Respiratory COPY Flashcards
1
Q
Pharynx function, regoins, Lining
A
- Common opening for digestive and respiratory system
- 3 region- Nasopharynx (TRE), Oropharynx (Stratified squamous epithelium), Laryngopharnyx
2
Q
Resistive Work
A
- Work to overcome airway resistance MAJOR
- Work to overcome tissue resistance MINOR
3
Q
Factors determining airway resistance
Airway Narrowing
- Dramatically ______ airway resistance what is an example of this?
- The ____ of the _____ _____ is controlled by?
- Stimulation of _____ receptors causes?
- ______ activity causes bronchoconstriction
A
- Increases, obstructive diseases
- Tone of the smooth muscle is controlled by the ANS
- B-adrenergic bronchodilation
- Parasympathetic activity
4
Q
Hemoglobin
A
5
Q
Hypercapnia
Increase in?
Cause by?
Symptoms?
A
- Increase in PaCO2
- Caused by
- Depression of the respiratory center by drugs (narcotics)
- Disease of the medulla
- Airway obstruction (sleep apnea, severe asthma, chronic bronchitis)
- Increased physiological dead space (emphysema)
- Neuromuscular diseases (amyotrophic lateral sclerosis)
- Symptoms: HA, confusion, increase cardiac output, HTN, arrythmias due to E+ abnormalitities
6
Q
Gas-exchange airways
Alveolar Sacs
A
- Alveoli make up the wall of the alveolar sac
7
Q
Effort- independent flow rate phenomenon
Explain
A
- 3 tests are performed A (Hard exhale), B (slow then hard), C (least forceful)
- Moral the end of exhalation is all the same for each
- The reason for this is compression of the airways by intrathoracic pressure
8
Q
Anti Anemic Drugs
WHat are the 3 oral Irons
WHo is IV iron reserved for?
Iron
A
9
Q
Overall structure of
- conducting airways
- Gas exchange airways
A
- Upper- Nasal cavity, pharynx, larynx
- Lower - Trachea, Bronchi, bronchioles
- Gas exchange airways- Respiratory bronchioles, alveolar ducts, alveolar sacs
10
Q
Larynx function, structure, lining
A
- Maintain an open passageway for air movement
- Vocal cords- Are primary source of sound production
- Structure- Endolarynx and cartilage
- Epiglottis- Prevents swallowed material from moving into larynx
- Lining: TRE and stratified squamous epithelium in regoins of “wear and tear”
11
Q
Pulmonary resistance
Pressure volume curve
Hysteresis
Lung Compliance
Major contributing forces to compliance
5 things
If lung volume is small what happens to surface tension?
A
- Pressure-volume curve of the lung
- The expiratory curve does not follow inspiration
- Hysteresis: Lung volume at a given transpulmonary pressure is higher during deflation then during inflation
- Lung compliance (CL)
- The slope of dV/dP is lung compliance, compliance decreases (the lungs become stiffer) at high lung volumes and very low lung volumes
- Lung compliance and pulmonary diseases
- Decreased compliance
- Fibrosis: Increased fibrous tissue
- Alveolar edema: prevents inflation of alveoli (surface tension change and lung volume decreases)
- Atelectasis: Collapse of alveoli
- Increased compliance
- Emyphysema: loss of alveolar and elastic tissue
- Aging lung: alteration of elastic tissue
- Asthma Attach: unknown
- Decreased compliance
- Major forces contributing to lung compliance
- Tissue elastic force
- Surface tension forces
Increases surface tension
12
Q
Erythropoeisis
A
13
Q
Leukocytes
A
14
Q
Regulation of erythro synthesis
A
15
Q
Nerves
A
- Respiratory centers control breath rate and depth
- Autonomic nervous system affects rate and depth through smooth muscle contraction/relaxation
- Parasympathetic tone: Vagus nerve connects smooth muscle cells, stimulation contricts airways by releasing acetylcholine
- Sympathetic tone: Stimulation causes release of catecholamine, which induces bronchodilation, (No innervation to smooth muscles but releases catecholamine)
16
Q
Airway cross sectional area
2 things,
end result
A
- Individual airway diameter, decreases with branching
- Overall or total cross-sectional diameter increases a lot
This results in a decreased airflow speed and a decrease in resistnance causing optimal diffusion.
17
Q
Forced Expiration
Dynamic Compression
A
- Airway Ptm= 10-10 = 0 airway tends to collapse (equal pressure point)
- Driving force PA-Ppl
- Increasing effort causes similat increase of PA and Ppl
18
Q
- Inspiration is ____ but _____ during rest is passive. The most important muscle of respiration is the?
- The _____ curve is nonlinear and shows ____. The ____ pressure of the lung is attributable to both its ____ tissue and the _____ ___ of the alveolar linging layer
- Properties of ___ affect lung compliance and abnormal ____ production causes?
- ____ ____ of the airways during forced expiration results in flow that is ____ independent.
A
- Inspiration is active, but expiration during rest is passive. The most important muscle of respiration is the diaphragm.
- The pressure-volume curve of the lung is nonlinear and shows hysteresis. The recoil pressure of the lung is attributable to both its elastic tissue and the surface tension of the alveolar lining layer.
- Properties of surfactant affect lung compliance, and abnormal surfactant production causes IRDS.
- Dynamic compression of the airways during a forced expiration results in flow that is “effort independent”.
19
Q
Lymphatic vessels
Deep and superficial
Main function?
A
- The deep lymphatic capillaries begin at the level of the terminal bronchioles, there are no lymphatic structures in the acinus
- The superficial lymphatic capillaries drain the membrane that surrounds the lungs
- Main thing keep lungs free of fluid
20
Q
Platelets
A
21
Q
Lymphoid organs
nodes
Part of the immune and ____ system
Facilitate?
Transport?
Cleanse?
A
22
Q
- Volume of air inspired or expired during a normal inspiration or expiration.
- Amount of air inspired forcefully after inspiration of normal tidal volume.
- Amount of air forcefully expired after expiration of normal tidal volume.
- Volume of air remaining in lungs at the end of a maximal expiration.
- Maximal amount of air that can be inhaled from the end-expiratory level of a tidal volume (VT+IRV).
- Volume of air in the lung at the end of a normal expiration.
- Volume change that occurs between maximal inspiration and maximal expiration (IRV+VT+ERV).
- Volume of air in the lung at the end of a maximal inspiration (RV + VC or FRC + IC).
A
- Tidal Volume
- Inspiratory reserve volume
- Expiratory reserve volume
- Residual volume
- Inspiratory capacity
- Functional residual capacity
- Vital capacity
- Total lung capacity
23
Q
Normal destruction of Senescent Erythrocytes
Decrease is RBC ___ production
Become _____ and lose property of _____ deformability
____ red cells, are sequestered and destroyed by ____ of the MPS Primarily?
The ____ takes over if the previous organ is absent (Kipffer cells)
_____ is reduced to billirubin and transported to the liver
_gs of Hemoglobin degraded ____?
A
24
Q
Regulation of Erythropoiesis
Number of circulating RBCs remain?
___ stimulates the production and release of?
Erythropoietin produced in? Causes an Increase in?
A
25
Dynamic compression
End of quiet inspiration
* Flow = 0
* Airway Ptm= 0 - (-10) = 10
*
26
Mechanics of Breathing: How the Lung is supported and Moved
1. Respiration related pressures
2. Muscles of respiration
3. Elastic properties of the lung (compliance)
4. Flow resistance properties (airway resistance)
5. Dynamic Compression
6. Work of Breathing
27
28
Lung Receptors
Irritant receptors
Located? Sensitive to? Cause?
Stretch Receptors
Location, Sensitive, Slow? Due to?
J Receptors
Response is? To what pressure?
Causes?
* Locate in the epithelium of the conducting airways.
* Proximal larger airways, absent in the distal airways.
* Sensitive to noxious gases, cigarette smoke, inhaled dusts, and cold air. Cause bronchoconstriction, may play a role in asthma
STRETCH
* Locate in airway smooth muscle.
* Sensitive to distension of the lungs.
* Slow ventilatory rate and volume due to an increase in expiratory time. (Herring-Breuer reflex)
J RECEPTORS
* Respond very quickly to increased pulmonary capillary pressure.
* Result in rapid, shallow breathing.
29
Peripheral receptors
Location what do they respond to?
What is less important than is central chemoreceptors?
4 things
* Located in aortic bodies and carotid bodies.
* Respond to fluctuations in blood O2 levels very fast.
* Responsible for all the increase of ventilation due to arterial hypoxemia.
* Response to arterial PCO2 is less important than that of the central chemoreceptors
* Peripheral chemoreceptors are located in the carotid and aortic bodies. They mainly respond to decreased arterial PO2, but are also stimulated by increased PCO2 and H+ (rapidly responding).
30
Central Controller
Medullary respiratory center
2 parts
Apneaustic area in pons
Pneumotaxic center of pons
* Dorsal respiratory group (DRG): Cells have inherent rhythm that causes inspiratory cycles , controls diaphragm & external intercostals. Active for 2 sec during inspiration & quiet for 3 sec during expiration.
* Ventral respiratory group (VRG): Increased DRG activity stimulates the VRG which stimulates internal intercostals & abdominal muscle layers during forced expiration.
Apneustic: Stimulates DRG for normal inspiration (2 sec) or longer during forced inspiration (maximum inhalation)
Pneumo:
* Inhibits apneustic area to allow exhalation;
* Modifies the pace set by DRG and VRG;
* Its absence causes increase in depth of respiration and a decrease in respiratory rate.
31
Physiologic Deadspace
definition
Deadspace is the ____ that is ____ but not ____ with blood, so there is no ____ exchange and it does not eliminate what?
is the volume of (wasted ) air that does not eliminate CO2. Also called functional dead space. Not all of the alveoli are perfused with blood; air in these alveoli doesn't exchange with the blood and is part of the dead space.
Dead space is the volume of lung that is ventilated, but is not perfused with blood, so there is no gas exchange, and it does not eliminate CO2
32
Anti Anemic Drugs
What type of anemia is it used for (2)
Vit B12
33
Gas-exchange airways
Alveolar Ducts
Passage of?
LINING?
Wall?
3 things
1. Passage of alveolar sacs (cluster to alveoli)
2. Lining: Mostly simple squamous epithelia
3. Thin-walled, fibro-elastic tubes, fewer smooth muscle spirals, many alveoli from walls
34
Aging and Hemalogic system
Aging is normal but?
35
Hemoglobin Picture
36
Compostition of Plasma
37
Regional differences in ventilation
Fact:
Regions of the normal ___ do not have the same \_\_\_\_\_.
The ___ regions of the lung ventilate better than?
Reason for this?
* Lung do not have the same ventilation
* Lower ventilates better than upper
* Intrapleural pressure is less negative at the bottom of the lung than at the top because of the weight of the lung and the configuration of the chest wall.
* The lower regions of the lung are better ventilated than the upper regions because of the effects of gravity on the lung.
38
Muscles of Respiration
Inspiration
* Diaphragm:
* External intercostals:
* Accessory muscles:
1. The most important muscle of inspiration; supplied by phrenic nerves that originate high in the cervical region
2. When contract; move ribs upward and forward
3. Accessory muscles: Sternocleidomastoid, scalene muscles
39
Airway resistance in Asthma
Airway conductance is ____ at a given recoil pressure due to _____ narrowing of ______ and ______ changes in the airways
What drug can be given to move the asthma line closer to normal?
* reduced, instrinsic narrowing, of the airways caused by contraction of smooth muscle
Bronchodilator (isoproterenol)
40
How does the carotid body send signals?
* Carotid body oxygen sensor releases neurotransmitter when detecting low PO2 .
* Information is transported to central controller by action potentials
41
Concetpts
42
The respiratory defense system
Filtration
Cilia
Goblet cells and ____ glands
Alveolar macrophages
SA=?
Removes ___ and \_\_\_
* Particles and pathogens
* **Filtration** in nasal cavity removes large particles
* **Cilia -** Sweep debris trapped in mucus toward the pharynx (mucus escalator)
* **Goblet cells and mucous glands** - Produce mucus that bathes exposed surfaces
* **Alveolar macrophages** - Engulf small particles that reach lungs
* SA= 100 m^2
43
3 functions of the Nasal Cavity and what is its lining made up of?
1. Removing particulate matter
2. Moisening air
3. Warming air
Lining: Typical respiratory epithelium (TRE)- ciliated pseudostratified columnar epithelium with goblet cells (release mucous)
44
Chest wall
Lungs are housed in?
Forces for lung inflation?
Pleura
Membrane?
Layers? 2
Pleural space?
* The lungs are housed in the thoracic cavity
* Forces for lung inflation is supplied by the muscle of respiration
Pleura
* Serous membrane
* Parietal and visceral layers
* Pleural space- Fluid, acts as lubricant, Pleuriisy inflammation, pneumothorax
45
Work of Breathing
Work =?
* Force x Distance
* Pressure change x volume change
46
Alveoli
Primary?
25-??? amount
Alveolar septum comprised of 6 things
* Primary gas exchange unit
* 25-300 million
* Septum
1. Dense network of fibers
2. Dense network of capillaries
3. Type 1 pneumocytes - Simple squamous cells
4. Type 2 pneumocytes - Low cuboidal sype cells, act as a reserve cell, can replate type 1, source of surfactant
5. Macrophage- Remove foreign materials (Dust cells) smokers are pink
6. Pores of Kohn- Collateral ventilation, macrophage, distribution of air
47
Composition of blood
Elements in blood
platelets in blank
48
Picture of regulation
49
Begin quiet expiration
Dynamic compression
Ptm = 9
holding airways open
50
Compliance is the ability of the lungs to stretch during a change in volume relative to an applied change in pressure
What happens in Emphysema?
* Increase lung compliance and pulmonary fibrosis decreases lung compliance.
51
Trachea- Structure, function, lining, divides into?, Carina?
* Windpipe, thinwalled rigid tube
* 4.5" long and 1" wide, 15-20 C-shaped cartilage rings
* Lining:TRE
* Cilia catches particles of dust
* Divides to form primary bronchi
* Carina= Cough reflex
52
Gas-exchange airways
Respiratory Bronchioles (17-23)
4 things
1. Transition from conducting to respiratory functions
2. Lining: Low columnar to low cuboidal, clara cells, larger tubes remain ciliated
3. No goblet cells, glands or cartilage
4. Supporting walls: SM and elastic fiebr networks
53
Muscles of respiration
Expiration
* Normal expiration (passive)
* Relaxation of diaphragm and external intercostals
* Forced expiration (active)
* Abdominal wall: Rectus abdominis, oblique muscles, and trnasversus abdominis
* Internal intercostals: pulling the ribs downward and inward, thus decreasing thoracic volume
54
Hematopoietic cells
55
Ventilation
How gas gets to the alveoli
6 things
1. Lung volumes
2. Measurements of lung volume
3. Total and alveoli ventilation
4. Anatomic and physiologic dead space
5. Regional difference in ventilation
6. Chemical control of ventilation
56
Which one is normal?
Obstructive, Restrictive
N, R, O
57
Iron cycle
58
Dynamic Compression and pulmonary diseases
Factors that exagerate dynamic compression?
2
Dynamic compression in emphysema
2
1. Resistance increase of the peripheral airways
2. Low lung volume
1. Driving pressure is reduced because of reduced recoil pressure
2. Loss of radial traction on the airways makes them more compressible
59
Airway resistance
Laminar and Turbulent
* Laminar slow- determined by Poiseuilles law
* resistance at different divisions of the airway is different- resistance mainly ocurrs in larger airway where speed is higher and the radius is small in comparison to terminal bronchioles
60
Drugs
Erythropoeitin
61
Functions of the Respiratory System
Primary function?
Internal and External respiration
Other 5 functions
* Gas exchange, exchange of O2 and CO2
* Internal respiration- Capillary oxygenated blood within body
* External- Air exchange in lungs
1. Regulation of blood pH
2. Air-conditioning
3. Protection
4. Voice production
5. Olfaction
62
Airway Closure
The volume of the lung at which airway closure begins is called?
When does it occur?
What increases this?
* Closing volume
* When the intra-Pleural pressure exceeds the airway pressure
* Airway diseases and aging increase the closing volume (earlier closure)
63
Hematopoiesis
64
Pathway of air in gas-exchange airways
1. Surfactant, Alveolus
2. Pass through the epithelial cells
3. Interstitial
4. To endothelial cells
5. to Plasma
6. To RBC for distribution
65
Iron cycle picture
66
* The _____ is a simple device for measuring lung volumes and functions (VT, FEV1, FVC, FEV1/FVC).
* ______ is the volume of lung that does not eliminate CO2. (anatomic vs. functional dead space)
* _____ of the normal lung do not have the same \_\_\_\_\_\_. The lower regions of the lung ventilate better than do the upper zones.
* ______ is regulated by CNS central pattern generator, areas in pons peripheral carotid, and aortic receptors.
* The\_\_\_\_\_of the blood is the most important factor controlling ventilation under normal conditions, and most of the control is via the \_\_\_\_\_\_\_\_\_.
* The spirometer is a simple device for measuring lung volumes and functions (VT, FEV1, FVC, FEV1/FVC).
* Dead space is the volume of lung that does not eliminate CO2. (anatomic vs. functional dead space)
* Regions of the normal lung do not have the same ventilation. The lower regions of the lung ventilate better than do the upper zones.
* Respiration is regulated by CNS central pattern generator, areas in pons peripheral carotid, and aortic receptors.
* The PCO2 of the blood is the most important factor controlling ventilation under normal conditions, and most of the control is via the central chemoreceptors.
67
Surface tension
Property of?
LaPlace's Law
Evidence that surface tension plays a role in compliance:
* Of the surface of a liquid
* P=2T/r
* r=radius
* T=Tension
* P=transmural pressure
* Saline effects
* Saline increases lung compliance a lot
* Foam from lungs makes stable bubbles
68
Factors determining airway resistance
Lung Volume
Relation to resistance?
* Resistance decreases as lung volume increases because the airways are more open.
69
Expiration process (passive)
1. Inspiratory muscle relax (diapragm rises and rib cage decends)
2. Thoracic cavity volume decreases
3. Elastic lungs recoil passively --\> lung volume decreases
4. Pulmonary pressure increases
5. Air flows down its pressure gradient
70
Objectives
71
Ventilation is defined?
The total volume of air taken into the lungs per minute is called?
The volume of the conducting airways outside of the alveoli. It does not participate in?
The amount of fresh gas getting to the alveoli that paricipates in gas exchange?
* The exchange of air between the atmosphere and the alveoli
* Minute ventilation (Ve)= total ventilation
* Anatomic deadspace, does not participate in ventilation
* Is the amount of fresh gas getting to the alveoli that participates in gas exchange
72
Anti Anemic Drugs
Folic Acid
73
Neurochemical control of ventilation
The 3 basic eliments of the respiratory control system:
1. . Sensors that gather information and feed it to the central controller.
2. Central controller in the brain coordinates the information and, in turn, sends impulses to the effectors.
3. Effectors (respiratory muscles) cause ventilation
74
Erythropoeisis
picture
75
Alveolar capillary unit
* The blood-gas interface is the alveolocapillary membrane very thin (0.2-0.3 micrometers)
* Surface area 100 m ^2
* Capillaries cover 90% of the surface
* Disorder that thickens the membrane impairs gas exchange.
76
How to measure lung volume
* Spirometry
* Tidal and Vital capacity
* Also helium (FRC)
77
Elastic work?
* Work to overcome the elastic recoil of the chest wall and the lung
* Work to overcome the surface tension of the alveoli
* Increased work in restrictive diseases (Fibrosis)
78
Bronchi/ Bronchioles
Conducting: 1-16
Respiratory: 17-23
Cartilage?
SM?
Lining?
Elastic fibers?
Glands?
Cells unique in bronchioles
From larger to terminal bronchiole 6 things
1. Cartilage decrease: Ring shaped cartilage gives way to cartilage plates and eventually disappear
2. Smooth muscle increases: SM increases in proportion and continuity as the vessel decreases in size
3. Lining: TRE to simple columnar epithelium, epithelial layering and thickness decreases, Cilia decreases
4. Elastic fibers appearance
5. Mucous glands decrease in size and number and fewer goblet cells
6. Clara cells bein to appear, unique in bronchioles (clara cells can reduce inflammation)
79
Hematopoiesis
Picture
80
Pulmonary Surfactant
Produced by?
Physiological importance?
Pathophysiology?
* Type II alveolar epithelial cells, line alveoli
* Physiological
* Decrease the surface tension of the alveolar lining layer
* Increase compliance
* Increase alveoli stability prevents small alveoli from collapsing, equalizes pressure between large and small alveoli
* Keep alveoli dry
* Patho- absence results in reduced lung compliance, alvealar atelectasis, and tendency for pulmonary edema
* IRDS
81
Development of leukocytes
82
Another picture
83
Mononuclear phagocyte system
Consists of? That originate?
They are transported into the bloodstream, differentiate into?
Mature in the tissue as?
What do they do to microorganisms
Mostly accumulates in?
84
Erythrocytes
85
Colony stimulating factors
86
Definition of Anemia
87
Anti Anemic Drugs
Iron
AEs
88
Central chemoreceptors
4 things
What are they not sensitive to?
* Located near the ventral surface of the medulla
* Surrounded by brain extracellular fluid
* Respond to changes in its hydrogen ion (H+) concentration
* An increase in H+ concentration stimulates ventilation
* Central chemoreceptors are sensitive to the PcO2 but not PO2 of blood
89
Anti Anemic Drugs
Vit B12 kinetics
90
Signs symptoms and classifications of Anemia
91
Respiration related pressures
1. Alveolar Pressure (PA)
2. Intrapleural pressure (Ppl)
3. Airway pressure gradient (Patm-Pa)
4. Transpulmonary pressure (PA-Ppl)
5. Transchest wall pressure
* Relative Patm, remains negative throughout inspiration process
* Pressure in space between parietal and visceral pleura
* This is the pressure gradient driving airflow into the lungs
* Transmural pressure across the lungs; increases and decreases with lung volume
* Ppl-Patm
92
Lymphoid organs
Spleen
Splenic Pulp
Venous Sinuses?
93
Tests of Lung Function
* The vital capacity measured with a forced expiration?
* The volume of gas exhaled in one second by a forced expiration from full inspiration
* The ration of FEV1 to FVC expressed as a percentage
* Majority of pts with lung disease have?
* Forced Vital Capacity (FVC)
* Forced Expiratory Volume (FEV1)
* FEV1/FVC
* FEV1
* Normal ratio is 80%
94
Hemoglobin synth
95
Inspiration process (active)
5 steps
1. Inspiratory muscles contract (diaphragm descends and rib cage rises)
2. Thoracic cavity volume increases
3. Lungs stretch --\> Lung volume increase
4. Intrapulmonary pressure drops
5. Air flow down its gradient
