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Pathophysiology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Types of Respiration

A

External- breathing

Internal- between the lungs and the blood

Cellular- use of oxygen to produce ATP
-The byproduct is carbon dioxide

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2
Q

Upper Respiratory System Functions

A
  • Warms and humidifies the air
  • Nose, pharynx
  • Filters air with hairs and cilia
  • Sinuses are air pockets
  • Ear drains into the pharynx
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3
Q

Lower Respiratory System

A
  • Larynx (voice box)
  • Trachea
  • Bronchi
  • Lungs with bronchioles and alveoli
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4
Q

Larynx

A
  • Voice box
  • Below pharynx
  • Opens the airway
  • Keeps food from lungs
  • Epiglottis blocks opening
  • Vocal cords (true vocal cords) produce the tone of our voice
  • Vocal folds may act as a sphincter to prevent air passage
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5
Q

Valsalva’s Maneuver

A
  • Glottis closes to prevent exhalation
  • Abdominal muscles contract
  • Intra-abdominal pressure rises
  • Helps to empty the rectum or stabilizes the trunk during heavy lifting
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6
Q

Trachea (Windpipe)

A

-Transports air
-Larynx to right and left bronchi
-C shaped rings with smooth muscle completing the circle
-Mucus is released from the epithelium of the trachea
-Trachealis muscle
~Connects posterior parts of cartilage rings
~Contracts during coughing to expel mucus
-Carina
~Last tracheal cartilage
~Point where trachea branches into two bronchi

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7
Q

Bronchi

A

-Trachea branches into right and left bronchi
-These branch into secondary bronchi then tertiary bronchi
~Right secondary bronchi have three branches
~Left has two branches
-Bronchioles are the smallest airways that lack cartilage BUT HAVE SMOOTH MUSCLE
-Warms and filters air
-Lined with cilia except for smallest bronchioles

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8
Q

Anatomy of the Lung

A 
2 lungs
  -Right has 3 lobes
  -Left has 2
Located in the throacic cavity
Sits on top of the diaphragm
Encased in pleural cavity and membranes
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9
Q

Alveoli

A

Location of gas exchange
300 million in the lungs
Look like grapes clustered on the end of a stem
Surfactant is a lipoprotein secreted from the alveoli that reduces surface tension

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10
Q

Infant Respiratory Distress Syndrome

A

Premature babies

Surfactant is not produced

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11
Q

Acinus

A

The functional unit of the lung
Airways and alveoli supplied by each terminal bronchiole
Includes the respiratory bronchioles, alveolar ducts and alveolar sacs.
3-5 acini supported by thin sheets of connective tissue are known as a lobule

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12
Q

Alveolar Cells

A

Alveoli I cells- respiratory
Alveoli II cells- produce surfactant
Alveolar macrophages

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13
Q

Microscopic Alveoli

A

Connective tissue that makes the lungs elastic

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14
Q

Pulmonary Capillaries

A

Bring blood close the the alveoli
Blood comes from the heart to the lungs by the pulmonary artery that become the small pulmonary capillaries
Returns to the heart by the pulmonary veins
Bronchial arteries feed lung tissue itself

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15
Q

Pleurae

A

Thin, double-layered serosa
Parietal pleura on thoracic wall and superior face of diaphragm
Visceral pleura on external lung surface
Pleural fluid fills the slitlike pleural cavity
-Provides lubrication and surface tension

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16
Q

The Pleural Layers

A

Lung-> Visceral Pleura->Pleural Space->Parietal Pleura

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17
Q

Intrapleural Pressure

A

Pressure in the pleural cavity
Fluctuates with breathing
Always a negative pressure compared to the pressure in the alveoli

Higher pressure keeps lungs pushed out

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18
Q

Atelectasis

A

Lung collapse from injury or the tearing of the visceral pleura

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19
Q

Pneumothorax

A

Air in lungs (Darker on x-ray)

Chest tube

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20
Q

Pleurisy

A

Inflammation of the pleura
Decrease production of fluid
NOT pleural effusion (leakage of fluid from another location)

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21
Q

Inspiration

A

Active process

  • Inspiratory muscles contract
  • Thoracic volume increases
  • Lungs are stretched and intrapulmonary volume increases
  • Lungs are stretched and intrapulmonary volume increases
  • Intrapulmonary pressure drops (to -1mmHg)
  • Air flows into the lungs, down its pressure gradient, until P(pul)=P(atm)
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22
Q

Expiration

A

Quiet expiration is normally a passive process
-Inspiratory muscles relax
-Thoracic cavity volume decreases
-Elastic lungs recoil and intrapulmonary volume decreases
-P(pul) rises (to +1mmHg)
Air flows out of the lungs down its pressure gradient until P(pul)=0

Forced expiration is an active process: it uses abdominal and internal intercostal muscles

23
Q

Physical Factors Influencing Pulmonary Ventilation

A

Inspiratory muscles consume energy to overcome three factors that hinder air passage and pulmonary ventilation

  1. Airway resistance
  2. Alveolar surface tension
  3. Lung compliance
24
Q

Atmospheric Pressure

A

The pressure of the air at sea level
760mmHg
Equals the pressure in the alveoli
The pressure in the pleura is usually -4 or 756mmHg

25
Q

Muscle Control

A

Diaphragm

External intercostal muscles

26
Q

Inspiration & Expiration

A

Inspiration brings air in and expiration forces air out
The diaphragm contracts and lowers increasing the volume of the lungs. This decreases the pressure in the lungs by -1mmHg which will create a vacuum
The diaphragm raises and forces air out
The external intercostals also aid this process
Expiration is passive unless we cough, sneeze or have forced breathing

27
Q

Normal Breathing

A 
500mL 
Tidal Volume
Residual volume- air left after expiration so lungs don't collapse
IRV
ERV
28
Q

Anatomical Dead Space

A

150mL is left in the airways and does not exchange gas

If tidal volume is 500 only 350 is exchanging gas

29
Q

Pulmonary Function Tests

A

Spirometer: instrument used to measure respiratory volumes and capacities
Spirometry can distinguish between
-Obstructive pulmonary disease- increased airway resistance (e.g., bronchitis)
-Restrictive disorders- reduction in total lung capacity due to structural or function lung changes (e.g., fibrosis or TB)

30
Q

Pulmonary Function Tests

A

Minute ventilation: total amount of gas flow into or out of the respiratory tract in one minute
Forced vital capacity (FVC): gas forcibly expelled after taking a deep breath
Forced expiratory volume (FEV): the amount of gas expelled during specific time intervals of the FVC

31
Q

Nonrespiratory Air Movements

A

Most result from reflex action

Examples include: cough, sneeze, crying, laughing, hiccups, and yawns.

32
Q

The Nervous System

A

Regulates breathing

Unconscious and Conscious

33
Q

Respiration is Chemistry

A

Constant measuring of 02 and CO2 in the blood
78% nitrogen
20% oxygen
0.04% CO2 in the air
The partial pressure of 02 is greater in the alveoli than in the blood and CO2 is greater in blood
-Passively these gases move from high to low pressure

34
Q

Oxygen Transport

A

On hemoglobin 98.5%
-Oxyhemoglobin 02 + Hgb
-Deoxyhemoglobin -02
Usually on all four irons in hemoglobin
-Venous reserve- venous blood still has 75% 02 remaining bound on the hgb- it doesn’t go away!
Also in plasma 1.5%
Bohr effect- oxygen unloading, decrease affinity for hgb and is promoted by increase in CO2

35
Q

Homeostatic Imbalance

A

Hypoxia

  • Inadequate 02 delivery to tissues
  • Due to a variety of causes
    • Too few RBCs
    • Abdnormal or too little Hb
    • Blocked circulation
    • Metabolic poisons
    • Pulmonary disease
    • Carbon monodixe
36
Q

Carbon Dioxide Transport

A 
These are 3 ways CO2 is carried to lungs
On Hb (20-25%)
In plasma (10%)
RBCs turn CO2 into bicarbonate ion (65-70%) the bicarb is released into plasma
37
Q

Respiratory Center

A

Medulla oblongata
-Dorsal and ventral respiratory ganglia
-Ventral controls breathing
-Dorsal monitors the chemoreceptors in the periphery
-Expiration is passive unless forced
Pons helps to regulate by fine-tuning breathing
Hypothalamus creates emotive changes
We can control motor over the diaphragm and intercostal muscles

38
Q

Chemical Receptors (CO2 and 02 levels)

A

Attempting homeostasis
CO2 is more acidic
We have 02 sensors in the aortic and carotid bodies
-the aortic is sensed by CN X
-the cartoids are sensed by CN IX
Exhaling more often will decrease the levels of acidity in the body
When levels reach critical status, we will inhale (drowning victims get water in their lungs this way)

39
Q

Respiratory Defense

A

Mucous membranes have well-developed blood supply that warms and humidifies the air
Mucous blanket forms from mucous membranes and cilia pulse the captured particles up and send them into the digestive tract and it is destroyed by gastric acid (it also has antiviral and antibacterial secretions)
Nasal hairs act as cilia

40
Q

Respiratory Signs and Symptoms

A 
Cough
-Productive with sputum
-Nonproductive or dry
-Hemoptysis
Dyspnea
-SOB from obstruction or decreased lung compliance
Cyanosis
-Contains large amounts of deoxyhemoglobin
-Creates a dark red-blue color
41
Q

Hypoperfusion is due to:

A

Heart Failure
-Left sided heart failure leads to back up in the pulmonary system. That back up causes pulmonary htn. This can then back up to the right ventricle which causes cor pulmonale (right ventricular enlargement and failure)
Thromboembolism in pulmonary vessels.
Reduced ventilation
-When ventilation is decreased, there is a constriction of all the pulonary arterioles, which will cause blood to move more quickly through the lungs and cause pulmonary htn.

42
Q

Hypoventilation vs Hypoperfusion

A 
Obstructive lung diseases
-Chronic bronchitis
-Pulmonary emphysema
-Chronic airway obstruction
-Bronchial asthma
Restrictive lung disease
-Severe kyphosis, scoliosis
-Muscular dystrophy causes muscular weakness of respiratory muscles 
Fibrosis of the lung tissue due to autoimmune diseases, infections, drugs etc.
43
Q

Homeostatic Imbalances

A

COPD
-Exemplified by chronic bronchitis and emphysema
-Irreversible decrease in the ability to force air our of the lungs
Other common features:
-Hx of smoking in 80% of patients
-Dyspnea: labored breathing (“air hunger”)
-Coughing and frequent pulmonary infectipns
Most develop resp. failure (ypoventilation) accompanied by respiratory acidosis

44
Q

Bronchitis

A 
Inflammation of the bronchi
Cough with lots of phlegm
Acute or Chronic
Yields yellow or white phlegm
"Blue bloaters" cyanosis due to decrease in oxygen
45
Q

Emphysema

A

Damage to the alveoli
Airways collapse during expiration and air cannot get out
Usually smoking-induced or due to long-term exposure to air pollutants

46
Q

Asthma

A

Constriction of the bronchioles, inflammation and mucous production
May be autoimmune response increasing inflammation and initiating bronchoconstriction

47
Q

Pneumonia

A

Infection inflames the lung parenchyma or tissues.
It can also happen when the pulmonary capillary endothelium are damaged from inhaled irritants that then bring inflammation to that region of the lungs.
Virus or bacteria, or aspiration
Alveoli secrete fluid
Cough with phlegm

48
Q

ARDS

A

Damage to the pulmonary capillaries making them permeable.

49
Q

TB

A 
Bacterial infection
Infection by mycobacterium TB
Airborne
Forms a focus in the lungs
May leave scar on lungs
Coughing, fever, night sweats, weight loss
Dx by x-rays and skin test TB test
Tx with antibiotics
50
Q

Botulism

A 
Poison by bacterial toxin
Clostridium botulinum
Found in under-cooked foods
Blocks transmission of nerve signals to skeletal muscles
Fatal d/t paralysis or resp. muscles.
51
Q

Lung Cancer

A

Proliferation of abnormal lung cells
Cancer is abdnormal growth of any cells
Strongly associated with smoking
More than 90% of lung cancer patients are current or former smokes
Some were exposed to second hand smoke
Radon gas and workplace chemicals (asbestos) can also cause
Symptoms-persistent cough, coughing up blood, chest pain with cough
Three most common types
1. Squamous cell carcinoma (20-40%) in bronchial epithlium
2. Adenocarcinoma (40% of cases) originates in peripheral lung areas
3. Small cell carcinoma (20%) contains lymphocyte-like cells that originate in the primary bronchi and subsequently metastasize

52
Q

CHF

A

CV condition
Heart becomes less efficient
Left heart fails fluid fills up on the lungs
Tx focus on reducing fluid

53
Q

Cystic Fibrosis

A

Inherited condition
One defective gene causes mucous producing cells in the lungs to produce a thick sticky mucus.
The mucus inhibits lung air flow causing infection of the airway.
Treatment includes consistent physical therapy to dislodge mucus and keep the airways open.

Pathophysiology (6 decks)

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