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Human Body_TP > Respiratory System Physiology > Flashcards

Respiratory System Physiology Flashcards

1
Q

types of epithelium in the lungs

A

columnar epithelium —> stratified epithelium with mucosy material that traps small particles in microns

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2
Q

what types of particles get through the layers?

A

silica, bugs, and bacteria that are too small to be trapped go through the air space

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3
Q

functions of lung

A

-gas exchange- take in O2 for body to function and exhale CO2
-filter inspired air
-defends against inhaled particles
-immunological surveillance- lung is exposed to the outside environment
-peptide processing- produce and process peptides that regulate functions

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4
Q

what do we need to do to breathe?

A

-breathing is automatic but we can induce it consciously
-breathing center in brainstem and regulates ventilation
-circulation is automatic- transport O2 to the tissues and the CO2 away
-respiration is automatic and affected by the environment

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5
Q

breathing: the steps

A

-respiration is regulated by CO2 levels in the blood and is affected by low O2 levels but the primary is CO2 levels
-stimulus to start breathing
-lungs expand/muscle contracts and muscles are in the ribcage (intercostal muscle) and diaphragm (men use diaphragm more than women) —> creates negative pressure in chest and expands lung
-air comes in (higher in O2 than CO2)
-gets carried to alveoli and O2 gets diffused to capillaries
-O2 gets picked up by hemoglobin and CO2 will diffuse to alveolar space and when you exhale it gets removed
-pulmonary veins carry oxygen rich blood and carried to left ventricle and CO2 gets carried to lungs
-exhaled air with oxygen and CO2 goes out
-process begins again

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6
Q

anatomy

A

-respiratory bronchiole (last airway)- in the beginning they are lined by ciliated columnar epithelium then it flattens to cuboidal then flat
-in the alveolar duct you have flat epithelia, which branches into alveolar sacs that contain alveoli —> increases surface area
-capillaries are lined with endothelial cells that have a permeable cytoplasm and junctions between them
-permeability varies depending on conditions like if there is inflammation in the cytoplasm, the permeability will increase

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7
Q

how many cell types line aveolar spaces?

A

two types

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8
Q

type I pneumocytes

A

-flat cells in the cytoplasm that are difficult to see under a microscope and the nuclei are small
-basement membrane underneath

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9
Q

type II pneumocytes

A

-bigger and plumper so they are easier to spot and they produce surfactant, which decreases the tension of surfaces to keep them open
-basement membrane underneath

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10
Q

what are the layers air goes through?

A

air and cells travel through the cytoplasm —> basement membrane —> cytoplasm —> capillary space

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11
Q

what do macrophages do?

A

-air spaces have macrophages to clean up
-if one macrophage can’t do it, a bunch of them will fuse together to create one big macrophage

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12
Q

what are the types of giant cells?

A

osteoclasts, langerhan cells, and foreign body giant cells

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13
Q

arteriole wall

A

-airways, air spaces, and alveoli
-alveoli are composed of the alveolar wall, capillaries, and flat big cells called type I and type II pneumocytes

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14
Q

what do clinicians do for premature babies who do not produce enough surfactant?

A

-inject surfactant into them
-they can also give steroids to accelerate maturation of cells and supplemental O2 but have to be careful not to give too much O2 since that can be toxic

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15
Q

how does air travel from the terminal bronchioles?

A

respiratory bronchioles (lined by ciliated columnar epithelium) —> alveolar duct —> atrium —> alveolar sac (flat)

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16
Q

how do we decide to breathe?

A

central controller (brain stem) gives output to effectors (respiratory muscles), which send to sensors (chemoreceptors and stretch receptors) and they will give input back to the brainstem to increase/decrease breathing

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17
Q

central chemoreceptors

A

-from the capillaries, CO2, H+, and HCO3 will diffuse from the blood-brain barrier to the extracellular fluid and the chemoreceptors will react to the CO2 and pH environment
-receptors are located near the ventral surface of the medulla
-sensitive to the CO2 in the blood but not the O2
-chemoreceptors are based in CSF —> CO2 to get across to ECF then CSF to drop pH

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17
Q

CO2 and O2 stimulate ventilation

A

-as CO2 levels increase, they stimulate ventilation and the level of ventilation depends on the amount of O2 in the air
-in the presence of hypoxia, move in more air to get the same amount of O2 when there is less O2 in the air
-low pH can also mean that there is more CO2 in the blood

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17
Q

peripheral chemoreceptors

A

-located in the carotid and aortic bodies
-respond to decreased arterial PO2 and increased PCO2 and H+
-rapidly responding
-only receptors that respond to decreased arterial PCO2
-these will kick when you have high altitude or hypoxia since the central chemoreceptors are more sensitive to CO2

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18
Q

ventilatory response to hypoxia

A

-only the peripheral chemoreceptors are involved (not in the brain)
-there is neglible control during normoxic conditions
-control becomes important in chronic hypoxic situations like the Himalaya and long-term hypoxemia caused by chronic lung disease —> want to move in more air to get the same amount of O2
-brain allows you to have high CO2 and people need hypoxic drive to breathe

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19
Q

how do we move air into lungs?

A

-lung has airways and air spaces
-bronchus- areas with cartilage
-bronchioles- areas without cartilage
-peripheral lung has few bronchi
-terminal bronchioles split into respiratory bronchioles and into alveoli

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20
Q

how many layers are there to airways?

A

-23 levels
-go 16 branching to get to the terminal bronchiole
-go 6 or 7 levels of branching, each airway branches into 2-3 branches
-no respiration in the conduction zone —> dead space volume that is 150 mls vs the volume of the alveolar region being 2.5-3 liters

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21
Q

what does the space in airways do?

A

-does not participate in respiration
-conducts the air to alveolar space for respiration
-called the dead space

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22
Q

physiological dead space

A

-anatomical dead space- fairly constant and spans up to level 16
-alveolar dead space- varies and spans levels 17-19
-these together make up the physiological dead space

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23
Q

cross section and airway generation

A

at level 16 the terminal bronchioles end and you see the exponential increase in the airway generation
-increase in cross-sectional area of the airways is due to the number of airways increasing —> past level 16 there are more branches that come off

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24
Q

airway resistance

A

-resistance changes depending on the size of the airways
-highest at 5th generation airways then decreases at terminal bronchiole
-in the beginning, the resistance goes up since the trachea gets smaller then as you divide further you have a decrease in resistance so very low in small airways since they tent up and there are so many that the air has many choices

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25
Q

why does resistance decrease as lung volume increases?

A

-large airways with a lot of cartilage don’t change much
-small airways have smooth muscle and elastic tissue that pulls them to a certain size but not more —> decreases resistance since the airways are pulled open
-elastic fibers in alveolar walls help keep them open but they are larger than airways
-negative pressure opens up capillaries
-breathe in dense gas, increase resistance

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26
Q

bronchial smooth muscle

A

-bronchial smooth muscle is controlled by the autonomic nervous system —> the stimulation of beta-adrenergic receptors causes bronchodilation
-in diseases where these malfunction like asthma or small airway disease —> airways contract and small glands make mucus so the thick mucus makes the airways narrower

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27
Q

how do you treat asthma?

A

-relaxing the muscle and filtering mucus
-taking steroids to reduce inflammation

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28
Q

total lung volume

A

6 liters

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29
Q

tidal volume

A

-certain amount of volume that moves into and out of the lungs during a breath
-1/12 of the total volume

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30
Q

crude way of measuring someone’s chest

A

-have patient breathe in and out and use tape measure to measure the circumference
-people with emphysema have barrel chests and use their diaphragm to breathe

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31
Q

expiratory reserve volume

A

extra air above normal that can be exhaled during forceful exhalation

32
Q

what is minute ventilation?

A

respiratory rate * tidal volume
Ex. the tidal volume is 500 ml and frequency is 15 1/min —> minute ventilation is 7500 ml/min and of the 7500, 5250 is used for alveolar ventilation

33
Q

tidal volume

A

dead space + alveolar volume

34
Q

pulmonary capillary blood + pulmonary blood flow

A

blood in pulmonary capillary is 70 ml amd pulmonary blood flow is 5000 ml/min —> push through the whole volume in one minute

35
Q

what are lungs covered by?

A

mesothelioma (pleura) with mesothelial lining and mesothelial cells are flat cells

36
Q

what does the mesothelium do?

A

provides a slippery, non-adhesive and protective surface that allows the pleura that covers the chest wall and the chest to slide together with virtuospace

37
Q

pneumothorax

A

-puncture chest wall/lung —> air will go from inside to outside and virtuospace increases
-negative pressure during inhalation is absent and the lung collapses
-if someone has a pneumothorax from a gunshot wound or knife, do not remove the object that is causing it so that the space can remain partially closed

38
Q

CT scan of pneumothorax

A

-in the CT scan, you see a big, black space which is air
-you have to suck the air out or inject something to make the surfaces stick together

39
Q

spontaneous pneumothorax

A

typically happens in young men who are tall and skinny and lack collagen

40
Q

surfactant

A

-reduces surface tension
-produced by type II pneumocytes
-reduces lung compliance if it is absent and can cause pulmonary edema

41
Q

how can lack of surfactant lead to pulmonary edema?

A

-it causes the alveoli to close or not open properly —> abnormal gas exchange
-lack of surfactant can lead to RDS, which can lead to pulmonary edema

42
Q

pulmonary circulation

A

-gas has to go from air to the lung
-pleura has systemic arteries, veins, lymphatics, and interlobular septa where the veins and lymphatic channels run to collect venous blood from the alveoli
-pulmonary arteries are running with airways and carrying venous blood to right heart
-systemic arteries are small and they provide enough oxygen to keep the tissue viable

43
Q

alveoli radiograph

A

-dark structures are red blood cells
-cross section through capillary and alveolar wall
-one alveolus
-alveoli is very thin @ 0.2-0.3 microns
-enormous surface area of 50-100 m^2
-very thin and can be easily damaged —> too much pressure to get air into lungs like on a ventilator with positive pressure and overextend the lung

44
Q

alveolus: sheet of blood

A

-holes are little spaces between cells where cellular components go through
-output of right heart goes to lung with lower pressures and into pulmonary arteries
-diameters of capillaries is 7-10 microns
-blood spends ~0.75 seconds in capillaries
-capillary segments are so short it seems like a sheet of blood

45
Q

vessels on the bronchus

A

-some lymphatic channels in the airway walls but most run with arteries and veins
-see lymphatic channels in disease processes or increased pressure in the venous system
-sometimes tumors get into lymphatic channels and you can see the channels that way
-pulmonary artery branches off the bronchus —> goes to capillaries along alveoli —> drain into pulmonary veins

46
Q

pulmonary vs systemic circulation pressures

A

-pressure in aorta of LV is 120/80 and as you go down to the capillary bed it becomes 30 then 20 and 10 in venous system
-osmotic pressure in blood —> normally the fluid doesn’t ooze out of capillary to tissue
-in the right heart you go up the right atrium and the pressure is 2 and the left heart results in 25/15 then decreases to 8 in the pulmonary veins
—> pulmonary circulation has much lower pressures than the systemic circulation (makes sense since pumping blood out to the whole body and not just the lungs)
-pulmonary artery- only artery in the body that carries deoxygenated blood (low pressure system)

47
Q

what is pulmonary hypertension?

A

-narrowing of lumen in the arteries
-walls thicken and the fibrin in the arteries narrows them and leads to hypertension high V/Q
-arteries get big and pop out with pink smooth muscle fibrosis and the walls are bigger

48
Q

how do we increase blood flow in the pulmonary circulation?

A

-increase in blood vessels or bigger ones (proliferated vessels don’t go away and can affect gas exchange but the widening of the vessels is reversible)
-increase in venous pressure due to obstruction can back up pressure to lungs —> creates chronic congestion and proliferation of capillaries

49
Q

why do more blood vessels affect gas exchange?

A

the heart must pump more blood through the additional vessels

50
Q

lung volumes vs pulmonary vessels

A

-when you breathe in, the blood vessels dilate a little but arterioles have a muscular wall and won’t be affected by negative pressure —> capillaries will dilate a little
-as the lung volume grows, capillaries open up a little and resistance decreases
-as the lung volume continues to grow, resistance grows too b/c the extra alveolar vessels dilate and capillaries thin out
-optimal condition and change in either direction results in increased resistance
-as you breathe in resistance to blood flow decreases in the extra-alveolar vessels and increases in capillaries for U-shaped curve

51
Q

ventilation and circulation

A

unobstructed air flow will result in gas exchange in the alveolar spaces where venous blood is oxygenated and arterial blood is present in pulmonary venous system

52
Q

discrepancy between perfusion and ventilation (V/Q mismatch)

A

-disruptions to air flow or blood supply decreasing or right to left shunt —> arterial blood less oxygenized
Ex. air volume is 4 liters/min and blood volume is 5 so ratio is air volume/blood volume —> 0.8 (normal) BUT of air volume goes down and blood volume is less or if blood volume increases

53
Q

high V/Q mismatch

A

-results in dead space and inadequate perfusion and adequate ventilation
-V/Q > 0.8 (blood volume decreases or air volume increases)
Ex. pulmonary embolism since the blood clot blocks flow in vessels

54
Q

low V/Q mismatch

A

-adequate perfusion and inadequate ventilation
-V/Q < 0.8 (increase in blood volume or decrease in air volume)
Ex. obstruction in airways, tumors, fluids, or toxic gases

55
Q

right-to-left shunt

A

-occurs when blood flows from the right side of the heart to the left, causing oxygen-poor blood to bypass the lungs and return directly to the body
-normal ventilation but you have a capillary that never sees an alveolar unit so it can’t pick up oxygen —> blood is shunting away from lung

56
Q

gas exchange

A

-O2 diffusion on the x-axis is time in the capillary and in normal O2 diffusion at the alveolar level
-curve flattens to the right, which signals abnormal condition and grossly abnormal is when the line is flatter (may take a full 0.75 of a second to pick up O2 before the RBC leaves capillary)
-some have grossly abnormal lungs they can’t pick up enough O2 before the RBC leaves —> even if you gave them enough O2, you couldn’t get to high enough threshold

57
Q

O2 transport: how to determine how much O2 is in the blood?

A

cardiac output * arterial O2 content

58
Q

arterial O2 content

A

dissolved O2 + Hb-bound O2

59
Q

what is Hb-bound O2?

A

O2 that is available for oxygenation of tissues

60
Q

how can Hb-O2 be found?

A

1.39 ml O2 * Hb (mg/ml) * (Hb sat/100)
-Hb can greatly change your O2-carrying content
-as O2 grows so does the hemoglobin saturation but exponentially
-Hb concentration affects O2 content and saturation —> in male it is 13-15 and 10 is low but functional so you start transfusing @ 6 or 7 but don’t want to transfuse before that
-more Hb you have, the less you require O2 saturation

61
Q

shifts in oxyhemoglobin dissociation curve

A

-lower body temp shifts the curve to the left so you need less O2 to get same saturation
-higher body temp shifts the curve to the right
Ex. when you have a fever you’re good for awhile but eventually it will require more O2
-increased pH levels, higher capnia, and DPG can shift levels to the right —> high PCO2 the further the curve goes to the right since you need more O2 in the air space for same saturation
-lower body temp the hemoglobin holds on to the oxygen

62
Q

gas concentrations in different compartments

A

-in arterial blood we lose O2 and venous blood has fairly constant level of PCO2 and it dramatically increases during inspiration
-higher PCO2 concentration in alveoli —> greater respiratory volume and increases inspiration
-% of saturation –> higher saturation means a lower level of ventilation for oxygen
-O2 is highest in the air, lower in lungs, less in arterioles, and you lose it in the tissues and CO2 is the highest

63
Q

inspiration (inhalation)

A

air flowing into the lungs

64
Q

expiration (exhalation)

A

air leaving the lungs

65
Q

lung diseases

A

airway disease, vascular disease, and parenchymal disease

66
Q

emphysema

A

-obstructive lung disease where the lung volume increases and alveolar tissue gets destroyed —> spaces increase and total surface decreases
-V/Q > 0.8 since there is a decrease in surface from the alveolar tissue being destroyed and the elasticity decreasing —> decrease in blood flow
-overinflated lung with loss of elasticity and small airways narrow down —> respiration not as efficient

67
Q

fibrosis

A

-caused by a buildup of scar tissue, which leads to constricted airways and mucus buildup in air spaces,
-alveoli are destroyed and the airways are obstructed by fibrosis
-prevents gas exchange and volume of lung shrinks
-diffusion goes down
-in a normal lung, the alveoli are uniform
-low V/Q < 0.8 since the ventilation is disrupted

68
Q

terminal bronchiole in a normal lung

A

-lymphocytes and macrophages
-air spaces don’t have macrophages

69
Q

asthma

A

-large airway with cartilage
-submosal salivary glands that become hyperplastic and secrete mucus into air spaces and bulge out
—> leads to smaller arteries and contraction of the airways
-low V/Q mismatch since adequate profusion and inadequate ventilation
-use bronchodilators to treat them
-airways that have less cartilage, the smooth muscle will be where cartilage is and gets hypertrophic
-smaller bronchiole and the smooth muscle is not prominent

70
Q

what comprises COPD?

A

emphysema and chronic bronchitis

71
Q

rhinitis

A

inflammation of the mucosa in the nose —> can block off the openings of the sphenoid, maxillary sinuses, and nasolacrimal —> causes headache by environment in bony sinuses doesn’t equal the external environment

72
Q

pulmonary hypertension with thrombo-embolis

A

-fibroblats grow in the lumen
-increases the blood flow
-higher blood pressure
-high V/Q since the profusion is inadequate but the ventilation is adequate
-can be treated with anti-coagulation therapy

73
Q

CT scans of normal vs emphysema

A

-little black holes of variable size, which represent air and the destruction of brachia
-black pigment is macrophages in interstitial fluid
-spaces are bigger or smaller in emphysema and classification is based on these spaces

74
Q

interstitial fibrosis

A

-when lungs become fibrotic and shrink —> they become rubbery and hard
-spaces with mucus and lined with respiratory epithelium
-airway epithelium replaces alveolar epithelium —> hinders breathing
-cystic spaces are filled with pink material or mucus —> no respiration occurs
-decreased V/Q since the profusion is adequate with inadequate ventilation —> air flow is compromised since the airways are surrounded by fibrosis and cannot expand

75
Q

restrictive lung disease

A

collagen is rigid and lung cannot expand —> air flow is decreased and the total lung capacity decreases

76
Q

residual lung volume

A

amount of air left in lung at the end of full expiration
Ex. people with asthma are closing earlier and trapping more air —> impedes ability to breathe

77
Q

pleural space

A

-causes negative pressure (chest wall wanting to expand while lungs want to collapse)
-fluid between visceral and parietal pleura

78
Q

pleural pressure

A

alveolar pressure - lung pressure

79
Q

normal V/Q relationship

A

-V is the ventilation and Q is the profusion
-each lung unit can have a slightly different V/Q relationship but under normal circumstances very uniform ventilation

Human Body_TP (25 decks)

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