Unit 4 Flashcards
Consists of nasopharynx and oropharynx, which helps filter and moisturize air that is inhaled
Upper conducting airways
Begin at level of trachea and connects larynx to bronchi
Lower conducting airways
What does not occur in the conducting airways?
Gas exchange
Primary gas exchange units of lung
Alveoli
can also occur in bronchioles
The alveoli have two types of epithelial cells:
I- provides structure (elastin)
II- secretes surfactant
*also has alveolar macrophages to remove foreign material to lymph
These type of diseases/illnesses increase thickness of respiratory membranes, affecting diffusion of gases across the membrane
Fibrosis, interstitial edema, or pulmonary edema
This type of disease results in decrease in surface area of respiratory membrane, resulting in decreased alveolar gas exchange
Emphysema
The mechanical movement of gas (air) into and out of the lung
Ventilation
How to measure alveolar ventilation
ABG to assess PaCO2
Reduces surface tension by forming a monomolecular layer between the fluid lining the alveoli and air in the alveoli- contributes to functional residual capacity (FRC)
Surfactant
Measure of lung and chest wall distensibility (ease at which these structures can be stretched, determined by alveolar surface tension and elastic recoil of lung/chest wall)
Compliance
Increased compliance, lung/chest wall is abnormally easy to inflate and has lost elastic recoil
Emphysema (chronic overinflation of lungs)
Decreased compliance, lungs are stuff and difficult to inflate
PNA, edema, fibrosis, or adult respiratory distress syndrome (ARDS)
Reduced oxygenation of cells in tissues
Hypoxia
Reduced oxygenation of arterial blood
Hypoxemia
Most common cause of hypoxemia
Abnormal V/Q (ventilation-perfusion) ratio
Blood passing through the pulmonary circulation to be oxygenated
Perfusion
Ratio of airflow into the lungs divided by the pulmonary blood flow
Ventilation-Perfusion ratio
Delivery of air to some alveoli is obstructed (mucus or alveoli collapse from atelectasis), reduced oxygenation of alveoli
Decreased/low V/Q
Alveoli ventilation is normal but capillary perfusion is compromised (pulmonary embolus or MI)
High V/Q
Two major patterns of pulmonary dysfunction
Obstructive and Restrictive
Increased resistance to airflow as a result of caliber reduction in conducting airways (worse with expiration)
Obstructive Pulmonary Disease
3 most common forms of obstructive respiratory disorders
Asthma, emphysema, and chronic bronchitis
COPD consists of which two pulmonary disorders?
Emphysema and chronic bronchitis
Hallmark of obstructive pulmonary disease
Decrease in expiratory flow rate
Most common signs and symptoms of obstructive lung disorders
Dyspnea and wheezing
Maximum volume to which the lungs can be expanded
Total lung capacity (TLC)
Volume of air remaining (RV) in lungs after most forceful expiration is ________ in obstructive lung disease due to trapping of air during expiration
Elevated
Obstructive alteration characterized by spastic contraction of smooth muscle of bronchioles
Asthma
Obstructive disorder characterized by hyper secretion of mucus and chronic productive cough
Chronic bronchitis
Diagnosis of chronic bronchitis requires the following criteria….
Chronic productive cough for 3 consecutive months of the year for 2 consecutive years
Chronic bronchitis affects the following cells (2)
Goblet cells (mucus-producing cells in bronchi) and cilia (causing paralysis of cilia)
Distinguishing characteristic of chronic bronchitis
Chronic inflammation
Excess air in lungs due to loss of lung elasticity and reduction of alveolar surface area from destruction of alveolar walls and enlargement of air spaces distal to the terminal bronchioles
Emphysema
Amount of air that moves into and out of the lungs with each breath
Tidal Volume (TV)
Maximal amount of air that can be forcibly exhaled from the point of maximal inspiration
Vital Capacity (VC)
Volume of air remaining in the lungs at end-expiration
Functional Residual Capacity (FRC)
Total amount of air that the lungs can hold
Total Lung Capacity (TLC)
Inflammatory condition characterized by edema of supraglottic area, including epiglottis and pharyngeal structutes- mostly pediatric cases, bacterial, medical emergency
Epiglottitis
Abnormal collection of fluid in pleural cavity- occurs when rate of fluid formation exceeds rate of its removal
Pleural Effusion
Elevated LDH and protein in pleural fluid indicate what type of pleural effusion?
Exudative
incomplete expansion of the lung or portion of the lung due to compression or obstruction
Atelectasis
Two types of acute respiratory failure
Hypoxemia due to failure of gas exchange function and hypercapnia/hypoxemia due to ventilatory failure
ARF- areas of lung are ventilated but not perfused or when areas are perfused but not ventilated
Hypoxemia d/u failure of gas exchange- V/Q mismatching
ARF- impediment of gas exchange between alveolar air and pulmonary blood
Hypoxemia d/t failure of gas exchange- impaired diffusion
ARF- unable to maintain level of alveolar ventilation sufficient to eliminate CO2 and keep O2 levels normal
Hypercapnia/Hypoxemic respiratory failure due to ventilatory failure
Demyelination of white matter in brain, spinal cord and optic nerve
MS
Controls impulses of emotion, hunger, sexual arousal, and aggression
Hippocampus
Produces and responds to nonverbal signs of anger, avoidance, fear
Amygdala
Regulation of body temp, endocrine, regulation of emotional expression
Hypothalamus
Responsible for conscious and unconscious ability to maintain balance and posture
Cerebellum
Has ipsilateral control of body
Cerebellum
Has contralateral control of body
Cerebral cortex
Important center for control of respiration
Pons
Lowest portion of brain stem controlling autonomic nervous system- HR, RR, BP, cough, swallowing, vomiting
Medulla
Chronic progressive disorder of basal ganglia leading to reduction of dopamine
Parkinson disease
Neurogenerative disease characterized by senile plaques (accumulations of beta-amyloid protein) and neurofibrillary tangles (protein tau)
Alzheimer disease
Causes cellular changes that result in brain atrophy due to loss of neurons in hippocampus and cortex
Alzheimer disease
CVA that usually occurs with activity
Hemorrhagic CVA
CVA that usually occurs at rest, most common cause of stroke from atherosclerotic blood vessels in brain
Thrombotic CVA
CVA that causes aphasia or neglect and visual field abnormalities
Thrombotic CVA
CVA that usually affects MCA with sudden onset of symptoms
Embolic CVA
Small CVA infarcts that are located in deep non-cortical regions of the brain/brain stem that heal and form small cavities- can produce motor and sensory hemiplegia and clumsy hand syndrome
Lacunar infarcts
Lacunar infarcts can be a result of _____ or ______.
Chronic hypertension or diabetes
Bleeding of cerebral aneurysm that results in defective or injured vascular in subarachnoid space
Subarachnoid hemorrhage
Failure to excrete bilirubin results in _____.
Jaundice
Increased portal pressure and blood osmotic pressure results in _______.
Ascites
Associated with flapping tremor
Hepatic encephalopathy
Results from accumulation of toxins in the blood (mainly ammonia)- occurs as liver fails to transform or detoxify the blood because of poor hepatocyte function
o Causes osmotic pressure to increase, leading to brain swelling and cerebral edema
o Can lead to herniation and death
Hepatic Encephalopathy
Normally converted to urea in liver and excreted by kidneys
Ammonia
Transmitted by oral-fecal route, can be asymptomatic
Hepatitis A
Most common cause of chronic liver disease, cirrhosis, liver cancer
Hepatitis C
Transmitted through contact with infected blood, body fluids or contaminated needles or maternal transmission
Hepatitis B
Causes induction of immune response against viral antigen
Hepatitis B
Causes direct cellular injury
Hepatitis C
4 stages of hepatitis
Incubation, prodromal, icteric, and recovery
Occurs 2 weeks after exposure and ends with appearance of jaundice
Fatigue, n/v, HA, low-grade fever
RUQ pain, weight loss
Infection is highly transmissible at this phase
Serum ALT and AST start to show variable increases
Prodromal phase
Lasts 2-6 weeks
Jaundice is caused by hepatocellular destruction and intrahepatic bile stasis (less likely in HCV)
Urine dark colored and stools clay colored from conjugated bili (before onset of jaundice)
Actual phase of illness
Liver is enlarged, smooth and tender- results in abdominal pain that persists or becomes more severe
Jaundice lasts 2-6 weeks or longer- severe itching
Prolonged prothrombin time
Icteric phase
Chronic disease of liver characterized by the autoimmune destruction of intralobar bile ducts causing cholestasis
Clinical manifestations
Insidious onset, progressive scarring, destruction of liver tissue
Liver becomes enlarged and takes on a green huge from accumulated bile
Pruritis, itching, weight loss, fatigue, dark urine, pale stools, osteoporosis, jaundice, serum alk phos elevated
Primary biliary cirrhosis
Prolonged obstruction of extrabiliary tree
o Most commonly caused by cholelithiasis or malignant neoplasms of biliary tree or head of pancreas
Secondary biliary cirrhosis
Produced in fetuses when developing in the womb. Drops down to essentially 0 by age 1. High levels may be a sign of liver cancer. Tumor marker. <10 ng/ml is normal. Above 500 ng/ml is a sign of liver cancer.
Alpha-fetoprotein
Released during acute phase inflammatory response- liver increases synthesis- binds to surface of invading microorganisms and targets them for destruction by complement and phagocytosis
C-reactive protein
Most dramatic rise is seen in cases of acute hepatocellular injury (not specific to liver)
o Viral hepatitis (rises in prodromal phase)
o Hypoxic or ischemic injury
o Acute toxic injury or Reye syndrome
AST
Type of hormone: epinephrine, norepinephrine, thyroid, dopamine
Amines/amino acids
Type of hormone: growth hormone, thyrotropin releasing hormone, insulin
Peptides/glycoproteins
Type of hormone: derivatives of cholesterol, include the sex hormones like estrogen and testosterones
Steroids
Type of hormone: arachidonic acid, leukotrienes, prostaglandins
Fatty acid derivatives
Metabolizes and inactivates hormones, rendering hormones water soluble for renal excretion
Liver
Regulated by hypothalamic broth-releasing hormone, has direct actions that stimulates growth of cartilage and insulin-like effects of promoting fuel storage in various tissues
Growth hormones
Ant. pituitary
Produced upon stimulation of tRH from hypothalamus, travels to thyroid gland to stimulate synthesis of thyroid hormones (T4 and T3)
Thyrotropin (TSH)
Ant. pituitary
Has the greatest metabolic effects
T3
AKA tri-ido-thyronine
T3
AKA thyroxine
T4
T3 and T4 are made of…
Iodine
One of the most common autoimmune diseases
o Unique antithyroid antibody that acts like a thyroid stimulating hormone
Detectable in blood by lab test- thyroid-stimulation immunoglobulin (TSI)
Graves disease
Two signs of Graves disease
Goiter and exophthalmos
Nonbacterial inflammation of the thyroid
Often preceded by viral infection
Lasts 2-4 months
Spontaneous recovery
Subacute primary hypothyroidism
Most common cause of hypothyroidism (and goiter)
Autoimmune disorder- thyroid may be totally destroyed by an autoimmune process
Mostly seen in middle-aged women
Hashimoto primary hypothyroidism
Indicative of severe or long-standing hypothyroidism
o Increased TSH, decreased free T4
o Cold intolerance, low energy, increased weight, edema
o Presence of non-pitting edema caused by increased mucopolysaccharide in connective tissues
o Face takes on a puffy look, especially around eyes
o Tongue becomes enlarged, voice hoarse and husky
o Mucopolysaccharide deposits can occur in heart causing cardiac dilation, bradycardia, pleural and pericardial effusion
Myxedema hypothyroidism
Result of absent thyroid tissue or defects in thyroid synthesis
o Common cause of preventable mental retardation because thyroid hormone is important in mental development
o Can be identified within 1st week of life through state mandated infant metabolic screenings (IMS)
o Manifestations of untreated cases are known as cretinism
o If identified before 6 weeks old, can be reversed and results in normal intelligence
Congenital hypothyroidism
Secreted in response to a rise in blood glucose- from where?
Insulin from beta cells
Secreted when blood glucose levels are low- from where?
Glucagon from alpha cells
Hypoglycemia occurs when BS is under
45 (but can be as high as 60 in some)
Combo of nocturnal hypoglycemia followed by rebound hyperglycemia
Somogyi effect
Relative deficiency of insulin and increase in insulin counterregulatory hormones like catecholamines, cortisol, glucagon, growth hormone
o Causing blood glucose levels to rise rapidly as a result of glucogenesis
o Polyuria and dehydration follow
- Hepatic glucose production increases, fat mobilization stimulated, ketone levels rise (ketosis) as a result of the nearly total use of fatty acids to produce ATP
Ketoacidosis
DKA occurs in which DM?
DM I
Caused by chronic hypoxia of nerve cells by effects of hyperglycemia
Diabetic neuropathy
Caused by microvascular disease due to changes in small blood vessels called hyaline arteriosclerosis
Diabetic retinopathy and nephropathy
Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face.
Abnormal writhing movements
Chorea
Most disabling symptom of PD
Slowness in initiating and performing movements and difficulty with sudden, unexpected stopping of voluntary movements.
Bradykinesia
