Pulmonary System I Flashcards
Define respiration
Exchange of gases between the atmosphere, blood and cells
What are the 3 processes required for respiration
ventilation (breathing)
External (pulmonary) respiration
Internal (Tissue) respiration
The CV assists the respiratory by
Transporting gases
What are the respiratory system STRUCTURAL DIVISION?
Upper Respiratory system
Lower respiratory system
What are the respiratory system FUNCTIONAL division
Conducting Zone
Respiratory Zone
What are the conduction zone
Dead space up to terminal bronchioles
What is the respiratory zone
Gas exchanges in alveoli
The UPPER respiratory consists of
PANP Paranasal sinuses Associated Structures Nose Pharynx
The LOWER respiratory consists of :
LLTB Larynx Lungs Trachea Bronchi
The upper respiratory tract : put in order nasopharynx ,oropharynx and laryngopharynx
NOL
Nasopharynx –>Oropharynx –>Laryngopharynx
Mallampati Score 1
Full visibility of Tonsils, Uvula, Soft palate (TUS)
Mallampati Score 2
Visibility of hard and soft palate, upper portion of tonsils and uvula
Mallampati Score 3
Soft and hard palate, and base of the uvula visible
Mallampati Score 4
Only hard palate visible
2 parts of the larynx
Thyroid Cartilages
Cricoid cartilages
True ribs are _______ and are _______to sternum via ______ cartilage
1-7 ; attached directly ; Costal
False ribs are ________ and are ________to sternum
8-10; indirectly attached
Floating ribs are ________ and are _______ to sternum
11-12; not attached to sternum.
Supernumary ribs are ____ribs and cervical ribs are
Extra; elongation of transverse process of 7th cervical vertebra
Supernumary ribs: Lumbar ribs
Elongation of transverse process of lumbar vertebra
Function of floating ribs?
What about the oblique orientation?
allow flexibility of movement that is needed for ventilation to occur
Oblique orientation allows for elevation of the rib cage involved with lung expansion
what is the upper most part of the sternum
Manubrium
Suprasternal notch is the
Jugular
Trachea lies where?
posterior to and in line with jugular notch
Suprasternal notch (jugular) signifies ? and is the ideal ___________
midpoint of trachea and ideal location for the distal tip of the endotracheal tube
Where does the manubrium joins the body of the sternum?
What occurs at this level ? Which is T__ - T___
Sternal angle of Louis
Bifurcation of the trachea (T4-T5)
What is the hinge-like joint between the manubrium and the body of the sternum?
Manubriosternal Joint
what is the function of the manubriosternal joint?
Allows hinge like forward movement of sternum during inspiration and backward movement during Expiration
***PART of the UPPER airway : nose function
***Warms, cleanses, and humidifies inhaled air
RESONATING CHAMBER THAT AMPLIFIED the voice
Bony and cartilaginous support: 3 parts
Superior
Inferior
Ala Nasi
Bony and cartilaginous support: Superior part –> _______bones medially and ______lateraly
Nasal bones; maxillae
Bony and cartilaginous support: Inferior part –>
Lateral and ALAR cartilages
What is the ALA NASI? What is shaped by ?
Flared portion shaped by dense CT , forms lateral wall of each nostril.
Nasal Cartilage Caveat?
beware of nose rings and other jewelry (Bovie)
What is the vestibule? what kind of tissue is it made of?
It is a dilated chamber inside ALA NASI..Stratified Squamous epithelium , vibrissae (guard hairs)
Nasal cavity extends
from nostrils to posterior nares
Nasal septum divides cavity into
right and left chambers called Nasal fossae
Function of the Turbinates and Sinuses
Warm, clean and MOISTEN AIR for the lungs
What are the nasal conchae and how many are there?
3 folds of tissue on lateral and nasal fossa
mucous membranes supported by thing scrolllike turbinates bones
Superior, middle, inferior
What are the meatuses
Narrow air passage beneath each conchae
narrowness and TURBULENCE ENSURES AIR CONTACT MUCOUS MEMBRANES.
What are the paranasal sinuses? MENFS
Maxillary Ethnoid Nasal cavity Frontal Sphenoid
Nasal Cavity -Mucosa
Olfactory: lines roof of nasal fossa
Respiratory: Lines rest of nasal cavity with CILIATED PSEUDOSTRATIFIED EPITHELIUM
What kind of tissue line the rest of the nasal cavity?
Ciliated pseudostratified Epithelium
What is the defensive role of mucosa?
What are the bacteria destroyed by?
Mucous (from goblet cells) Traps inhaled particles - Bacteria destroyed by LYSOZYME & IgA
Function of the Cilia or respiratory epithelium?
sweep debris laden mucus into pharynx to be swallowed.
What is the function of the Erectile tissue of inferior conchae?
Venous plexus that rhythmically engorges with BLOOD and SHIFTS flow or air from on side of fossa to the other once or twice an hour to PREVENT DRYING.
Spontaneous EPISTAXIS most common site is
INFERIOR CONCHA
3 regions of pharynx in order from superior to inferior?
Nasopharynx
Oropharynx
Laryngopharynx
Nasopharynx is made of ______ ______ and is located posterior to _______, dorsal to ______ palate. It receives________ and contains what _______ ________
Pseudostratified epithelium
choanae ; soft; auditory tubes; PHARYNGEAL TONSIL
The pharynx ____degrees ______ turn does what?
Turn 90 degrees downward; Traps large particles
Oropharynx is made of _______ ______ and is the space between________location?
what does it contain?
stratified squamous epithelium; space between soft palate and root of tongue.
Inferior to hyoid bone
PALATINE and LINGUAL TONSILS
Lagyngopharynx is made up of ______ ____
Location ?
Stratified squamous
Hyoid bone to level of cricoid cartilage.
Glottis
Vocal cords and opening between
What is the epiglottis? guards what? and function?
Flap of tissue that guards glottis, direct foods, and drink to esophagus
Note on INFANT LARYNX
Higher in throat–> Forms a continuous airway from nasal cavity that allows breathing while swallowing
In infant larynx, by age 2,
more muscular tongue forces larynx down
Where are TRUE VOCAL CORDS?
True vocal folds are attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage.
Larynx located in adults ________
Larynx located in children_______
C3-C6
C3-C5 (superior)
Framework of the larynx is formed by ____total pieces of cartilages (____paired and _____ unpaired)
9; 3; 3
What are the 9 total pieces of cartilage?
CETACC
Crycoid Epiglottis Thyroid Arytenoid (paired) Corniculate (paired) Cuneiform (paired)
Vertebral levels in the larynx
Hyoid (C2/C3)
Thyrohoid membrane (C4)
Laryngeal prominence (C5)
Cricoid cartilage and start of trachea (C6)
Which is the most superior of the 9 cartilages of the larynx?
Epiglottic Cartilage
Which is the largest of the 9 cartilages of the larynx? what does it form?
Thyroid Cartilage
Forms laryngeal prominence
Which is the cartilage of the 9 cartilages of the larynx, that connects LARYNX to TRACHEA
Cricoid Cartilage.
Which is the one out of the 9 cartilages of the larynx that is posterior to the thyroid cartilage?
ARYTENOID CARTILAGE
Arytenoid cartilage is composed of ______ and are located?
2; posterior to thyroid cartilage
Corniculate cartilage is composed of ____ and do what ?
Attached arytenoid cartilages like a PAIR OF HORNS
Which cartilage is attached like a PAIR OF HORNS?
CORNICULATE cartilage.
Which structures support soft tissue between arytenoids and EPIGLOTTIS?
Cuneiform Cartilages.
What is the narrowest portion of the airway in pediatric patients?
Cricoid
In pediatric patients newer studies suggest ?
The GLOTTIC OPENING may be the narrowest in the pediatric patient.
What is the RIMA GLOTTIDIS?
Opening between true vocal cords and the ARYTENOID cartilages.
-Narrowest portion of the upper airway in the adult
Glottis in the laryngeal cavity =
true vocal cords and the rima glottidis
If the laryngoscope blade is too deep?
looking down the esophagus and hiding the larynx
What is the function of the EXTRINSIC MUSCLES
Connect larynx to HYOID bone, elevate larynx during swallowing UP and FORWARD
What are the parts of the SUPRAHYOID muscles? (MDS)
Mylohoid
Stylohoid
Diagstric
What are the parts of the INFRAHYOID muscles? (SOTS)
Sternothyroid
Omohyoid
Thyrohyoid
Sternohyoid
What are the muscles of the LARYNGEAL INLETS? (ATO)
Aryepiglottic
Oblique aretynoid
Thryroepiglottic
What does the Aryepiglottic do?
Narrows inlet, closes glottis
What does the OBLIQUE ARETYNOID do?
narrows inlet, closes glottis
Together , the aryepiglottic and oblique aretynoid act as a PURSE-STRING sphincter during swallowing.
Which act as a purse string sphincter during swallowing?
Aryepiglottic
Oblique aretynoid
What is the role of THYROEPIGLOTTIC?
Widens inlet
Intrinsic Muscles function
Rotate corniculate and arytenoid cartilages.
The intrinsic muscle ADDUCTS (which sound)
tightens : HIGH PITCH SOUND
The Intrinsic muscle ABDUCTS (which sound)
Loosens: LOW PITCH SOUND
What are the muscles involved with movement of true cords?
Cricothyroids Lateral cricoarytenoids Oblique arytenoids Thyroarytenoids Transverse arytenoids
3 intrinsic muscles that ADDUCTS CORDS and closes ? (LOT)
Lateral cricoarytenoids
Transverse arytenoids
Oblique arytenoids
What is the ONLY INTRINSIC MUSCLE to lie outside the CARTILAGINOUS framework of the larynx?
CRICOTHYROIDS
Which intrinsic muscle TENSE VOCAL CORDS?
CRICOTHYROIDS
Which intrinsic muscle RELAX VOCAL FOLDS
THYROARYTENOIDS
________is part of the THYROARYTENOIDS
Vocalis m.
Which structure ADJUST TENSION of CORDS
Vocalis m.
Which structure adjust vocal cords and FOLDS , OPENS
Posterior cricoarytenoids
WHICH is the ONLY ABDUCTOR muscle of vocal cords?
Posterior Cricoarytenoids .
Blood Supply to the larynx
supplied via EXTERNAL CAROTIDS and SUBCLAVIAN ARTERIES and INTERNAL JUGULAR VEIN
Larynx innervated by
CN X Vagus
Motor: All intrinsic muscles EXCEPT the _____ are innervated by the _______
Cricothyroid; RECURRENT LARYNGEAL NERVE
Motor : The cricothyroid muscle is the only muscle not innervated by the laryngeal nerve , and is innervated by?
SUPERIOR LARYNGEAL NERVE.
Sensory : larynx innervation
INFERIOR BRANCH of SUPERIOR LARYNGEAL NERVE
What is the function of the inferior branch of superior laryngeal nerve?
Provides sensation for upper portion of the larynx down to and including upper half of the vocal cords.
What is the function of the RECURRENT LARYNGEAL NERVE?
Transmits sensation below that TRUE CORDS and half of the LOWER CORDS
Trachea is a ________tube, approx. _____long and ______ in diameter?
Fibrocartilaginous, 10-20cm and 12mm in diameter
Where does the trachea begins?
AT end of larynx (C6) and extends to T5-T6
What is the trachea supported by ?
16-20 C-Shaped rings of cartilage with smooth muscle posteriorly.
What is the lowest most portion of the trachea where it divides into PRIMARY bronchi?
CARINA
what is the trachea lined with? which function as?
Ciliated pseudostratified Epithelium which functions as MUCOCILIARY ESCALATOR.
The lungs produce ____Ml of mucous per day
100ml
What help trap precipitate?
Turbulent flow
Additional way to remove inhaled particles?
Cough Reflex
Explain the mucociliary Escalator Mechanism
Impaired by endotracheal intubation & Volatile anesthetics
Ciliary epithelial cells beat particles up the airway to be swallowed in the OROPHARYNX
Cilia remove “contaminated mucous”
Branching of Tracheobronchial Tree: Conducting ? does exchange occur here?
Dead zone TMLSBT
Trachea –> L and R main bronchi –>Lobar bronchi –>Segmental bronchi –>Bronchioles –>Terminale Bronchioles.
NO
Branching of Tracheobronchial Tree: RESPIRATORY?
Does exchange occur here?
Respiratory Bronchioles –>Alveolar ducts –>Alveolar Sacs –> Alveoli.
Yes
Conducting zone: Secondary LOBAR BRONCHI? what occurs ? how many on the right and left?
Bronchospasm occurs here
3 on the right, 2 on the left.
Segmental Bronchi? does bronchospasm occur here? Treat how?
Bronchospasm occurs here, it Can be treated by increasing positive pressure, deepening the anesthetic, increasing the inspiratory time of ventilators and directly spraying lidocaine into the trachea.
Segmental Bronchi how many on R and left?
TEN on the right, EIGHT on the LEFT
TERMINAL BRONCHIOLES
Diameter of and _____ mm contain_________
Relatively thick smooth muscle wall compared to lumen
• Can during asthma attack
• No ________ cells
1 mm; NO cartilage
contract
goblet
Parasympathetic –> Ach–> broncho________
constriction
Sympathetic –> Epi/NE –> Broncho_______
Dilation
Alveoli are formed from birth to age _____ they
continue to maximally expand until age______
4; 8
The respiratory Zone composed of: (4) which is the terminal respiratory unit?
Acinus (terminal respiratory unit)
• Respiratory bronchioles
• Alveolar ducts
• Alveoli
Where is the first segment of airway where gas exchange occurs?
Respiratory Bronchioles (Transitional zone)
What are the alveolar ducts?
Walls completely lined with alveoli
What are the alveolar sacs?
located at end of each 3rd generation of alveolar ducts
What is the main mechanism for gas transfer from the alveoli INTO BLOOD? Which dissolve easier?
Diffusion; lipid soluble
What is the formula for diffusion?
Area/thickness
In a normal lung zone the area of the blood gas interface is about
the size of a tennis court.
Alveoli _______million in the adult
300 million
What maximize surface area?
Polygon shape.
Surrounded by
1000 pulmonary capillaries each
Types of Alveoli
Type I alveolar cells - Squamous
Type II alveolar cells - Cuboital
Which type of alveoli involved in gas exchange?
Type I Form walls of alveoli, involved with gas exchange
which type of alveoli produce surfactant ? what can they do ?
Type II –> can differential into Type I cells if needed.
What happens in chronically injured lung?
Alveolar epithelium is lined entirely by Type II cells, limiting gas exchange.
What are pores of Kohn? Function?
opening in the wall between adjacent alveoli.
Allow for collateral ventilation.
What eliminates foreign debris?
Alveolar macrophages.
Perfusion Adjustments: Response to reduced ventilation
Decreased airflow => Reduced pO2 in blood vessels =>Vasoconstriction of pulmonary vessels =>Decreased blood flow => blood flow matches airflow.
Perfusion Adjustments: Response to increased ventilation
Increased airflow =>Elevated pO2 =>Vasodilation of pulmonary vessels =>increased blood flow => blood flow matches airflow
Ventilation Adjustments: Response to reduced perfusion
Decreased blood flow => Reduced PCO2 in alveoli =>Constriction of bronchioles =>Decreased airflow => airflow matches blood flow.
Ventilation Adjustments: Response to increased perfusion
Increased blood flow => Elevated PCO2 in alveoli =>Dilation of bronchioles =>Increased airflow =>Airflow matches blood flow.
Alveoli have a tendency to
collapse
What is alveolar collapse prevented by ?
a. Surfactant
b. Alveolar pores
c. Interdependence
What happens when an alveolus start to collapse?
The surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it.
Lungs located in the __________ occupy all of thoracic cavity except________
Thorax; mediastinum
Right lung has how many lobes______and receives ______ of cardiac output
3; 60%
Left lung has how many lobes?
2
Which lung lobe is more narrow?
left
The lungs are innervated by the __________. _______Fibers T2-T6 and ________ from the vagus.
pulmonary plexus;
Sympathetic fibers
Parasympathetic fibers.
Why is there normal perfusion and ventilation (V/Q)?
Because of different surface areas
Parasympathetic Fibers produces _______Of the airways and ______Mucus secretion by the mucus glands
Bronchoconstriction
Increased
Sympathetic hormones produce _______of the airways( __ response)
Bronchodilation; B2
Serous membranes that line the thoracic cavity and cover the lungs
Pleural membranes.
How much pleural fluid produced by lungs? ____cc; and prevents______________________
10; friction in the pleural cavity; creates pressure gradient
Attached to outer surface of the lungs
Visceral Pleura
Line the wall of the thoracic cavity which pleura?
Parietal
One breathing cycle
one cycle of inspiration and one cycle of expiration
At rest :
During exercise:
Quiet respiration
forced respiration.
Flow of air in and out of lung requires a_____
pressure difference between air pressure within lungs and outside body.
Muscles of Respiration: INhalation (SEDS)
Sternocleidomastoid
External Intercostals
Diaphragm
Scalene
Muscles of Respiration: EXhalation (TRIEDI)
Internal Intercostals Diaphragm External oblique Internal oblique Transversus abdominis Rectus abdominis
What account for most of TIDAL VOLUME?
Diaphragm
Dome shaped muscle that forms the floor of the thorax and separates the thoracic cavity and the abdominal cavity?
Diaphragm
The diaphragm into 2 halves:
Hemidiaphragms
Right hemidiaphragm is ________ than the left because _____Pushes left side down and ______ raises right side
HIGHER
Heart
LIVER
Major: diaphragmatic foramina
- Vena cava foramen
- Esophageal hiatus (esophagus and vagus nerve pass through; SITE OF HIATAL HERNIA
- Aortic Hiatus
Diaphragm is supplied by paired
Phrenic nerves
C3-C5
Which C provides 70% contribution of phrenic
C4
The innervation allows for
half of the diaphragm to continue working if one side is damaged.
Where does sensory diaphragmatic pain referred to?
shoulder areas.
Major factors affecting the position of the diaphragm
Recoil of lungs
Thoracic viscera pressure (CHF)
Abdominal viscera pressure (pregnancy)
Abdominal muscle activity (contraction pushes diaphragm upward)
Movement during normal breathing?
1-2 cm normal tidal breathing
7-13 cm with deep breathing
The diaphragm accounts for
60-75% of normal Tidal volume respiration.
_______Is a skeletal muscle and you can PARALIZE it ?
Diaphragm
Yes
External intercostal muscles oriented
Orientation? responsible for what percentage of TV? what happens to the ribs during inspiration?
obliquely forward and downward
responsible for up to 25% of tidal volume that enters lungs during normal breathing at rest
Lift up the ribs during inspiration
Internal intercostals muscles oriented?
backward and downward
assist in expiration by pulling the ribcage down
Aids in forced expiration.
Pressure changes in ventilation
At rest, diaphragm is relaxed , alveolar pressure is equal to atmospheric pressure and there is no air flow.
Inwardly directed force in the alveoli which must be overcome to expand the lungs during inspiration?
Surface tension
Decreases the size of the alveoli during expiration
Elastic recoil
Ease with which the lungs and thoracic wall can be expanded?
Compliance
Surface tension
Inwardly directed force in the alveoli which must be overcome to expand the lungs during each inspiration
Elastic recoil
Decreases the size of the alveoli during expiration
Compliance
Ease with which the lungs and thoracic wall can be expanded
