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
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)
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
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
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)
