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Respiratory System > Resp 8 - Sensory aspects of respiratory disease > Flashcards

Resp 8 - Sensory aspects of respiratory disease Flashcards

1
Q

What does cough protect us from?

A
  1. Inhaled foreign material

2. Excess mucus secretion

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2
Q

When mucociliary function is impaired, what do we do more?

A

Cough

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3
Q

What happens in the expulsive phase of coughing?

A

Mucus in airways stimulates cough mechanism. High velocity airflow generated, which expels the mucus.

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4
Q

Nerve terminals are present on the surface of epithelium. Why?

A

They are well placed to sense the external environment - may trigger a cough response

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5
Q

Where are cough receptors located?

A

Airway epithelium.

  1. Most abundant on posterior wall of trachea.
  2. Found at main carina
  3. Absent beyond the bronchioles.
  4. Found mainly in the proximal airways and branch points of large airways.
  5. Also found in larynx, pharynx and external auditory meatus, diaphragm, pleura, pericardium and stomach.
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6
Q

Sensory receptors in the lungs and airways can be divided into 3 main types.
What are they?

A
  1. C-fibre receptors
  2. Rapidly adapting stretch receptors
  3. Slowly adapting stretch receptors
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7
Q

Describe C-fibre receptors

A
  1. Free nerve endings
  2. Present in larynx, trachea, bronchi and lungs
  3. Unmyelinated (so slow conduction)
  4. Respond to chemical irritants and inflammation
  5. Release substance P, Neurokinin A and Calcitonin gene related peptide (all neuropeptides)
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8
Q

Describe rapidly adapting stretch receptors

A
  1. Myelinated - fast conduction
  2. Present in nasa-pharynx, larynx, trachea and bronchi
  3. Respond to mechanical, chemical irritant and inflammatory stimuli
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9
Q

Describe slowly adapting stretch receptors

A
  1. Myelinated
  2. Located in airway smooth muscle (mainly trachea and main bronchi)
  3. Slowly and rapid adapting stretch receptors are mechanoreceptors which respond to lung inflation
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10
Q

Rapidly adapted stretch receptors are involved in?

What about slowly adapting stretch receptors?

A

Rapidly = Inspiration

Slowly = Expiration

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11
Q

What are C-fibres stimulated by?

A

Chemicals

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12
Q

Which nerve do all sensory nerves from the airways pass through?

A

The vagus nerve (10th cranial nerve)

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13
Q

What are the 2 types of sensors that lead to cough and where are they located?

A
  1. Mechanoreceptors - nodose ganglion

2. Nociceptors - jugular ganglion

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14
Q

Name 2 things that mechanoreceptors are activated by?

A
  1. Mechanical displacement

2. Citric acid

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15
Q

Name 4 things that nociceptors are activated by?

A
  1. Caspaicin
  2. Bradykinin
  3. Citric acid
  4. Cinnamaldehyde
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16
Q

What does the cough centre consist of?

A

Nucleus tractus solitarius - bunch of neurones connected to medullary cough pattern generator

17
Q

How does a cough come about?

A
  1. Sensory information goes to brainstem via vagus nerve (and also superior laryngeal nerve).
  2. Some signal goes to cerebral cortex.
  3. Medullary cough pattern generator stimulates various muscles needed to cough. (efferent pathway)
    4.
18
Q

What are the 3 main phases of coughing?

A
  1. Inspiratory phase - opening of trachea
  2. Glottic closure
  3. Expiratory phase
19
Q

Describe the mechanics of coughing

A
  1. Coughing produces an increase in intrapulmonary pressure - compresses posterior tracheal membrane to form a crescent shape - this increases flow and contributes to sound
20
Q

Acute coughs are usually the most common. They last less than 3 weeks. What is the most common cause?

A

Rhinovirus

21
Q

How long do chronic persistent coughs last?

A

Over 3 weeks

22
Q

What is gastro-oesophageal reflux?

A

Protons coming from stomach can activate cough receptors which consequently activate brainstem cough receptors

23
Q

What is chronic cough an indicator of? What is it aka?

A

Increased cough reflex

Aka Cough Hypersensitivity Syndrome

24
Q

What are chronic coughers particularly sensitive to?

A

Capsaicin

25
Q

How does cough hypersensitivity syndrome occur?

A

Due to “plasticity” of neural mechanisms.

Involves:

  1. Increased excitability of afferent nerves
  2. Increase in receptor numbers (e.g. TRPV1)
  3. Increase in neurotransmitter in brainstem (e.g. neurokinins)

Aside from plasticity, increase in inflammatory mediators also increases the risk of hypersensitivity

26
Q

What drugs can we currently use to manage cough hypersensitivity?

A
  1. Amitryptiline
  2. Gabapentin
  3. Opiates (e.g. morphine, codeine)

(4. Experimental)

27
Q

Which respiratory organ does the vagus nerve (10th) innervate?

A

Pharynx, Larynx, Lungs

28
Q

Which respiratory organ does the trigeminal (5) nerve innervate?

A

Nose

29
Q

Which respiratory organ does the Glossopharyngeal nerve (9) innervate?

A

The pharynx

30
Q

Where does chest wall pain sensation come from?

A

Spinal nerves

31
Q

What is the difference in the receptors used between touch and pain?

A

Touch = travels via Aa and Ab fibres via dorsal horn

Pain = Ad and C fibres via spina-thalamic tract

32
Q

What is the MAIN difference between the pain pathway and the touch pathway?

A

Touch pathway = goes to contralateral side at the level of the CAUDAL MEDULLA (crosses onto other side at brainstem)

Pain pathway = goes to contralateral side at the same anatomical level

33
Q

Where do both touch and pain go to?

A

Primary somatosensory cortex

34
Q

Distinguish somatic and visceral pain

NB there is another type of pain called neuropathic

A

Visceral pain = pain from internal organs. Difficult to localise, referred to somatic structures

Somatic pain = skin and subcutaneous tissue. Somatic = localised.

35
Q

Where are there more pain fibres (afferent fibres), in viscera or somatic?

A

Somatic has more afferents

36
Q

What provokes chest pain from the respiratory system?

A
  1. Pleuropulmonary disorders (e.g. pulmonary embolism, pneumothorax, etc)
  2. Tracheobronchitis
  3. Inflammation/trauma to chest wall
  4. Referred pain
37
Q

What non-respiratory disorders can result in chest pain?

A
  1. CV disorders
  2. GI disorders
  3. Psychiatric disorders
38
Q

How is dyspnoea graded?

A

Using a clinical dyspnoea scale. Grade 0 - 4 (American Thoracic Society - used clinically)

Borg scale also used

39
Q

How is dyspnoea treated?

A

The cause must be treated (e.g. heart, lung).

Therapeutically, bronchodilators/drugs affecting brain (e.g. diazepam/morphine)/lung resection. Or pulmonary rehab (e.g. general fitness)

Respiratory System (16 decks)

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