Respiratory Anatomy and Physiology Flashcards
The movement of gases across a cell membrane
Respiration
Between the alveoli and the capillaries
External respiration
Between the capillaries and the cells
Internal respiration
Mechanical movement of air in and out of your lungs
Ventilation
Superior most portion of the sternum
Manubrium
Largest part of the sternum
Sternal body
Cartilage, inferior most portion of the sternum
Xiphoid process
At what manubriosternal joint does the trachea biferaction occur under?
Angle of Louis
_____ runs on the inferior aspect of each rib
Neurovascular bundle
Musculature (I-IV)
Diaphragm, intercostals, innermost layer, accessory muscles
In an adult, the diaphragm povides ___% of the effort of breathing. In children the diaphragm provides __% of the effort of breathing.
60, 75
The diaphragm consists of what muscle type?
Involuntary (smooth) and voluntary (skeletal)
What nerve controls the diaphgram?
Phrenic nerve
Types of intercostal muscles
External intercostals-run anteriorly/inferiorly (towards the front and downwards)
Internal intercostals-run posteriorly/inferiorly
Why do the intercostals run in a criss cross orientation?
To lift the rib cage
Innermost layer is arragned_____
Vertically
The innermost layer cause the ribcage to get____. Used in _____
Smaller
Forced exhalation
Accessory muscles
Pectorial, abdominal, neck muscles, sternocledomastoid
The angle of louis iat as the ___ rib attachment point
Second
What is the line of demarcation for the upper and lower airways
Vocal cords
Increases surface area in the nasal cavity
Turbinates
Turbinates contain___ and they are _____. Both of these items contribute to them filtering, warming and humidifying
Ciliated goblet cells
Vascular
Purpose of the turbinates
- Filters
- Warm air (because vascular)
- Humidifies (goblet cells keep things moist)
Purpose of sinuses
Drainage-drains fluid from the nasopharynx
Resonance
Lightens skull
Four sinus areas
- Frontal sinus
- Ethmoid sinus
- Spenoid sinus
- Maxillary sinus
What two sinus areas give one a headache when one has a sinus infection?
Ethmoid and sphenoid sinuses
What connects the middle ear with the sinuses?
Eustachian tubes
Superior most portion of the larynx (really in the pharynx), leaf shaped, protects the airway located in the hypopharynx
Epiglottis
Largest portion of the larynx, most prominant, known as the “voice box” ecause it houses vocal cords
Thyroid cartilage
Circular cartilage, inferior most part of the larynx. Anchor for the trachea
Cricoid cartilage
What do you put pressure on if there is gastric distension. If you push on it, it will close off the esophagus
Cricoid cartilage
When vocal cords snap shut and prevent air from getting in
laryngospasm
Landmark for surgical airways
Cricothyroid membrane
Three parts of the pharynx
Nasopharynx, oropharynx, hypopharynx
Upper and lower airway is made of the:
Pharynx and larynx
______ are embedded in the epithelial lining of the smooth muscle of the trachea
Epithelial goblet cells
Purpose of goblet cells in the trachea?
Create mucus and trap debris to filter out debris
Where are the epithelial cells in the trachea?
The lining of the lumen
Double layered reflecting serous membrane that covers the lung
Pleura
Means produces fluid
Serous
Covers the lining of the lung itself
Visceral pleura
Layer of the serous membrane that covers the chest wall
Parietal pleura
Thin layer of secretion between the visceral and parietal pleura creates _____ that allows the lung to attach to the chest wall
Surface tension
What issues may lead to the collapse of the lung due to a lack of surface tension?
Chest trauma such as a tension pneumothorax
Difference between left and right lungs
Right has a larger diameter (feeding three lobes) and at less of an angle. Left is more horizontal because heart is in the way
If you aspirate, which lung will the item most likely go into?
The right lung
Space between the hemithoraxes
Mediastenum
Each lung is located in a _____
Hemithorax
Items within the mediastenum
Esophagus, heart, great vessels, part of the trachea
The great vessels consist of
Aorta, pulmonary artery, superior/inferior vena cava, pulmonary viens
What we inhale (i.e. room air) consists of:
21% oxygen
76% nitrogen
3% other
What we exhale consists of:
16% oxygen
76% nitrogen
CO2
What is the point at which the atmosphere will not support us, deficient in oxygen (i.e. you need to use a breathing apparatus)?
19.5%
Movement of gases is based on____
Diffusion, i.e. a concentration gradient
Diffusion occurs until you achieve ____
Equilibrium
How do we reset the CO2 concentration gradient?
Exhaling
For respiration, when a steady state is achieved, need to re-set the system. The O2 concentration gradient is re-set when?
Whenever the heart beats
Cells in the aveoli where gas exchange occurs
Type I cells
Type I cells have ____that allow gas exchange to occur more easily between type 1 cells and capilliary walls. Makes them more permeable
Repiratory membranes
Cells in the aveoli that produce surfactant
Type II cells
Surfactant serves as a ____ for water. Prevents ____
Dispersal agent
Surface tension
Surface tension in the aveoli will cause ____
Atelectasis
When is surfactant produced?
In the last month of gestation
Air that you move in a resting ventillation
Tidal volume
Minute volume
Tidal volume (volume/breath) x Respiratory rate (breath/minute)
Average adult minute volume
500cc/breath x 16 breaths/minute=8L/minute
Areas not in aveoli, where there is no gase exchange
Dead space
Two types of dead space
Anatomic dead space
Physiological dead space
Non-aveolar space (trachea, pharynx, etc), approximately 150 cc
Anatomic dead space
Non functioning aveoli (COPD, pulmonary edema)
Physiological dead space
Additional reserve air that you can bring in
Inspiratory reserve volume
Additional air that you can exhale
Expiratory reserve volume
Air left over after a forced exhalation. Can be around 2L
Residual volume
Vital capacity+residual volume
Total lung capacity
IRV+VT+ERV
Vital capacity
What do we see decrease with air. Makes it more difficult to compenstate when there is an issue, i.e. trauma
Vital capacity
Factors that increase the work of breathing:
Resistence in the respiratory system (bronchoconstriction)
Compliance-loss of elasticity
Surface tension-atelectasis
Fraction of inspired O2
FiO2 (i.e. FiO2 from air is 0.21)
FiO2 if nasal cannula at 3l/m
4% per liter/minute->.04x3=.12+FiO2RA .21=.33
FiO2 for non-rebreather mask
0.95
FiO2 for BVM + O2 tank
1
Receptors that help us mediate breathing are a type of:
Neurological control
Receptors that help us mediate breathing:
Irritant
Stretch receptors
J receptors
Receptors that are embedded in the airways. When detects irritant, stimulate a cough. Triggers parasympathetic response
Irritant
Receptors that are embedded in the aveoli. Designed to prevent overinflation.
Stretch receptors
What will stretch receptors do if activated?
Cause reduction in respiratory rate
Reduce tidal volume
Associated with capillary beds. Do not want perfusion as a baby in womb (because lungs filled with liquid), so need to tell brain
J receptors
What is responsible for regulating breathing
Brainstem-pons and medulla
The medulla contains the ____ and _____, which are responsible for regulating breathing
Dorsal respiratory group (DRG)
Ventral respiratory group (VRG)
Responsible for normal breathing. Sends out nerve impulses at intervals (2 blasts stimulation, 3 second inactivity)
Dorsal respiratory group (DRG)
Why does the DRG send out nerve impulses at a ration of 2/3
Pressure decreases and openig airways. When breath out, airway closes, so spend more time exhaling because the airways are more constricted
Inactive during normal respiration. Supplements the DRG
Ventral respiratory group (VRG)
When stimulate the VRG no longer exhale ____ because accessory muscles activate
Passively
Inspiratory neurons that help with inspiration
VRGi
Expiratory neurons that help with expiration
VRGe
Centers in the pons that helps with breathing:
Apneustic center
Pneumotaxic center
Stimulated when you are in extremis. Stimulates DRG and VRGi. Purely inspirational
Apneustic center
Inhibits apneustic center, stimulates VRGe, prevents overinflation
Pneumotaxic center
The pneumotaxic center is triggered by _____
Stretch receptors that feed into the medulla
Why may the pons and medulla’s ability to interact be compromised
Increasing ICP will push down on brainstem
What sort of breathing may result from increasing ICP inhibiting the pons and medulla from interacting properly
Cheynes-stokes (cyclic pattern, crescendo like breathing followed by a period of apnea)
Apneustic breathing-heightened inspiration, shortened respiration-gasping because lungs are now overinflated. Usually leads to respiratory arrest
Biot’s breathing-irregular breathing
Intercostal nerves exit the spinal cord where?
T1-T11
Phrenic nerves exit the spinal cord where?
C3-C5
Chemoreceptors-CO2 drive
Hypercarbic drive/hypercapnic drive
____ changes in CO2 which result in ___ changes in H+ to create _____large changes in respiration rate
Small
Small
Large
CO2 goes through the ____ and is then dissolved in ___.
Blood brain barrier
CSF
The CO2 becomes _____ to create H+. As CO2 increases, the ___ in the blood increases.
Carbonic acid
acidity
O2 drive
Hypoxic drive
Is the O2 drive more or less sensitive than the hypercarbic drive?
Less
At what point are the hypercarbic and hypoxic drive most sensitive?
When the are working together
Aeorbic equation
Glucose+02=energy+CO2+H2O
During the first step of metabolism, glucose and 02 react to form:
Energy and pyruvate
Where do pyruvate and O2 react to form energy+CO2+H20
Mitochondria
What carries 97% of O2? What happens to the remainign 3%?
Hemoglobin
The remaining 3% dissolves in plasma
Where does CO2 go?
23% binds to hemoglobin
7% is dissolved in plasma
70% dissolved in red blood cells in cytosol
Chemical reaction that allows red blood cells to carry CO2 around (dissolved in cytosol)
CO2+H20->H2CO3->H+ + HCO3
1-14 acid versus basic
1=acid
14=basic
Blood is what on the pH scale?
7.32-7.45 (kind of basic)
Respiratory acidosis
increased [CO2]+ increased [H+]->increased RR
Trying to blow off more CO2
Why does blowing off CO2 make the blood less acidic?
To reduce H+ can reduce CO2. Creates room for the reaction to go in the opposite direction, which reduces the H+
Metabolic acidosis occurs with
ASA, DKA, OD, lactic acid
Also trying to blow of CO2 to reduce acidity
If you hyperventillate, what issue may arise when it comes to the hypercarbic drive?
Respiratory aklylotic
If you hyperventillate without a respiratory pathology, it will cause the amount of CO2 in your blood ot drop, and will cause the amount of H+ to drop and make you alkaladic (more basic)
increase RR->decrease [CO2] + decrease [H+]
[CO2]+[H+]->RR is a ____ equation
Buffer
