like appearance
3. Gray hepatization - days 5 to 7. 4. Resolution - day 8 to 3 weeks
Exudate is digested, ingested and coughed up
Atypical or interstitial pneumonia
Patchy areas concentrated in the perihilar region
Lung abscess
In bronchial segment
Aspired microbe that causes abscess
Tuberculosis
Mycobacterium tuberculosis
90-95% aren’t aware they are infected.
Aerobe!
Hard surface - survive on surfaces and inside of macrophages infecting them.
Transmitted via inhalation infecting the lung.
Upper lobes are affected the most
It can be in any organ, but it usually starts in the lung. If not cured, it invades other organs
Hypersensitivity pneumonitis
farmer’s lung, pigeon breeders lung, air conditioner , interstitial pneumonia and fibrosis, non-caseating granulomas.
Body mistakenly thinks its pneumoniae
bronchiectasis
Bronchi = bronchus
ectasis = dilation/expansion
Chronic inflammation make the bronchi and bronchioles get dilated
Obstructive lung disease - the infection makes mucus which obstructs airway.
secondary to ciliary dyskinesia - cilia don’t move normally.
Bacteria starts to multiply. Overtime after being damaged and having the elastin damaged/destroyed from the chronic inflammation, the airways dilate.
Goodpasture’s syndrome
Autoimmune disorder
Goodpasture syndrome is a rare disorder in which your body mistakenly makes antibodies that attack the lungs and kidneys. It most often occurs in people ages 20 to 30 or older than age 60. It is more common in men. It can be fatal if not quickly diagnosed and treated.
Causes hemoptysis.
In kidneys: Hematuria - blood in the urine
Autoantibodies bind to specific of the alpha chain
type 2 hypersensitivity reaction
What is the most abundant protein in the human body?
Collagen - triple helix, each chain is 1 of6 types.
Basement membrane
sheet-like, made of protein (various), found in every organ system
Asthma
It is small bronchi airway disease.
This causes two negative things: restriction or contraction of smooth muscle and over production of immune product - mucus
People die
Pleural effusion
Wetness outside the lungs
Increased hydrostatic pressure/heart failure
