Respiratory System Flashcards
What is the respiratory system involved in?
- Gas exchange
- Speech
- Smell
What are the two functional parts of the respiratory system?
- Conducting portion
- Respiratory portion
What does the Conducting portion of the respiratory system do?
- Transports air
- Conditions air (warms and moistens)
What does the Respiratory portion of the respiratory system do?
- Thin, moist, delicate membrane
- Site of gaseous exchange
What are the 4 paranasal sinuses?
- Frontal sinuses
- Ethmoidal cells
- Maxillary sinuses
- Sphenoidal sinus
What is the purpose of the 4 paranasal sinuses?
Warm, moisten and filter air
Why does air need to be conditioned?
- Warmed for efficient gas exchange
- Moistened to not damage delicate membranes
- Filtered from pathogens
Anatomically, what does the conducting portion cover?
Nasal cavity to Terminal Bronchi
What are the subdivisions of the thoracic cavity?
- Mediastinum
- Pulmonary cavities
What are the anatomical differences between the right and the left lung?
Right: 3 lobes, short, broad and larger
Left: 2 lobes, tall and narrow
What are the 3 lobes of the right lung?
- Superior
- Inferior
- Med
What are the subdivisions of bronchi?
- Right and Left main/primary Bronchus
- Lobar Bronchi
- Segmental bronchi of middle lobe
- Terminal bronchi
- Respiratory bronchioles
What are the alveolar sacks surrounded by?
Capillary beds that Receive deoxygenated blood via pulmonary arteries and Send oxygenated blood via pulmonary veins
What is an artery?
Carries blood away from the heart (oxygenated)
What is a vein?
Carries blood to the heart (deoxygenated)
How is the respiratory system divided anatomically?
- Upper respiratory tract (Nasal cavity to pharynx to larynx)
- Lower respiratory tract (Trachea to bronchi to lungs)
What is an URT infection?
Common cold
What is a LRT infection?
Pneumonia
What are the functions of the thoracic cage?
Protection and respiratory movements
Which ribs are ‘floating’ and why?
11 and 12 aren’t connected to the sternum
What is breathing?
The mechanism in which fresh atmospheric air passes to alveoli and stale air leaves alveoli
What are the 3 planes of movement in breathing?
- Vertical
- Antero-posterior
- Transverse
What is the function of the diaphragm?
- Closes off thoracic outlet
- Separates thorax from abdomen
- Plays major role in breathing
- Apertures allow passage of structures (vessels, nerves, oesophagus) to and from abdomen.
Which nerves keep the diaphragm alive?
Phrenic nerves - C3, 4 and 5
What are the 3 thin muscle layers within each intercostal space?
- External intercostal
- Internal intercostal
- Innermost intercostal
What else is found in each intercostal space?
- Intercostal nerve
- Intercostal artery
- Intercostal vein
What are the pleura?
Each lung is surrounded by a membranous sac that encloses the lung and forms the pleural
cavity. There are two pleural cavities either side of the heart in the thorax.
What is the pleural cavity and it’s purpose?
It contains a thin film of fluid which a) helps the lungs to slide and b) creates
surface tension between the parietal and visceral (lung) layers to aid inspiration.
What are the two types of pleura?
- Visceral
- Parietal
What are the 4 divisions of the parietal pleura?
- Cervical
- Costal
- Diaphragmatic
- Mediastinal
Why is it important to divide the parietal pleura into sections?
Different parts of the parietal pleura
receive sensory innervation from
different nerves (pain the patient reports may be in site or nerve origin)
What is ventilation?
The process of moving gases in (inspiration) and out (expiration) of the lungs
Whats breathing (V2)?
The bodily function that leads to ventilation of the lungs. Also known as (external) respiration
What are the two classifications of diseases affecting ventilation?
- Obstructive conditions (tubes aren’t as effective in conducting gases)
- Restrictive conditions (loss of elasticity in the lungs or chest wall)
What are examples of obstructive conditions?
Asthma, chronic obstructive pulmonary disease, lung cancer
What are examples of restrictive conditions?
Intrinsic - pulmonary fibrosis
Extrinsic - pneumothorax, disorders of the thoracic skeleton
What moves during quiet breathing?
-diaphragm -external intercostals stabilise ribcage
What moves during increased effort breathing?
- diaphragm
- external intercostals lift & expand ribcage
- accessory muscles
- neck muscles
- shoulder girdle muscles
Which nerves supply intercostals?
segmental thoracic nerves
What can spinal cord injury lead to?
ventilatory muscle paralysis
What is the effect of the thoracic cage expanding on the intrapleural space?
It exerts an increasing negative pressure on it
How is the volume of air moving in and out of the lungs during ventilation measured?
Spirometer
What are the 4 lung volumes?
- Tidal volume
- Inspiratory reserve volume
- Expiratory reserve volume
- Residual volume
What is the tidal volume?
Volume of air moved in or out of the lungs during normal breathing
What are the typical values of tidal volume?
At rest: 6-7 ml/Kg
Exercise: 15 ml/Kg
What is the Inspiratory reserve volume?
After a normal expiration, take as deep a breath in as possible
What is the Expiratory reserve volume?
After a normal inspiration, breath out as deeply as possible
What is the Residual volume?
Even after a maximal expiration, a volume of air remains in the lungs.
What is the cause of residual volume?
The rigid nature of the thorax and the pleural attachments of the lungs to the chest wall that prevent complete emptying of the lungs
Which lung volume cannot be measured by spirometry?
Residual volume
What is the total lung capacity?
TV + IRV + ERV + RV
What is the vital capacity?
TV + IRV + ERV
After a maximal inspiration make a maximal expiration
What is the functional residual capacity?
ERV + RV
What is a vitalograph spirometer used to measure?
- the forced vital capacity (FVC)
- the forced expiratory volume in 1 second (FEV1)
What is a peak flow meter used to measure?
The peak expiratory flow rate (PEFR)
What is used to distinguish between obstructive and restrictive conditions?
FEV1/FVC ratio
reversibility of airflow limitation
What are the uses of PEFR?
- Convenient way of measuring airway obstruction
- Not as good as spirometry for airway limitation
- Patients can use it to monitor COPD or asthma at hoem
When are the measurements of FEV1 and PEFR made?
Before and after inhalation
Is airway constriction in asthma reversible?
Yes. FEV1 and PEFR would be restored to normal after Salbutamol
Is airway constriction in COPD reversible?
No.
(or nearly irreversible
<15%, or <200 mL/s, improvement in FEV1 and PEFR after salbutamol)
What is the relationship between intrathoracic pressure and lung volume during tidal breathing?
Hysteresis
What is hysteresis?
the phenomenon in which the value of a physical property lags behind changes in the effect causing it
Why does hysteresis occur in the lungs?
because of the elastic nature of the tissues
What is compliance?
the change in lung volume per unit change in intrathoracic pressure
C = ΔV / ΔP
How is compliance measured?
- Spirometry for volume
- Oesophageal balloon for pressure
What is the recoil pressure if the lungs?
Pressure driving the lung to collapse. Difference between alveolar pressure and intrapleural pressure.
What is the recoil pressure of the chest wall?
Intrapleural pressure – barometric pressure
What is the Functional Residual Capacity?
the relaxation point of the respiratory system when chest wall & lung recoil pressures are equal but opposite (equilibrium)
Which diseases are associated with reduced compliance?
- Circumferential burn
- Pulmonary fibrosis
- Kyphoscoliosis
- Emphysema
What is surfactant produced by?
type II alveolar cells
What does surfactant consist of?
90% phospholipid, 10% protein
What does surfactant do?
Acts as a detergent to reduce alveolar surface tension
How does the surfactant reduce alveolar surface tension?
- Increases pulmonary compliance
- Prevents atelectasis
- Aids alveolar recruitment
- Minimises alveolar fluid
What illness is surfactant deficient in?
Infant respiratory distress syndrome (premature babies do not produce enough)
What is Pulmonary Fibrosis?
Pulmonary fibrosis is a condition in which the lung tissue becomes thickened, stiff and scarred over a period of time, becomes less elastic.
What is Kyphoscoliosis?
A deformity of the spine characterized by abnormal curvature of the vertebral column in two planes (coronal and sagittal). It is a combination of kyphosis and scoliosis
What is a Circumferential burn?
A burn that goes all the way round the body. The scar tissue is inelastic and restricts the expansion of the chest.
What is emphysema?
Type of COPD. It means destruction of the lung. In emphysema, the breathing tubes are narrowed and the air sacs are damaged.
What can cause alveoli in dependent lung regions to be poorly ventilated?
When the closing capacity exceeds the functional residual capacity
What is the law of Laplace in relation to the lungs?
According to the law of Laplace, the alveolar surface tension for a particular alveolar radius must be opposed by an appropriate transmural pressure.
How does the body stop smaller alveoli from collapsing and emptying into larger alveoli?
By producing surfactant which reduces the surface tension of the alveoli.
What happens to surfactant as alveolar volume increases?
It becomes more dispersed - and each alveolus produces the same amount of surfactant.
How is turbulent flow different from laminar flow?
- Increased flow
- Reduced calibre
- Branching
Is laminar flow more efficient than turbulent flow?
Yes. Work increases by the power of 2 in turbulent
What percentage of your energy expenditure is the work of breathing in health at rest?
2-5% of energy expenditure
What percentage of your energy expenditure is the work of breathing at maximal hyperventilation?
30% of energy expenditure