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pulmonology > Respiratory phys part 1 > Flashcards

Respiratory phys part 1 Flashcards

1
Q

Define pulmonary

A

anything to do with the lungs

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2
Q

define ventilation

A

movement of air going in and out

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3
Q

Define respiration

A

process of cellular metabolism

  • cells need oxygen coupled with protein, glucose or fat to create ATP
  • byproduct of this metabolism is CO2
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4
Q

What is the purpose of the respiratory system?

A
  • to support cellular respiration by delivering O2 to the cells, removing CO2 because without O2 all tissues are affected.
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5
Q

How does respiration involve both tthe respiratory and circulatory systems? (4 processes)

A
  • 4 processes that supply the body with O2 and dispose of CO2:
  • pulmonary ventilation (air in and out)
  • external respiration (exchange of gas at lungs)
  • transport in the systemic circulation
  • internal respiration (exchange of gas at the tissues)
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6
Q

What are the major organs of the respiratory system?

A
  • nose, nasal cavity andparanasal sinuses
  • pharynx
  • larynx
  • trachea
  • bronchi and their branches
  • lungs and alveoli
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7
Q

What are the 3 categories of the respiratory system?

A
  • conducting zone: conduits to gas exchange sites, this includes all resp. structures that don’t participate in gas exchange (dead space)
  • respiratory zone: site of gas exchange (micro structures: respiratory bronchioles, alveolar ducts and alveoli)
  • Respiratory muscles: diaphragm and other muscles that promote ventilation
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8
Q

Relationship of trachea to the esophagus?

A
  • trachea is anterior to the esophagus
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9
Q

Layers of tracheal wall?

A
  • outermost: hyaline cartilage
  • middle: submucosa
  • innermost: ciliated mucosa
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10
Q

What are the conducting zone structures of the upper airway?

A
  • nose and sinuses
  • pharynx: nasopharynx which includes the adenoids, oropharynx which includes the palatine tonsils, and lingual tonsil and epiglottis, and laryngopharynx which houses the vocal cords
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11
Q

What is the fxn of the nose and sinuses?

A
  • produce mucus, warm, humidify and filter the air

- nasal mucosa: continuous with mucosa of lower respiratory tract and extends into nasolacrimal ducts

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12
Q

Anatomy of the conducting zone structures?

A
  • trachea: right and left main (primary) bronchi
  • each main bronchus enter hilum of one lung (R bronchus is wider, shorter, and more vertical than left)
  • each main bronchus branches into lobar (secondary) bronchi (three right and 2 left) - each lobar bronchus supplies one lobe
  • each lobar bronchus branches into segmental (tertiary) bronchi: segmental bronchi divide repeatedly
  • bronchioles are less than 1 mm in diameter
  • terminal bronchioles are smallest, less than 0.5 mm diameter
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13
Q

How many orders of branching do the air passages undergo?

A
  • 23 orders

- branching pattern called bronchial (respiratory) tree

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14
Q

What constricts the bronchioles?

A
  • smooth muscle (bronchodilators work on smooth muscle during asthma attack)
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15
Q

What is the importance of elastic fibers that surround alveoli?

A
  • impt for maintaining elasticity and compliance of the lungs
  • pts with CT disorders - elastic fibers become very stiff and they develop restrictive disease
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16
Q

What kind of structural changes occur throughout the conducting zone?

A
  • from bronchi through bronchioles - structural changes occur
  • cartilage rings give way to plates, and cartilage is absent from bronchioles
  • epithelium changes from pseudostratifiied columnar to cuboidal, cilia and goblet cells become sparse
  • relative amount of smooth muscle increases
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17
Q

What makes up the respiratory zone?

A
  • respiratory bronchioles, alveolar ducts, and alveolar sacs (clusters of alveoli)
  • about 300 million alveoli account for most of lungs volume and are main site for gas exchange
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18
Q

What kind of cells make up the alveoli?

A
  • walls: squamous epithelial cells that are only 1 cell layer thick (type 1 cells)
  • scattered type II cuboidal cells that secrete surfactant and antimicrobial proteins (lysozymes)
  • alveoloar and capillary walls and fused basement membranes, only 0.5 micrometer thick - air-blood barrier
  • macrophages: clean out debris and infection (no cilia in alveoli) - keep alveolar surfaces sterile
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19
Q

What is purpose of open pores that alveoli contain?

A
  • connect adjacent alveoli

- allow air pressure throughout lung to be equalized

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20
Q

What is the hilum?

A
  • or root, site of vascular and bronchial attachments
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21
Q

structure of the lungs?

A
  • left lung is smaller, separated into 2 lobes by oblique fissure
  • R lung has 3 lobes separated by oblique and horizontal fissures
  • bronchopulmonary segments ( 10 right, and 8-9 on left)
  • lobules are smallest subdivisions, served by bronchioles and their branches
  • each segment has own blood supply
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22
Q

Blood supply to the lungs? Pulmonary circulation

A
  • pulmonary circulation (low pressure, and high volume)
  • pulmonary arteries deliver systemic venous blood (branch profusely along with bronchi, and feed into the pulmonary capillary networks)
  • pulmonary veins carry oxygenated blood from respiratory zones to the heart
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23
Q

Blood supply to the lungs? Systemic circulation?

A
  • high pressure and low volume
  • bronchial arteries provide oxygenated blood to lung tissue (arise from aorta and enter lungs at hilum, supply all lung tissue except alveoli)
  • bronchial veins anastomose with pulmonary veins
  • Bronchial veins anastomose with pulmonary veins
  • pulm. veins carry most venous blood back to the heart
24
Q

What is the pleurae?

A
  • thin, double layered serosa
  • parietal pleura on thoracic wall and superior face of diaphragm
  • visceral pleura on external lung surface
  • pleural fluid fills the slitlike pleural cavity: provides lubrication and surface tension
25
Q

Describe the innervation of the lungs?

A
  • parasympathetic stimulation = constriction of bronchioles

- sympathetic = dilation of the bronchioles

26
Q

2 phases of the mechanics of breathing?

A
  • ventilation consists of 2 phases:
    1. inspiration: gas flows into lungs
    2. expiration: gases exit the lungs
27
Q

What principles do the mechanics of breathing rely on?

A
  • pressure relationships in the thoracic cavity (intrapulmonary vs. intrapleural pressures)
  • pulmonary ventilation: boyles law, airway resistance, alveoloar resistance, alveolar surface tension, and lung compliance
28
Q

What is the pressure that keeps the lungs inflated?

A

transpulmonary pressure: this equals= Ppul (intrapulm)- Pip (intrapleural)
- Ppul and Pip can never be the same because then trans pressure would be 0 and the lungs would collapse (having a hole in the lungs) - need negative pressure to keep lungs inflated

29
Q

Pressure relationships in the thoracic cavity?

A
  • P atm is the pressure exerted by the air surrounding the body (760 mm Hg at sea level)
  • neg resp pressure is less than P atm
  • positive is greater than P atm
  • 0 is = to P atm
30
Q

What is intrapulmonary pressure?

A
  • intraalveolar pressure (Ppul)
  • pressure in alveoli, fluctuates with breathing but always equalized with P atm because not separated from atm Pressure (in the same compartment - open system)
31
Q

What is intrapleural pressure?

A
  • Pip: pressure in pleural cavity
  • fluctuates with breathing
  • always a negative pressure (less than Patm and Ppul)
  • caused by opposing forces created by inward forces that promote lung collapse: elastic recoil of lungs decrease lung size, and surface tension of alveolar fluid reduces alveolar size
  • one outward force that tend to enlarge the lungs: elasticity of chest wall pulls the thorax out
32
Q

What is purpose of transpulmonary pressure?

A
  • keep lungs open
  • Ppul-Pip= transpulmonary pressure
  • the greater the transpulm pressure the larger the lungs
  • if Ppul= Pip then lungs would collapse
33
Q

What occurs when pleura loses integrity?

A
  • results in equalization of intrapleural pressure so lungs collapse, transpulm pressure would be 0
34
Q

What is atelectasis (lung collapse) due to?

A

due to either:

  1. lack of air delivery: plugged bronchioles -leads to collapse of alveoli
  2. lack of integrity of pleura (wound that allows air entry into pleural cavity (pneumothorax)
35
Q

What are 2 main categories of conditions that cause atelectasis?

A
  • pleural problems (pneumothorax)
  • ventilation problems
    ( infection: pneumonia)
36
Q

How does pulmonary ventilation occur?

A
  • through inspiration and expiration
  • mechanical processes that depend on volume changes in the thoracic cavity: volume changes lead to pressure changes and pressure changes lead to gases flow to equalize the pressure
37
Q

What is Boyle’s law?

A
  • relationship b/t pressure and volume of gas
  • pressure varies inversely with volume
  • more volume leads to less pressure
38
Q

Describe the process of inspiration

A
  • active process
  • inspiratory muscles contract
  • thoracic volume increases
  • lungs are stretched and intrapulm. volume increases
  • intrapulm pressure drops (-1 mm Hg) and air flows into the lungs down its pressure gradient until Ppul=Patm
39
Q

Is expiration passive or active?

A
  • can be both
    quiet expiration is passive process:
  • inspiratory muscles relax
  • thoracic cavity volume decreases
  • elastic recoil and intrapulm. volume decreases
  • Ppul rises to +1 mm Hg (greater than Patm) so air flows out of lungs down its pressure gradient until Ppul= 0
  • forced expiration: active process using abdominal and internal intercostal muscles
40
Q

When does intrapulmonary pressure increase and decrease?

A
  • increases during expiration and lung volume decreases

- decreases during inspiration as lung volume increases

41
Q

When does intrapleural pressure become negative?

A
  • when chest wall expands during inspiration, and it returns back to inital value as chest wall recoils
42
Q

What are the physical factors that influence pulmonary ventilation? inspiratory muscles have to overcome what 3 factors that hinder air passage and pulmonary ventilation?

A
  • airway resistance
  • alveolar surface tension
  • lung compliance
43
Q

What is the major nonelastic source of resistance to gas flow?

A
  • friction
44
Q

What is relationship between flow, pressure, and resistance?

A
  • flow = change in pressure/ resistance

- gas flow changes inversely with resistance (increase resistance you will decrease flow)

45
Q

Why is resistance usually insignificant?

A
  • because:
  • large airway diameteres in the first part of the conducting zone
  • progressive branching of airways as they get smaller, increasing the total cross-sectional area
  • resistance disappears at the terminal bronchioles where diffusion drives gas movement
46
Q

Where is the greatest resistance to flow seen?

A
  • in medium sized bronchi because after that pt they branch a lot more and so the surface area is increased, that is why least amount of resistance is in terminal bronchioles
47
Q

What occurs when airway resistance rises?

A
  • breathing movements become more strenous
  • severe constriction or obstruction of bronchioles can cause respiratory failure and can occur during acute asthma attacks and stop ventilation
48
Q

What helps dilate the bronchioles and reduces air resistance? what kind of stimulation is this?

A
  • epi which is released from sympathetic nervous system

- sympathetic response (relaxes smooth muscle)

49
Q

What forces increases airway resistance?

A
  • bronchospasm
  • secretions
  • mucosal edema
50
Q

What are the 3 types of COPD, what happens in COPD?

A
  • alveoli or bronchioles or both are destroyed
  • lungs with COPD showed 72-89% reduction in number of terminal bronchioles/lung
    3 types:
    emphysema (destruction of alveoli), chronic bronchitis (destruction of bronchioles), and COPD (combo of two)
51
Q

What conditions increase airway resistance?

A 
COPD
- emphysema and Chronic bronchitis
asthma
cystic fibrosis
sleep apnea (Upper airway resistance)
52
Q

What 3 factors that hinder air passage and pulmonary ventialtion do the inspiratory muscles have to overcome?

A
  • inspiratory muscles overcome 3 factors that hinder air passage and pulmonary ventilation:
    1. airway resistance
    2. alveolar surface tension
    3. lung compliance
53
Q

What is alveolar surface tension?

A
  • surface tension: attracts liquid molecules to one another at a gas liquid interface
  • resists any force that tends to increase the surface area of the liquid
54
Q

WHat is produced by the type II alveolar cells to reduce alveolar fluid surface tension?

A
  • surfactant, a detergent like lipid and protein complex produced by type II alveolar cells
  • discourages alveolar collapse
  • insufficient quantity in premature infants cause infant respiratory distress syndrome (can give surfactant to babies)
55
Q

What is lung compliance?

A
  • a measure of the change in lung volume that occurs with a given change in transpulmonary pressure
    low compliance: doesnt expand very easily
    high compliance: very easy to expand lungs
56
Q

Why is lung compliance normally high?

A

due to:

  1. distensibility of healthy lung tissue
  2. ability of the thoracic cage to expand during inspiration under normal circumstances
  3. reduction of alveolar surface tension secondary to surfactant
57
Q

What kind of conditions decrease lung compliance?

A
  • nonelastic scar tissue (restrictive lung disease)
  • reduced production of surfactant
  • decreased flexibility of thoracic cage
  • deformities of thorax
  • ossification of costal cartilage
  • paralysis of intercostal muscles

pulmonology (20 decks)

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