Respiratory Pathophysiology Flashcards
Requirements for Proper External Respiration
(4)
- Pulmonary _____ can involve abnormalities of one or more of these requirements
- Hypoxia:
- Hypoxemia:
Ventilation
Gas Exchange
Gas Transport
Tissue Extraction/Deposition
- disorders
- Low oxygen lvls (usually referring to tissue)
- Low oxygen content of blood
Abnormal Ventilation
(3)
Under first category (5)
- Pleural Abnormalities
- Pneumothorax
- Open Pneumothorax
- Tension Pneumothorax
- Spontaneous Pneumothorax
- Hemothorax or Pleural Effusion
- Restrictive Lung Disease
- Obstructive Pulmonary Disease
Abnormal Ventilation (Notes)
- Restrictive Lung Disease:
- Obstructive Lung Disease:
- reduced elasticity of lungs and increased respiratory effort
- any disease that results in airway narrowing -> reduces ability to expel air -> air trapping
Abnormal Gas Exchange
(4)
Adult Respiratory Distress
High Altitude - reduced atmospheric PO2
Pulmonary edema
Ventilation-Perfusion Mismatch
Abnormal Gas Exchange (Notes)
- ARDS: injury like _____ damages airway/alveolar capillary junction -> _____ -> ___ accumulation -> impaired gas exchange
- High altitude: ____ PO2 -> effects ____ gradient that drives gas exchange
- Ventilation Perfusion Mismatch: either your ____ lungs but can’t ventilate or can ____ but no perfusion (ie. PE)
- smoking -> inflammation -> fluid
- lower -> pressure
- perfusing, ventilate
Abnormal Gas Transport
(1)
:when the fundamental problem is the oxygen _____ ability of blood (reduced ___, reduced ___, altered ____ of Hb)
CO Poisoning:
Anemic Hypoxia
: carrying, (rbc, hb, altereted quality)
: no reduced RBC or Hb, CO competes with O2 with a much higher affinity to binding sites of Hb
Abnormal Tissue Extraction/Deposition/Utilization
(1)
: originates from the cells themselves
(1): ____ effect of impairing aerobic ____ so cells can’t use O2 (blocks (1) which is last step in (1))
Histotoxic Hypoxia
- Cyanide Poisoning: poisoning, metabolism, electron transport chain, O2 metabolism
Traumatic Pneumothorax
= ____ common and usually caused by?
- Intrapleural space usually filled with ____ and NO ___ which has a slightly _____ pressure (___ than atmospheric and alveolar pressure)
- Result is a _____ lung and impaired ventilation
- Puncture wound lets air __ and pleural fluid _____ w atmospheric pressure -> interrupted ____ _____/breaks glue and lung collapses
- What happens when you inhale?
- What happens when you exhale?
= most, traumatic injury such as knife/gunshot wound
- fluid, NO air, negative pressure (less)
-
collapsed
- in, equilibrates, surface tension
- Thoracic cavity expands and pressure goes down and creates a pressure gradient for airflow -> air is sucked in “sucking chest wound”
- Seals the wound
Tension Pneumothorax
= When someone has an injury like a traumatic pneumothorax -> pressure is going to ____ through that ___ way valve
- Effects: _____ of heart and mediastinum, ______ of space of other lung
- Treatment: _____ inflate lungs until touching thoracic wall and then vaseline ____ to create and air tight ____ and restore ____ between lungs and chest wall
= build up, one way valve
- shifting, impingement
- mechanically, bandage, seal, contact
Spontaneous Pneumothorax
=
- Etiology: pt has occult pulmonary ____ that has injured integrity of pleural membrane
- Prevalance in what type of people?
- Effects = lung collapses but no (1), why?
- Sx = _____ breathing, air ____
Spontaneous break in visceral pleura that causes collapse of lung
- disease
- young, healthy, even athletic men (20, 30, tall, frequently swimmers)
- NO TENSION PNEUMO bc not enough air is coming in through airway into affected lung and therefore is rare
- labored breathing, air hunger
Pleural Effusion vs. Hemothorax
Hemothorax =
Pleural Effusion =
Tx =
Blood in thoracic cavity that starts to impinge on lungs (usually caused by traumatic injury)
Fluid accumulation in intrapleural space when abnormal turnover of intrapleural fluid: impairment of drainage
Drainage of blood or fluid by chest tube
Impaired Gas Exchange
V/Q Mismatch (V = ___, Q = ___)
- Perfusion Obstructions (2)
- Ventilation Obstructions (3)
V = Ventilation, Q = Perfusion
- Pulmonary Embolus
- Tumor Obstruction (obsructing blood flow)
- Impaired ventilation mechanics
- Obstructive or restrictive pulmonary disease
- Tumor Obstruction (pressing on airway)
V/Q Mismatch
Any V/Q Mismatch impairs ___ ____
- Equal V/Q Ratio = __
- Normal V/Q Ratio at rest = __ in lungs
- High Value V/Q Ratio =
- Low Value V/Q Ratio =
Gas Exchange
- 1
- 0.8
- Perfusion Obstruction (PE, tumor obstructing blood flow)
- Ventilation Issue
Impaired Gas Exchange
Pulmonary Edema = excessive pulmonary capillary ___ ____
Causes (3)
Blood Pressure
- Hypertension
- Left-Sided Heart Failure
- Fluid Volume Overload
Pulmonary Edema (Notes)
- Fluid volume _____ -> increased pulmonary cap __ -> ____ fluid into ____ space
- Presentation: ___ ___ sputum, c_____
- Reduced gas ____ and _____ of blood, potentially life-threatening
- Tx (1)
- overload -> BP -> pushed, alveolar
- pink frothy sputum, crackles
- exchange, oxygenation
- Diuretics
Abnormal Gas Transport
Anemic Hypoxia
Carbon Monoxide Poisoning
- Carbon Monoxide: is a product of incomplete _____ or organic matter. It ____ to Hb at the __ binding site with an ____ over 200x stronger than O2.
- Can cause signficant _____ in blood oxygenation by reducing the Hb O2 __ saturation.
- The reduced oxygenation can be difficult to detect since ___ (blood gases) will be ____ and most pulse oximeters cannot differentiate btween ___hemoglobin and ___hemoglobin. Detection can be made through use of a?
- combustion, binds at O2 binding site, affinity
- reduction, %
- PaO2, normal, oxy and carboxy, pulse CO-oximeter
CO Poisoning (Notes)
AKA when oxygen’s ____ ability of blood goes down
- CO binds to heme group on Hb with an affinity over 200x stronger than that of O2 (practically _____ binding) -> reduces oxygenation of blood overall
- Difficult to diagnose bc CO is ___less, ___less, makes Hb ___ so person will either look ___ or ___
- Pulse ox reflects light of O2 and CO on Hb in the same way, cbc ____, blood gas ____ bc PO2 (O2 is whats in plasma)
- Early sx: H__/H_____ (haunted house)
- Usually diagnosed by situation: found in car w ____
Carrying ability goes down
- irreversible binding
- odorless, colorless, red, normal or flushed (not cyanotic)
- normal, normal
- HA, Hallucinations
- vomit
Obstructive vs. Restrictive Pulmonary Disease
-
Obstructive Pulmonary Disease
- Characterized by? (3)
- Common Disorders (3)
-
Restrictive Pulmonary Disease
- Characterized by? (2)
- Common Disorders (2)
-
Obstructive
- airway narrowing, air trapping, expiratory wheezing
- Asthma, Acute and Chronic Bronchitis, Emphysema
-
Restrictive
- Decreased lung compliance, increased respiratory effort
- Pulmonary Fibrosis, Infant Respiratory Distress Syndrome
Restrictive Pulmonary Disease (Notes)
- Decreased lung ____, decreased ____ and more difficult to get it to expand
- Infant Respiratory Distress Syndrome =
- compliance, elasticity
- not enough pulmonary surfactant causes alveolar collapse which causes difficulty in expansion
Measuring Lung Volumes and Function through Spirometry
- Pulmonary Function Tests (ie. spirometry) are performed to differentiate between?
- Spirometry: mouthpiece that person breaths into - device can measure _____ of air moving in and out of lungs, also allows us to perform ___
- Difficult when pt cannot be compliant: _____, adults with ____ _____
- between obstructive and restrictive pulmonary disease
- volume, PFTs
- children, cognitive impairment
Lung Volumes we can measure through Spirometry
- (1): Total volume of air that can occupy lungs (just under 6L) -> __ + __ (also cannot be measured by spirometry bc can’t measure __)
-
(1): Amount of air you can move in and out of your lungs
- (1): volume of air left in lungs after max exhalation (Difference between ___ and ___) _____ measure using spirometry
- (1): air moving in and out of lungs during normal restful breathing (a small fraction of __ in healthy individual) ~___mL
- Total Lung Capacity -> VC + RV, RV
-
Vital Capacity
- Residual Volume, TLC and VC, cannot measure
- Tidal Volume, fraction of VC, ~500mL
Lung Volumes we can measure through Spirometry
- (1): max volume person can move into their lungs
- (1): Difference betwen IC and TV (how much more air can you move in after a normal restful breath)
- (1): how much air you can move out after normal exhalation (much ____ than inspiratory reserve)
- (1): amount of air left in lungs after restful exhalation
- Inspiratory Capacity (IC)
- Inspiratory Reserve Volume (IRV)
- Expiratory Reserve Volume (ERV) smaller than IRV
- Functional Residual Capacity (FRC)
Residual Volume
- On forceful expiration - abdominal and intercostal muscles contract to get thoracic cavity as small as possible -> creates high intrathoracic pressure that causes _____ airways to _____ and ___ air _____ of it
- Cannot measure ___ and ____ using Spirometry bc you can only measure air that you can move and out using spirometry
- unsupported airways collapse and trap air downstream of it
- RV and TLC
Pulmonary Function Tests: Forced Expiration
Forced Expiratory Test =
- Forced exhalation causes increase pressure in chest ____ and to a ____ extent (those unsupported airways (little straws) are going to collapse _____ -> increased _____ volume
Forced Vital Capacity (FVC)
Forced Expiratory Volume (FEV1) =
Normal lung function FEV1 = ___% of FVC
- If FEV1 is <85%, what does that suggest?
have person slowly take in as big of a breath as they can and ask them to forcefully exhale as hard and fast as they can (maximal inhalation -> forceful exhalation)
- faster, greater, SOONER -> increased residual volume
Forced expiratory volume at 1 second (volume of air you get out within 1st second)
85%
- suggests that small airways are closing earlier -> obstructive lung disease (airway narrowing causes collapse sooner)
Volume Changes in Restrictive Lung Disease (Lung is less elastic)
FEV1 and FVC usually _____
Problem is more about _______ capacity
- Inspiratory Capacity =
- Tidal Volume =
- Vital Capacity =
- Inspiratory Reserve Volume =
- Total Lung Capacity =
- ERV =
- Residual Volume =
Normal
Inspiratory
- decreases
- same
- decreases dt decreased IC
- decreases
- decreases
- normal
- same
Volume Changes in Obstructive Lung Disease (Airway narrowing/collapse sooner -> Air Trapping)
FEV1 and FVC =
What volume is effected more severely?
Residual Volume =
Decreased significantly
Expiratory capacity
Increases (air trapping) -> Chronic hypercapnia (CO2)
Pulmonary Fibrosis
What type of lung disease?
the development of excess ______ ______ tissue in the lungs (lung _____)
Some common causes:
- Inhalation/exposure to ______ or _______ pollutants (a____, d____, etc)
- Can be a complication of certain disorders involving chronic _____ especially of _____ tissue (scl_____, systemic ______ erythmatosus, ______ arthritis, etc)
- Certain medications (a______, m______, etc)
- ______ infections
- _______ therapy to chest
Restrictive Lung Disease
fibrous connective, scarring
- environmental, occupational (asbestos, dust)
- inflammation, connective (scleroderma, lupus, rheumatoid)
- amiodarone, methotrexate
- repeated
- radiation
opaque appearance from scar tissue (collagen replacing elastin)
Major Obstructive Lung Diseases
(3)
- All create airway ______ but different in nature
- COPD reserved for severe forms of _____ + ______
Asthma
Bronchitis
Emphysema
- narrowing
- bronchitis + emphysema
Why asthma makes it hard to breathe
In an asthmatic person, the muscle of the bronchiole tubes t____ and th_____, and the air passages become _____ and ____-filled, making it difficult for air to move
tighten, thicken, inflamed, mucus filled
Pathophysiology of Asthma
Made up of 2 arms
- Suffering from ______ ______ in lungs +
-
______ (irritants, allergens) that cause ______ during an acute _____
- Acute inflammatory response on top of chronic inflammation during attack -> activation of Ig_, Mast Cell ______ -> vaso_____ -> increased cap _____ -> increased c_____ and _____ production -> _____ of walls of airways
- _______ caused by WBC releasing ___ during acute inflammation -> acute and severe narrowing, constant state of ______ of airways
- chronic inflammation
-
Triggers, bronchospasm, attack
- Ige, Mast Cell Degranulation, dilation, permeability, congestion, mucus, narrowing
- Bronchospasm, ROS, hyperresponsiveness
Treatment of Asthma (Notes)
- (2) meds
- (2) Important reasons why we want to control chronic inflammation
- Meds to control chronic inflammation + rescue medication (bronchodilators)
- Reduce risk of attacks
- Reduce risk of fibrosis/scarring
Bronchitis
=
- Unlike asthma, where inflammation leads to bronchospasm, inflammation in bronchitis leads to?
- Mucus ______ cilia that line the airways and if you can’t get mucus out -> better environment for ____ to live and cause _____ _____*
- Acute Bronchitis: can occur from (1) that evolves into bronchitis (lasts 1-1.5m), typical characteristic of severe, ______ ______ (usually productive)
- Chronic Bronchitis: usually caused by chronic _____ -> malfunction/elimination of ____ -> can’t get mucus out and again frequent ____ and chronic ____
Inflammation of larger bronchiolar airways
- congestion of airway with thickening and increased mucus production*
- immobilizes, bacteria, frequent infection*
- upper respiratory infection, persistent cough
- smoking, cilia, infections, cough
Patho of Chronic Bronchitis
- Starts with (1) or (1)
- _____ of airway epithelium
- I______ of inflammatory cells and release of _____ (neutrophils, macrophages, lymphocytes, leukotrienes, interleukins)
- _____ bronchial irritation and inflammation
- Chronic bronchitis (bronchial e____, hypersecretion of _____, ______ malfunction, ______ colonization of airways)
- Airway _____, air _____, loss of (1) for gas exchange. _____ exacerbations (_____, bronchospasm)
- D_____, C_____, Hypoxemia, Hyper_____
- tobacco smoke, air pollution
- Inflammation
- Infiltration, cytokines
- Continuous
- edema, mucus, ciliary, bacterial
- obstruction, trapping, SA, frequent (infections)
- Dyspnea, cough, hypercapnia
Chronic Bronchitis (Notes)
Main cause in the US?
In other countires can be cuased by?
If not treated what can it lead to?
SMOKING
Air pollution can be so bad to cause it
(no smoking cessation), frequent exacerbations can lead to Emphysema
Emphysema
Results from chronic bronchitis -> weakened and _____ airway sacs (____ of lung tissue) no longer participating in gas exchange
The airway narrowing that is happening in emphysema is a ______ NARROWING -> LOSS OF ______ of AIRWAY SACS**
collapse (loss of lung tissue)
FUNCTIONAL -> LOSS OF INTERDEPENDENCE* OF AIRWAY SACS
2 Routes of Emphysema
- Primary Emphysema (1)
- Trypsin =
- Anti-Trypsin =
- What is happening in primary empyhsema?
- (2) Most ______
- How does this also effect protease activity?
- Inherited a1 Anti-trypsin deficiency
- (protease) enzyme that breaks down protein in lungs so new protein can be made (normal turnover)
- prevents over-digestion of protein in lungs
- Protease activity out of control -> progressive breakdown of lung tissue -> primary emphysema
- Smoking, Air pollution MOST COMMON
- Chronic inflammatory process of bronchitis alters the relationship between trypsin and anti-trypsin -> also enhancing activity of protease (breakdown of tissue)
COPD (Notes)
Bronchitis + Emphysema
- Presenation: air _____, reduced gas _____
- Interventions: ____ expiratory breathing -> to get more air out and improve air trapping
- Common Manifestations
- Body adapts to hypercapnia and CO2 is no longer the?
- (1) becomes primary drive for breathing -> peripheral chemoreceptors that don’t stimulate breathing until O2 drops to ~__mmHg (__-__%) -> if you oxygenate pts above that lvl you eliminate their drive to breathe
- Chronic Hypoxemia -> _____ of fingernails, _____ of pulmonary vessles -> pulm ___ -> right sided ___ -> dependent _____, congestion of ____, congestion of ___ tract (loss of ____)
- Chronic _____ -> a lot of energy goes to coughing -> _____ arms and legs, ____ chest, use of ____ muscles
- trapping, exchange
- slow
- CO2 no longer primary drive for breathing
- O2, 60 (90-92%)
- clubbing, constriction, HTN, HF, edema, liver, GI (loss of appetite)
- cough -> skinny arms/legs, barrel chest, accessory
