Respiratory Physiology Flashcards
How is airflow through the airway calculated
Alveolar pressure - (atmospheric pressure / Resistance)
Function of airway cilia
To transport mucus from the airways to the pharynx where it is swallowed
What is the water vapour within the airways at 37 degrees
6.3kPa
What is the intrapleural pressure at the beginning of inspiration
-4cmH2O
What is the peak intrapleural pressure on inspiration
- 9cmH20 during normal breathing
- 30cmH2O during exercise
What type of process is exhalation
Passive process from recoil of the chest wall
List the 3 forces acting on the lung
- Elastic nature of lungs = inward pull on visceral pleura
- Surfactant = inward pressure
- Negative intrapleural pressure = outward pull
What is Hysteresis
Unequal pressure required to maintain a given lung volume on inspiration and expiration
Where is surfactant produced
Type 2 alveolar cells
Describe surface tension
- Occurs at all air-fluid interfaces
- Water molecules are more attached to each other than the surrounding gas molecules
- Creates an inward pressure
Biggest contributor to the elastic recoil of the lungs
Surface tension
What is the primary purpose of surfactant
Reduce surface tension at the pulmonary air-liquid interface to reduce work of breathing
Define the Law of Laplace
Alveolar distending pressure is proportional to surface tension / radius
What does the Law of Laplace imply
As alveoli decrease in size the pressure within them would increase and result in collapse (if surfactant were not present)
What is the relationship between alveolar radius and surfactant production
They increase or decrease in tandem
Describe lung compliance
- The ease at which the lungs can be inflated
- Compliance = change in volume / change in pressure
What two factors govern lung compliance
- Elasticity of the lung parenchyma
2. Surface tension
List conditions that increase lung compliance
Emphysema
List conditions that reduce lung compliance
- Scarring/fibrosis
- Pulmonary oedema
- Deficiency of surfactant e.g. prematurity
- Decreased lung expansion e.g. paralysis
- Supine position
- Mechanical ventilation (due to reduced pulmonary blood flow)
- Age
- Breathing 100% O2
What class as non-elastic forces of chest wall movement
- Airway resistance
- Frictional forces
- Inertia of the air and tissues
How is airway resistance divided throughout the respiratory tract
- 1/3rd = upper airways
- 2/3rd = tracheobronchial tree (primarily the medium-sized bronchi)
Relationship between resistance and lung volume
Resistance falls as lung volumes increase as the elastic parenchyma pulls open the bronchioles
Describe the 4 phases of lung expansion
- Takes considerable pressure increase before there is change in volume
- Expansion of the lung is proportional to the increase in pressure
- Maximum capacity
- In the initial stage the lung volume is maintained until the pressure falls considerably
Shape of the lung inflation (compliance) curve
Sigmoid
How does tension pneumothorax develop
Lung injury forms a valve in which air leaks into the pleural cavity but closes during expiration leading to positive intrapleural pressure
When does a sucking pneumothorax develop
If defect in the chest wall is greater than 2/3rd the diameter of the trachea then air will enter via the chest wall as oppose to traditional airway
Define tidal volume
Air taken in and exhaled during quiet breathing
Define inspiratory reserve volume
Maximum volume of air that can be inspired in excess of normal inspiration
Define expiratory reserve volume q
Maximum volume of air that can be expired forcefully after normal expiration
Define functional residual capacity
Volume of gas left in the lungs. after expiration during normal breathing
How is functional residual capacity calculated
Using Helium dilution method
Define residual volume
Volume of air remaining after maximal expiration (FRC - ERV)
Define vital capacity
Volume of air that is expelled from maximal inspiration to maximal expiration
Define anatomical deadspace
Volume of gas that does mix with air in the alveoli
Define physiological deadspace
Volume of gas that may reach air in the alveoli but due to lack of perfusion does not take part in gas exchange (includes anatomical deadspace)
How is anatomical deadspace calculated
Fowler’s method - uses nitrogen analyser
How is physiological deadspace calulated
Bohr equation - based on principle that all expired CO2 comes from the alveoli
What factors increase anatomical dead space
- Increasing size of patient
- Standing position
- Increased lung volume
- Bronchodilatation
- Ventilation
Factors increasing physiological deadspace
- Hypotension
- Hypoventilation
- Emphysema and PE
- Positive pressure ventilation
Define closing capacity
The volume of the lungs at which small airways at the base of the lungs start to close (usually 10% of vital capacity)
What factors increase closing capacity
- Increasing age
- Supine posture
- Anaesthesia
How is diffusion capacity measured
- Inhalation of CO
2. Measurement of arterial CO
What reduces diffusion capacity
- Increase in diffusion distance e.g. pulmonary oedema
- Loss of alveolar surface area e.g. emphysema
Describe hypoxic pulmonary vasoconstriction
Hypoxia or hypercapnia result in constriction of the small alveolar vessels to divert blood to better oxygenated areas of the lung
What is the typical pulmonary artery pressure
25/8mmHg
What 3 factors determine pulmonary blood flow
- Hydrostatic pressure in the pulmonary arteries
- Pressure in the pulmonary veins
- Pressure of air in the alveoli
Where in the lung is pulmonary blood flow the worst
Apex of the lung - alveolar pressure is similar to PA pressure causing small vessels to be compressed
What happens to pulmonary resistance when Cardiac output increases and why
Reduces:
- Distension of already open vessels
- Recruitment of additional vessels
What does V/Q equal in alveoli that are ventilated but not perfused
Infinity
What does V/Q equal in alveoli that are not ventilated but well perfused
0
Where is the ideal V/Q of 1 found in the lung
Approximately 2/3rd the way up the chest
List the causes of PE
- DVT
- Fat embolism
- Amniotic fluid embolism
- Air embolism
- Tumour fragments
List the physiological changes associated with PE
- Increased pulmonary vascular resistance
- Pulmonary HTN
- Increased RV afterload
- Reduced LV output
- Impaired gas exchange
- Decreased lung compliance from reduced surfactant
Normal volume of fluid in the lung interstitium
20-30ml
List the three stages of pulmonary oedema
- Interstitial oedema
- Alveolar oedema
- Airway oedema
List the physiological effects of pulmonary oedema
- Decreased lung compliance
- Increased airway resistance
What are the 2 phases of ARDS
- Acute exudative
2. Late organisation
What forms during the acute exudative phase of ARDS
Hyaline membranes
What occurs in the organisation phase of ARDS
- Regeneration of type 2 pneumocytes
2. Hyaline membranes organise with pulmonary fibrosis
What 3 factors affect the diffusion of gasses in the lungs and peripheral tissues
- Pressure gradient
- Diffusion coefficient
- Tissue factors
What does oxygen have to cross to reach the circulation in the lungs
- Pulmonary surfactant
- Alveolar epithelium
- Alveolar epithelium basement membrane
- Pulmonary capillary endothelium
How does alveolar air composition differ from room air composition
Addition of water vapour and constant removal of O2
Define shunting
Passage of blood through the lungs without coming into contact with ventilated alveoli
Causes of shunting
- Pneumonia
- ASD
- VSD
- PDA
Describe the structure of Hb
- Consists of 4 peptide chains = 2 alpha and 2 beta chains
- Each chain has a haem group
- Haem group = protoporphyrin ring surrounding ferrous (Fe2+) molecule
How much oxygen can each gram of Hb carry
1.34ml
What does the oxygen dissociation curve illustrate
Relationship between the partial pressure of O2 and the concentration of O2 in the blood
What does a right shift of the oxygen dissociation curve demonstrate
Reduced affinity for oxygen of haemoglobin and thus oxygen will be released at a higher pO2 (Bohr Effect)
What does a left shift of the oxygen dissociation curve demonstrate
Increased affinity for oxygen of haemoglobin
List the causes of a left shift of the oxygen dissociation curve
- Alkalosis
- Reduced temperature
- Reduced 2,3-DPG
- Carbon monoxide
- Fetal Hb
List the causes of a right shift of the oxygen dissociation curve
- Acidosis
- Increased temperature
- Increased 2,3-DPG
- Carbon dioxide
- Altitude
Describe the Bohr effect
Right shift of the oxygen dissociation curve, the factors causing this are present in active tissues, it represents ma mechanism to increase oxygen extraction
Does anaemia affect the oxygen dissociation curve
No
Describe the structure of fetal Hb (differences from adult Hb)
Different globin chains = 2 alpha and 2 gamma
Purpose of fetal Hb
Has a greater affinity for O2 and allows the foetus to extract blood from the circulation
What is the function of myoglobin
Acts a storage molecule for oxygen - provides additional O2 in muscles during periods of anaerobic respiration
List the 3 methods of CO2 transport
- Carbamino groups
- Dissolved CO2 - 10%
- HCO3 - 60-70%
Outline the process by which CO2 is transported as HCO3
- CO2 diffuses into RBC
- Reacts with water to form carbonic acid
- Carbonic acid dissociates into H+ and HCO3-
- H+ binds to Hb and the HCO3- diffuses out of the cell into plasma
- To maintain balance CL- diffuses into the RBC (chloride shift)
Define the Haldane Effect
The amount of CO2 carried increases as the oxygen level falls
Where is the respiratory centre located
Medulla oblongata (contain inspiratory and expiratory nerurons)
What is the role of the Apneustic centre in the pons
Prolongs inspiration and results in short expiratory efforts
What is the role of the pneumotaxic centre in the pons
Inhibits inspiratory neurons and shortens inspiration
Where controls the ability to hold a breath
Cerebral cortex
Where are central chemoreceptors located
In the CNS, close to the respiratory centre of the medulla
How are central chemoreceptors stimulated
Sensitive to changes in arterial CO2:
- CO2 reacts with water in the brain to produce H+
- pH falls and directly stimulates the receptor
What is the most important stimulus to respiration
CO2
Where are the peripheral chemoreceptors located
- Carotid body
2. Aortic bodies
What stimulates peripheral chemoreceptors
- Hypoxia <8kPa
2. Changes in arterial pH
Describe the Hering-Breur reflex
Prevents lung overinflation - stretch receptors in the lung send inhibitory signals via the vagus
Define hypoxia
Deficiency of oxygen in the tissues
Define hypoxaemia
Reduction in the concentration of oxygen in the arterial blood
Define histotoxic hypoxia
Poisoning of the enzymes involved in cellular respiration. Oxygen is available but cannot be utilised. e.g. Cyanide poisoning