Respiratory Disorders: Emphysema Flashcards
What is emphysema?
Destruction of alveolar walls and capillary beds
Alveolar wall and capillary are involved with __________ _________
capillary exchange or GE
What 2 things can destruction of alveolar wall and capillary cause?
- l/o compliance
2. enlarged distal airspaces
How does l/o compliance impact filling/emptying of alveoli?
l/o compliance–> decrease elastic tissue and recoil of alveoli–> increase residual volume –> filling/emptying of alveoli is impacted
Elastic tissue provides _____ and recoil ______ out the ____
compliance
pushes
air
How are enlarged distal airspaces formed?
by destroying wall of adjoining millions of little alveoli–> fewer and larger alveoli are created–> decrease SA for GE
Etiology of Emphysema (2)
- smoking
2. genetic deficiency of alpha-1 anti-trypsin (~1%)
What is Trypsin? Function
enzyme that breakdowns protein in the gut and aging structures for regeneration of tissue
Alpha-1 is the _____
subclass
Alpha-1 Anti-trypsin Function? What does it protect the lung from?
oppose the breakdown of proteins so useful tissues are not excessively broken down
It protect the lung from breakdown
What happens in deficient alpha-1 anti-trypsin?
Trypsin are freely breaking down functional tissues of the walls of alveoli and capillaries
Patho: Alpha-1 anti-trypsin regulates ______. Why must be regulated? What happens if there is deficient alpha-1 anti-trypsin?
proteases–> breaks down structural proteins
Proteases must be regulated otherwise it continuously break down protein structures
If there is a deficient of alpha-1 anti-trypsin–>proteases fxn freely and cause destruction of lung structures (alveoli, bronchi, etc)
Patho: Deficiency of alpha-1 anti-trypsin is damaging to the ____ and cause what (2)?
lungs
- irreversible destruction resulting in distended air spaces where there is no GE
- air become trapped in alveoli–> increase work of breathing
Patho: What are 2 effects of smoking in Emphysema?
- inhibits alpha-1 antitrypsin –> regulation of proteases is lost causing destruction in lung
- attracts inflm cells–> releasing more proteases and cause inflammatory damage –> more destruction
Patho: How do proteases impair ventilation?
proteases destroy alveolar walls –> alveoli merge –> decrease SA–> distended air space develop–> ventilation impaired
d/t damage, air coming in move into spaces between _______ creating large ______ of ___ between _______. This is also known as ______ _____.
alveoli
pockets
air
alveoli
dead space
In dead space, there is no ____ ______, and air will not _____ or _____ the pocket or within alveoli. What result from this?
GE
leave or enter
increase respiratory effort (increase work of breathing) d/t compromised GE and ventilation
What membrane surrounds the lung and which airspaces are pushed into?
pleural membrane
Patho: Destruction of capillary causes ____ ______.
impaired perfusion
Give an example of a physiological dead space in the respiratory tract?
trachea
Which variable of V:P ratio is compromised? How is perfusion impacted?
both ventilation and perfusion
b/c capillaries are damaged
In destructions of capillaries, which is associated with the capillaries?
terminal a/w
Fig. 29.11: In a view of the right lung with emphysema, what are the black areas of the lungs? What are they referred as?
Black area = collection of air trapped in alveoli
referred to as blebs or bullae
Whats the difference between bullae and bleb?
Bullae are large collection of air trapped in dead space
Bleb is a small collection
Fig. 29.11: What is the acinus?
the functional unit of gas exchanging structure of the lung distal to the terminal bronchiole
Fig. 29.11: What does the acinar consist of? Explain in right order.
respiratory bronchioles–> alveolar ducts–> alveolar sacs–> alveoli
Fig. 29.11: What is centrilobular emphysema? What part of the acinus is damaged?
destruction in the terminal and respiratory bronchioles
proximal acinar
Fig. 29.11: What is panacinar emphysema? What is another name for it?
the acinus is uniformly damaged (everything distal to the respiratory bronchioles)
panlobular
Fig. 29.10: Smoking inhibits ____ ____-______ and attracts ________ ____ and favours the recruitment of which 2 defense cells?
alpha-1 anti-trypsin and inflm cells
favours the recruitment of macrophages and neutrophils (and elastase)
Fig. 29.10: As a result of decreased ___ ___-______, proteases are free to cause damage specifically the _____ tissue. What kind of protease cause this damage?
elastic tissues
elastase
Manifestations of Emphysema (10)
- dyspnea
- cough
- activity intolerance
- xs sputum prod.
- wheezing and crackles
- hypoxemia and hypercapnia
- barrel chest (emphysema)
Several mnfst are following an initially ________ onset
insidious
What cause dyspnea in emphysema?
prob w/ ventilation and GE–> hypoxemia–> hypoxia –> dyspnea
What triggers the cough? How is it described?
inflm –> xs mucus secretion–> exudate –> irritation of alveoli and a/w–> trigger coughs
productive and dry at times
Why is there activity intolerance? How is it displayed? When age is this mnfst most pronounced?
d/t lack of oxygen in cells to metb and produce ATP –> inadequate energy
difficulty getting up a flight of stairs and bus
50-60–> seek medical attention
What contribute to xs sputum (2). What is this function?
continuous prod. of mucus and exudate from inflm
to clear the a/w and alveoli
Wheezing and crackles are caused by _____ ____ in ______ ____. Wheezing is a result of compromised ______. Crackles are ____ d/t air passing over ______ in resp tract.
forceful air
narrow tubes
a/w
wet
fluids
What is hypoxemia and hypercapnia? What lab values is used?
hypoxemia = deficiency of O2
hypercapnia = build up of CO2
ABGs changes in gas levels
What is a barrel chest? Causes (2)
chest become fixed in an inspiratory position b/c air is trapped between alveoli
increase respiratory effort and use of accessory muscles
Give 5 examples of accessory muscles?
- sternocleidomastoid
- scalene muscles
- Pectoralis major and minor
- Latissimus Dorsi
- Serratus Anterior
What does APD and TD stand for and what is the ratio normally and in barrel chest? Explain location.
APD = anteroposterior diameter –> vertical, front to back
TD = transverse diameter –> horizontal side to side
Normal = APD:TD –> 1:2
Barrel Chest = APD is equal or twice the size of TD –> 1:1 or 2:1
