Respiratory physiology (pie for finals) Flashcards
Define what is meant by internal respiration ?
- Our body systems are made of cells
- These cells need a constant supply of oxygen (O2) to produce energy and function
- The carbon dioxide (CO2) produced by the cellular reactions must continuously be removed from our bodies
- Internal respiration refers to the intracellular mechanisms which consume O2 and produces CO2
Define what external respiration is
- The term external respiration refers to the sequence of events that lead to the exchange of O2 and CO2 between the external environment and the cells of the body
- It involves four steps
What are the 4 main steps of external respiration ?
- Ventilation -the mechanical process of moving gas in and out of the lungs
- Gas exchange between alveoli and blood - the exchange of O2 and CO2 between the air in the alveoli and the blood in the pulmonary capillaries
- Gas transport in the blood - the binding and transport of of O2 and CO2 in the circulating blood
- Gas exchange at the tissue level - the exchange of O2 and CO2 between the blood in the systemic capillaries and the body cells
What are the 4 body systems involved in external respiration ?
- The Respiratory System
- The Cardiovascular System
- The Haematology System
- The Nervous System
Define what ventilation is
The mechanical process of moving air between the atmosphere and alveolar sacs
In terms of pressure what what condition needs to be met for ventilation to occur
The intra-alveolar pressure must become less than atmospheric pressure for air to flow into the lungs during inspiration.
Define what boyles law is
At any constant temperature the pressure exerted by a gas varies inversely with the volume of the gas i.e. as the volume of a gas increases the pressure exerted by the gas decreases
Before inspiration the intra-alveolar pressure is equivalent to atmospheric pressure, how is a lower pressure then achieved during inspiration ?
During inspiration the thorax and lungs expand as a result of contraction of inspiratory muscles and because of boyles law this increase in intra-alveolar volume containing the gas results in decreased intra-alveolar pressure
How does movement of the chest wall expand the lungs as there is no physical connection between the lungs and chest wall?
Two forces hold the thoracic wall and the lungs in close opposition:
- The intrapleural fluid cohesiveness: The water molecules in the intrapleural fluid are attracted to each other and resist being pulled apart. Hence the pleural membranes tend to stick together.
- The negative intrapleural pressure: the lungs are forced to expand outwards while the chest is forced to squeeze inwards. (Across the lung wall, the intra-alveolar pressure of 760 pushes outward, while the intrapleural pressure of 756 pushes inward. This causes the lungs to stretch to fill the larger thoracic cavity. Across the thoracic wall, the atmospheric pressure of 760 pushes inward, while the intrapleural pressure of 756 pushes outward
Describe what inspiration is
- Inspiration is an active process brought about by contraction of inspiratory muscles
- The chest wall and lungs stretched
- The Increase in the size of the lungs make the intra-alveolar pressure to fall
- This is because air molecules become contained in a larger volume (Boyle’s Law)
- The air then enters the lungs down its pressure gradient until the intra-alveolar pressure become equal to atmospheric pressure
Inspiration is an active process depending on muscle contraction. What 2 muscles does it depend on and what specifically do they do ?
- Diaphragm (major inspiratory muscle) - increases the volume of the thorax vertically by contracting
- The external intercostal muscle - lifts the ribs and moves out the sternum by contracting
Describe the process of expiration
- Normal expiration is a passive process brought about by relaxation of inspiratory muscles
- The chest wall and stretched lungs recoil to their preinspiratory size because of their elastic properties
- The recoil of the lungs make the intra-alveolar pressure to rise
- This is because air molecules become contained in a smaller volume (Boyle’s Law)
- The air then leaves the lungs down its pressure gradient until the intra-alveolar pressure become equal to atmospheric pressure
What condition can abolish the trasmural pressure gradient needed for lung expansion and what may this result in ?
Pnuemothorax - this can then result in lung collapse
What causes the lungs to recoil during expiration?
(i.e. what gives the lungs their elastic behaviour - because it is a passive process so something inherint must cause it)
- Elastic connective tissue in the lungs - the whole structure bounces back into shape
- But even more important is the alveolar surface tension
What is alveolar surface tension ?
- It is the attraction between water molecules at liquid air interface
- In the alveoli this produces a force which resists the stretching of the lungs
If alveoli were lined with water alone the surface tension would be too strong so the alveoli would collapse, therefore what prevents collapse of alveoli?
Pulmonary surfactant - it lowers alveolar surface tension by interspersing between the water molecules lining the alveoli
What is pulmonary surfactant and what is it produced by?
Pulmonary surfactant is a complex mixture of lipids and proteins secreted by type II alveoli
What does the law of LaPlace state + state the equation which deomstrates this?
It states smaller alveoli (with smaller radius - r) have a higher tendency to collapse
What is a secondary factor alongside pulmonary surfactant which helps keep alveoli open ?
Alveolar Interdependence - if an alveolus start to collapse the surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it
This is an overview of the main opposing forces acting on the lungs
What are the major inspiratory muscles of respiration ?
Diaphragm and external intercostal muscles
What are the acessory muscles of inspiration (they contract only during forceful inspiration) ?
Sternocleidomastoid, scalenus, pectoral
What are the muscles of active expiration ? ( they contract only during active expiration)
Note - Recall expiration is usually passive
Abdominal muscles and internal intercostal muscles
Define what tidal volume is and state the average value
- The volume of air entering or leaving lungs during a single breath
- Average = 0.5 L
Define what inspiratory reserve volume is and state the average value for it
- It is the extra volume of air that can be maximally inspired over and above the typical resting tidal volume
- Average = 3.0L
Define what expiratory reserve volume is and state the average value for it
- It is the extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume
- Average = 1.0L
Define what residual volume is and state the average value
- It is the minimum volume of air remaining in the lungs even after a maximal expiration
- Average = 1.2L
Define what inspiratory capacity is and state the average value
It is the maximum volume of air that can be inspired at the end of a normal quiet expiration (IC =IRV + TV)
Define what functional residual capacity is and state the average value
- It is the volume of air in lungs at end of normal passive expiration (FRC = ERV + RV)
- Average value = 2.2L
Define what vital capacity is and state the average value
- It is the maximum volume of air that can be moved out during a single breath following a maximal inspiration (VC = IRV + TV + ERV)
- Avergae = 4.5L
Define what total lung capacity is and state the average value
- It is the total volume of air the lungs can hold (TLC = VC + RV)
- Average = 5.7L
Lung volumes and capacities are measured using what ?
Spirometry
Why is it not possible to measure total lung volume using spirometry ?
Because residual volume can not be measured by spirometry, hence total lung volume cannot be measured
What happens to residual volume in emphysema ?
Increases due to loss of the elastic recoil of the lungs
Spirometry is done to measure Dynamic Lung Volumes - what are the 3 main ones it measures ?
- FVC = Forced Vital Capacity (max volume that can be forciblly expelled from the lungs following a max inspiration)
- FEV1 = Forced Expiratory volume in one second. Volume of air that can be expired during the first second of expiration in an FVC (Forced Vital Capacity) determination.
- FEV1/FVC ratio. The proportion of the FVC that can be expired in the first second = (FEV1/FVC) X 100% - Normally > 70%
Measuring dyanmic lung volumes is useful in the diagnosis of what?
Obstructive and Restrictive Lung Disease
What are the dyanmic lung volumes results in spirometry suggestive of obstrcutive airway disease?
- FVC = low or normal
- FEV1 = low
- FEV1/FVC % = low (<70%)
What are the dyanmic lung volumes results in spirometry suggestive of restrictive airway disease?
- FVC = low
- FVE1 = low
- FEV1/FVC % = normal
Resistance to flow in the airway normally is very low and therefore air moves with a small pressure gradient. What however is the Primary determinant of airway resistance?
The radius of the conducting airway
What causes bronchoconstriction and what causes bronchodilatation ?
- Parasympathetic stimulation causes bronchoconstriction
- Sympathetic stimulation causes bronchodilatation
Why is expiration more difficult than inspiration in patients obstructive airway disease e.g. Asthma, COPD etc?
Due to dyanmic airway compression:
- Dynamic airway compression causes no problems in normal people - increased airway resistance causes an increase in airway pressure upstream. This helps open the airways by increasing the the driving pressure between the alveolus and airway (i.e. the pressure downstream)
- If there is an obstruction (e.g. asthma or COPD), the driving pressure between the alveolus and airway is lost over the obstructed segment. This causes a fall in airway pressure along the airway downstream resulting in airway compression by the rising pleural pressure during active expiration
What does a peak flow meter estimate and what is it useful in assessing ?
It estimates peak flow rate which asseses airway function which is useful in patients with obstructive airway disease
How is a reading using a peak flow meter taken?
- It is measured by the patient giving a short sharp below into the peak flow meter
- The best of three attempts is usually taken
Decribe what is meant by pulmonary compliance
- Compliance is measure of effort that has to go into stretching or distending the lungs
- The less compliant the lungs are, the more work is required to produce a given degree of inflation
What is meant by decreased pulmonary compliance and give examples of causes
- Decreased pulmonary compliance means greater change in pressure is needed to produce a given change in volume (i.e. lungs are stiffer). This causes SOBOE
- Causes e.g. pulmonary fibrosis, pulmonary oedema, lung collapse, pneumonia, absence of surfactant
Conditions which cause decreased pulmonary compliance may cause what type of pattern on spirometry ?
A restrictive pattern
What is the underlying reason for increased pulmonary compliance and give the 2 main examples of causes for it
Increased pulmonary compliance is caused by loss of the normal elastic recoil of the lungs
- Increased compliance occurs in emphysema. Patients have to work harder to get the air out of the lungs – hyperinflation of lungs
- Compliance also increases with increasing age
What is the normal energy ependiture for normal work of breathing ?
3% of total energy expenditure
Give some examples of reasons for increased work of breathing
- When pulmonary compliance is decreased
- When airway resistance is increased
- When elastic recoil is decreased (increased pulmonary compliance)
- When there is a need for increased ventilation
Define what pulmonary ventilation is
- It is the volume of air breathed in and out per minute
- Pulmonary Ventilation (L) = tidal volume (L/breath) x Respiratory Rate (breath/min)