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Patho II Exam 1 > Respiratory Ventilation > Flashcards

Respiratory Ventilation Flashcards

1
Q

what are the two types of respiration taking place within the body?

A

external respiration: which takes the gases (fresh air) from the environment and brings them into the lung

internal respiration: taking the gases from the blood and using it in the cells during cellular respiration

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2
Q

what is external respiration?
(another name) & what does the process include

A

also called ventilation

  1. takes environmental air into the lungs via inspiration
  2. removes waste product of CO2 from alveoli back to the environment via expiration
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3
Q

structures within the conduit (conduction portion of the airway)

& their function

A

structures
- nose
- pharynx
- trachea
- bronchi
- terminal bronchioles

function
- low resistance pathway allows for easy flow to lungs
- moistens the air
-nose filters
- protects against and removes FB, particles, etc.

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4
Q

How is the tracho-bronchial tree set up? which zones are conducting? which zones are respiratory?

A

tracho-bronchial tree is a dichotomous tree – each branch becomes 2

conducting zone: zones 0-16 where gas is just passing though (no gas exchange)

respiratory zone: 17-23 where gas exchange occurs –> the respiratory bronchioles, alveolar ducts and alveolar sacs

** sacs = majority of gas exchange**

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5
Q

what is the respiratory portion of the airway?

& whats its function

A

structures
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
- alveoli

function
- gas exchange

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6
Q

cell types within the alveoli

how do they interact with the capillary at the pulmonary interface?

A
  • type 1 pneumocyte: responsible for the exchange of gas via diffusion
  • type 2 pneumocyte: responsible for creating surfactant

Pulmonary interface –> connection between the basement membrane of the T1P and the capillary
- the basement membrane fuses with the capillary (THIN) to create this surface
** as large as a tennis court**

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7
Q

What forces are involved in ventilation?

A

ventilation: the force of moving air in and out of the lungs to effective reach the pulmonary interface

  1. muscles of respiration
  2. respiratory pressure
  3. surfactant
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8
Q

explain the muscles of respiration and how they work

A
  1. diaphragm
    - pulls DOWN on inhalation
  2. external intercostal muscles
    - pull OUT on inhalation

Result: collectively allows lungs to inflate as chest expands

  1. diaphragm
    - relaxes back up
  2. internal intercostal muscles contract
    - pulls in
  • lungs recoil – where they want to be

Result: chest contracts down & lungs retract in

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9
Q

explain the driving force (law) behind the air flow of ventilation

  • volume & pressure
A

Boyles Law –> with all else constant

  • increasing volume –> decrease pressure
  • decrease volume –> increase pressure
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10
Q

how is air pulled into and out of the lungs?

  • think pressures and changes in pressures
A
  • air will go from high pressure to low pressure –> want to create a lower pressure inside the alveoli to pull the air from atmosphere into the lungs
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11
Q

what are the relative pressures during inspiration

A

atmospheric pressure: 760 mmHg (pressure 0)

alveolar pressure: due to the contraction of muscles and increasing of the space (increase volume) –> decrease the pressure inside the alveoli (approx. -1 mmHg)

** thus, air will flow from the atmosphere into the lungs (alveoli) **

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12
Q

what are the relative pressures during expiration

A

atmospheric pressure: still 760 mmHG (pressure 0)

once the lung volume has reaching max capacity –> then muscle trigger to relax and the lung wants to collapse –> this triggers a decrease in volume –> thus triggering an increase in pressure (approx. +1 mmHg)

air flows from the alveoli to the atmosphere outwards

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13
Q

explain the mechanism of intrapleural pressure during inspiration and expiration

A

intrapleural pressure is always negative
(in healthy pts. approx. -4)

during inspiration:
- pleural space gets pulled with contraction of the muscles (increasing the potential space) therefore decreasing the pressure –> MORE NEGATIVE (approx. -6)

during expiration:
- the muscles relax, the space decreases in volume and therefore the pressure increases back to its baseline

** can vary from -2 –> -6**

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14
Q

explain what FRC is and how it’s maintained

whats it like in inspiration? expiration?

A

FRC: functional residual capactiy

  • the starting point for breathing –> point at which your breathe is not in or out
  • at this point: the pressure gradient is maintained because the force of the chest wall wants to pull out while force of the lungs wants to pull in – keeping them at a constant
  • at end inspiration: the FRC is +.5 L (500 mL)
  • at end expiration: back to 0
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15
Q

describe the pressures within a pneumothroax

A
  • ** pneumothorax = the intrapleural pressure is = to atmospheric pressure**
  • thus you loose the vacuum created to breathe
  • lungs cannot maintain expansion & collapse
  • uniliateral redcued ventilation
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16
Q

Explain the concept of lung compliance

what are the factors

A

lung compliance factors
- how easy the lung can inflate
- the amount of surface tension within the air-water interface of the alveoli

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17
Q

what are clinical correlations with lung compliance?

A

increased compliance: emphysema
- you have an increased ability to maintain an open airway because you’ve lost the elastic fibers of the connective tissue – but that becomes an issue because you cannot expell the air out
- alveoli walls are being destroyed so you additionally have a collapse of the alveoli & decreased gas exchange

decreased compliance: pulmonary fiberosis
- the walls of the alveoli are becoming more rigid and less elastic leading to the inability to inflate

18
Q

how does surfactant work? what is its role in lung compliance

A

surfactant is a lipoprotein coating the internal alveoli surface (made by T2P)

decreases the surface tension within the alveoli

** surface tension arises because of the cohesive bonds between liquid molecules & their desire to contract**

too much contraction of the alveoli will collapse them –> surfactant works to ensure that they stay open (small)

stabilize the alveoli (keep small open and keep large from overinflating)

19
Q

explain how increased fluid in the alveol will impact surface tension

A

increasing fluid within the alveoli (like pneumonia or CHF) will increase surface tension (between the air-water molecules) therefore causing the molecules to want to contract –> making it more difficult to breath

** would need pressures of -20 to -30 inside to drive respiration without surfactant**

20
Q

surfactant and infants

A
  • surfactant produced at the 7 1/2 month mark –> premi babies need ventilation to assist
  • respiratory distress syndrome of the newborn will require artificial ventilation
21
Q

what are the reliatve resistances to air flow by strucutre within the respiratory passage
(as percentages for each area of the respiratory tract)

A

nose: 50%
pharynx and larynx: 25%
chest airways: 25%

22
Q

what physiological properties will impact the resistance to airflow

A
  • MOST IMPORTANT: diameter of the conduit (think about asthma)
  • length of the airway (longer = more resistance)
  • smooth muscle tone (contracted = harder)
  • gas property
23
Q

what are some pathological changes that can happen to body that will increase resistance to airflow

A
  • inflammation of the airway
  • constriction of the airway
  • buildup of mucus within the airway (or other substances)
24
Q

how does asthma influence the resistance to airflow

A
  • inflammatory state –> triggers mucus secretion in excess
  • hyperresponsiveness of the airway –> smooth muscle contraction triggers decrease diameter of the airway
25
Q

how is ventilation distrubted throughout the lungs

A

majority of ventiliation occurs at the base of the lung
- because of gravity, lung hanging in cavity, etc.
- maximal gas exchange occurrs here

as more ventilation is needed, upper lobes are recruited

26
Q

explain the relationship between volumes and capacity

A

volume: amount of air (single quantity)
capacity: multiple volumes together

27
Q

define tidal volume

A

the volume of air inspired in a normal breath

should be approx. 500 mL in healthly indivdual

28
Q

define inspiratory reserve volume

A

the amount of air you can inspire (take in) after you have already inhaled regularly

the max amount of air inhaled possible

approx. 3100mL (3L)

29
Q

define expiratory reserve volume

A

the amount of air you can breath out after you have already exhaled

the max amount you can exhale

approx. 2100 mL

30
Q

define residual volume

A

the amount of air that will remain in the lungs after you have breathed everything out

it cannot be forced out

approx. 1200 mL

31
Q

define vital capacity

A

capacitiy – added up volumes
vital — what you are able to do while living!!

tidal volume + inspiratory reserve volume + expiratory reserve volume = VC

32
Q

define inspiratory capacity

A

the maximum amount of volume you can take in

tidal volume + inspiratory reserve volume = IC

33
Q

define functional residual capactiy

A

the total amount of exhale (able to be exhaled or not)

expiratory reserve volume + residual volume

34
Q

define total lung capactiy

A

sum of all volumes
tidal volume + inspiratory reserve + expiratory reserve + residual = 6000mL

35
Q

when is pulmonary function testing conducted?

A

for lung diseases…
- obstructive diseases
- restrictive diseases
- mixed diseases

** in attempts to quantify the decrease in pulmonary function and ventilation**

36
Q

what categorizes diseases as obstructive respiratory diseases

examples

A
  • restriction in the air flow due to resistance

examples
- asthma (resistance from mucus, inflammation & decreased diameter)
- chronic bronchitis (increased mucus)
- cystic fibrosis (increase mucus)
- COPD ( CB and asthma)
- emphysema (airway collapse resulting in air trapping at low pressures)

37
Q

what categorizes restrictive respiratory diseases

examples

A

decrease in pulmonary compliance (ability to inflate)

** so they require a greater force to ventilate**

examples
- respiratory distress syndrome (need more pressure)
- pulmonary fiberosis (fiberous tissue doesnt expand)
- scoliosis (need more force to move the bones)

38
Q

when doing a pulmonary function test, what are the most important measurements to note

A

FVC: forced vital capacity (total amount of air expelled during the test)
** affected by age, gender and body height**

FEV1 = forced expiratory volume in 1 second
** should be a % of the FVC – normal is 70%**

in obstructed diseases FEV1 is 20-30%

the ration of FEV1/FVC is useful for obstructive disease measurements

39
Q

what is the difference between anatomical and physiological dead space

A

anatomical: no gas exchange occurrs here (like the conducting spaces of the airway)

physiological: anatomical dead space but also areas where the surface has been damanged and can no longer exchange gas

40
Q

what is minute alveolar ventilation (MAV)?

equation?

A

amount of air that reaches the alveoli per minute

MAV = RR x (TV - physiologic dead space)
normal MAV = 4.5 L

Patho II Exam 1 (4 decks)

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