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physiology allied health > Unit 4: Respiratory System > Flashcards

Unit 4: Respiratory System Flashcards

1
Q

O2 path

A

environment -> lungs -> blood -> body tissue

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2
Q

CO2 path

A

body tissue -> blood -> lungs -> environment

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3
Q

general function of respiratory system

A

obtain O2 for use by body cells and eliminate CO2 body cell production

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4
Q

two separate but related respiratory system processes

A
  • internal respiration
  • expiration respiration
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5
Q

internal respiration

A
  • cellular respiration within the mitochondria for aerobic energy
  • oxidative phosphorylation
  • an exchange of gases between the cells of the body and the blood
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6
Q

external respiration

A

exchange of oxygen and carbon dioxide between atmosphere and body tissues

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7
Q

O2% in air

A

21

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8
Q

nitrogen % in air

A

79

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9
Q

external respiration steps

A
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10
Q

ventilation definiton

A

gas exchange between the atmosphere and alveoli in the lungs

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11
Q

does the brain control the atria and ventricles contracting simultaneously

A

no, no neural input

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12
Q

ways to lower resting heart rate

A

exercise

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13
Q

average heart rate

A

70

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14
Q

average breaths per minute

A

12

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15
Q

average heart size

A

6L

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16
Q

secondary functions of respiratory system

A
  • short term regulation of pH (acid-base balance)
  • enable speech, singing, and other vocalizations
  • defend against pathogens in airways
  • removes, modifies, activates or inactivates materials passing through pulmonary circulation
  • eliminate heat and water
  • assist venous return
  • nose is the smell organ
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17
Q

why do we humidify the air we breathe

A

to help gas exchange

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18
Q

upper airway anatomy and labeled

A
  • nasal cavity (nose)
  • oral cavity
  • pharynx
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19
Q

does the pharynx allow passage of food/drink or air

A

both

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20
Q

conducting zone anatomy and labeled

A
  • larynx
  • glottis
  • trachea
  • cartilage rings
  • left lung
  • right lung
  • primary bronchi
  • secondary bronchi
  • tertiary bronchi
  • terminal bronchioles
  • diaphragm
  • terminal bronchiole
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21
Q

respiratory zone anatomy and labeled

A
  • terminal bronchiole
  • respiratory bronchioles
  • alveolar sac
  • alveoli
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22
Q

alveoli

A
  • site of gas exchange
  • high capillary net
  • pores of kohn
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23
Q

trachea structure

A
  • 2.5 cm diameter
  • 10 cm long
  • c-shaped cartilage bands for structural rigidity
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24
Q

primary bronchi structure

A
  • right and left
  • rings of cartilage
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25
Q

secondary bronchi structure

A
  • 3 right side (to 2 lobes of right lung)
  • 2 left side (to 2 lobes of left lung)
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26
Q

tertiary bronchi structure

A
  • 20-23 orders of branching
  • up to 8 million tubules
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27
Q

bronchioles structure

A
  • less than 1 mm diameter
  • no cartilage, risk of collapse
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28
Q

how bronchioles minimize risk of collapse

A

walls of elastic fiber and smooth muscle

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29
Q

air passageway volume and function

A
  • 150 mL volume
  • dead space
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30
Q

functions of the conducting zone

A
  • air passageway
  • increase air temperature to body temperature
  • humidify air
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31
Q

epithelium of the conducting zone

A
  • process: mucus escalator
  • goblet cells
  • ciliated cells
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32
Q

goblet cells of the conducting zone

A
  • secret mucus
  • trap foreign particles
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33
Q

ciliated cells of the conducting zone

A

propel the mucus up the glottis to be swallowed or expelled

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34
Q

what is paralyzed in the conducting zone in smokers and how do they compensate

A
  • ciliated cells
  • cough to expel mucus
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35
Q

function of the respiratory zone

A

exchange gases between air and blood by diffusion

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36
Q

epithelium of the respiratory zone

A
  • epithelial cells of alveoli
  • endothelial cells of capillary
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37
Q

pores of kohn function

A

permit airflow between adjacent alveoli (collateral ventilation)

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38
Q

3 alveoli cell types

A
  • type 1 alveolar cells
  • type 2 alveolar cells
  • alveolar marchophages
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39
Q

type 1 alveolar cells

A
  • walls of alveoli
  • single layer epithelial cells
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40
Q

type 2 alveolar cells

A
  • secrete surfactant
  • reduce surface tension in alveolar walls
  • helps prevent alveolar collapse
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41
Q

alveolar macrophages

A

removes foreign particles

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42
Q

respiratory membrane diffusion barrier width and composition

A
  • 0.2 microns thick
  • alveoli (type 1 cells and basement membrane)
  • capillaries (endothelial cells and basement membrane)
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43
Q

hypoxemia

A
  • low O2 carrying capacity
  • inefficient gas exchange
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44
Q

pleural sac composition

A
  • visceral pleura
  • parietal pleura
  • intrapleural space
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45
Q

three pressures important in ventilation

A
  • atmospheric (barometric) pressure
  • intra-alveolar (intrapulmonary) pressure
  • intrapleural pressure (intrathoracic pressure)
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46
Q

atmospheric pressure

A
  • 760 mmHg at sea level
  • decreases as altitude increases
  • normally other lung pressure given relative to atmospheric (set Patm = 0 mmHg)
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47
Q

intra-alveolar pressure

A
  • pressure of air in alveoli
  • varies with respiration phases (negative or less than atmospheric during inspiration; positive or more than atmospheric during expiration)
  • difference between Palv and Patm drives ventilation
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48
Q

intrapleural pressure

A
  • pressure inside pleural sac
  • varies with respiration phases (at rest, 756 or -4 mmHg
  • always less than Palv
  • always negative under normal conditions at rest
  • negative pressure due to elasticity in lungs and chest wall (lungs recoil inward, chest wall recoils outward, opposing pulls on intrapleural space, surface tension of intrapleural fluid hold wall and lungs together - H2O molecules are polar, attract to each other -, sub-atmospheric P due to vacuum in the pleural cavity)
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49
Q

functional residual capacity (FRC)

A

volume of air in lungs between breaths

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50
Q

what does pneumothorax cause

A

collapsed lung

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51
Q

traumatic vs spontaneous pneumothorax

A
  • traumatic: physical trauma to the chest (ex: puncture wound in chest wall)
  • spontaneous: sudden onset of a collapsed lung without any apparent cause (ex: hole in lung)
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52
Q

mechanics of breathing

A
  • atmospheric pressure is constant
  • changes in alveolar pressure create gradients
  • Boyle’s law
  • alveolar pressure can change by volume change
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53
Q

air flow equation

A

R = resistance to air flow (resistance related to radius of airways and mucus)

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54
Q

boyle’s law

A

pressure is inversely related to volume in an airtight container

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55
Q

factors determining intra-alveolar pressure

A
  • quantity of air in alveoli
  • volume of alveoli
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56
Q

intra-alveolar pressure during inspiration

A
  • lungs expand, alveolar volume increases
  • Palv decreases
  • pressure gradient: air into lungs
  • quantity of air in alveoli rises
  • Palv increases
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57
Q

intra-alveolar pressure during expiration

A
  • lungs recoil, alveolar volume decreases
  • Palv increases
  • pressure gradient: air out of lungs
  • quantity of air decreases
  • Palv decreases
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58
Q

respiratory muscle activity during inspiration

A
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59
Q

principle muscles of inspiration

A
  • external intercostals (elevate ribs)
  • interchondral part of internal intercostals (also elevate ribs)
  • diaphragm (domes descend, increase chest dimension and elevate lower ribs)
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60
Q

accessory muscles of inspiration

A
  • sternocleidomastoid (elevates sternum)
  • scalenus anterior middle and posterior (elevate and fix upper ribs)
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61
Q

muscles of expiration during quiet breathing

A

passive recoil of lungs

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62
Q

muscle of expiration during active breathing

A
  • internal intercostals (except interchondral parts)
  • adbominal muscles (depress lower ribs, compress abdominal contents)
  • rectus abdominis
  • external oblique
  • internal oblique
  • transversus abdominis
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63
Q

respiratory muscle activity during expiration

A
64
Q

flow-volume loop

A

a plot of inspiratory and expiratory flow (on the Y-axis) against volume (on the X-axis) during the performance of maximally forced inspiratory and expiratory maneuvers

65
Q

factors affecting pulmonary ventilation

A
  • lung compliance
  • airway resistance
66
Q

lung compliance

A
  • ease with ehich lungs can be stretched
  • less compliant lungs = more work required to produce a given degree of inflation
  • affected by elasticity and surface tension of lungs and alveoli
67
Q

airway resistance

A
  • affected by passive forces, contractile activity of smooth muscle and mucus secretion
  • increased in pathologies
68
Q

quiet breathing requires what % of total energy expenditure

A

3

69
Q

lungs normally operate at …

A

half full

70
Q

work of breathing is increased in which situations

A
  • pulmonary compliance decrease
  • airway resistance increase
  • elastic recoil decrease
  • increased ventilation needed
71
Q

spirometer

A

measures the amount of air you can breathe out in one second and the total volume of air you can exhale in one forced breath

72
Q

(pulmonary) minute ventilation definition

A

total volume of air entering and leaving respiratory system each minute

73
Q

minute ventilation equation

A

V(T) x RR

74
Q

normal minute ventilation

A

500 mL x 12 breaths/min = 6000 mL/min

75
Q

alveolar ventilation

A
  • volume of air exchanged between the atmosphere and alveoli per minute
  • less than pulmonary ventilation due to anatomical dead space
  • more important than pulmonary ventilation
76
Q

anatomical dead space

A
  • volume of air in conducting airways that is useless for gas exchange
  • 150 mL in adults
77
Q

why does hyperventilation not allow for oxygen to come in

A

old air is not fully pushed out, pushed down during inspiration, no new O2 able to enter

78
Q

high volume = ______ resistance

A

low

79
Q

perfusion definition

A

blood flow

80
Q

does gravity affect perfusion or ventilation more

A

perfusion

81
Q

two main classifications of respiratory diseases

A
  • obstructive
  • restrictive
82
Q

obstructive respiratory diseases

A
  • airway narrowing
  • increased airway resistance
  • reduced flow during expiration
83
Q

restrictive respiratory diseases

A
  • reduced compliance
  • scar tissue formation
  • fibrosis
84
Q

obstructive respiratory disease examples

A
  • emphysema
  • chronic bronchitis
  • asthma
85
Q

restrictive respiratory disease example

A

pulmonary fibrosis

86
Q

fibrosis

A

thickening or scarring of tissue

87
Q

other conditions that impair diffusion of O2 and CO2

A
  • neuromuscular disorders (affect inspiratory muscle contraction)
  • inadequate perfusion (gas exchange)
  • ventilation:perfusion imbalances
88
Q

forced expired volume (FEV)

A
  • measures how much air a person can exhale during a forced breath
  • over 80% is normal, under 80% is a sign of disorder
89
Q

what is used to diagnose obstructive respiratory diseases

A

forced expired volume tests

90
Q

forced vital capacity

A

the total amount of air exhaled during the FEV test

91
Q

asthma clinical symptoms

A
  • airway hyper-reactivity
  • reversible airway narrowing
  • mucous thickening
  • smooth muscle constriction by spasms in small airways
  • most common childhood respiratory disease
  • severe narrowing is lethal
92
Q

asthma causes

A
  • allergens, pollens, animal fur, dust
  • smoking, smog, airborne pollutants
  • changes in air temp, humidity, pressure
  • exercise
  • emotional stress, anxiety
93
Q

asthma treatment

A
  • bronchodilators
  • anti-inflammatory
  • O2
94
Q

bronchitis clinical symptoms

A
  • airway wall inflammation
  • excessive mucous production
  • airway narrowing and coughing (but cough cannot get rid of mucous)
  • reversible
95
Q

bronchitis causes

A
  • bacterial and viral infections
  • smoking
  • airborne pollutants
  • chronic irritation
96
Q

emphysema clinical symptoms

A
  • irreversible
  • destruction of alveolar walls (small airway collapse)
  • enlargement of air sacs
  • increased lung compliance via destruction of elastic fibers, excessive release of trypsin enzyme (trypsin can break alveolar walls), and reduced elastic lung recoil (trapped air)
97
Q

emphysema causes

A
  • smoking induced inflammation
  • cilia destruction, tar accumulation
  • airborne contamination
  • genetic lack of anti-trypsin production
98
Q

pulmonary fibrosis

A
  • diffuse interstitial lung disease
  • results from over 130 disorders
99
Q

pulmonary fibrosis clinical symptoms

A
  • reduced elasticity
  • reduced compliance of lung and chest wall
  • increased work to breathe
  • slim patients (breathing requires effort)
100
Q

pulmonary fibrosis causes

A
  • no known cause in 2/3 of cases
  • asbestos fiber breathing (also causes lung cancer)
  • inflammation
  • scar tissue formation
101
Q

total pressure

A

the sum of all partial pressures

102
Q

partial pressures of a gas depend on

A
  • fractional concentration of the gas
  • total pressure of gas mixture
103
Q

composition of air

A
  • 79% nitrogen
  • 21% oxygen
  • trace amounts carbon dioxide, helium, argon, etc.
  • water depends on humidity
104
Q

ficks’ law (rate of diffusion)

A
  • Vgas = rate of diffusion
  • A = surface area (increases during exercises, more pulmonary capillaries open, alveoli expand for deep breaths)
  • T = thickness (normally constant, increases in pathological conditions)
  • (triangle)P = pressure difference
  • D = diffusion constant
  • S = gas solubility
  • MW = molecular weight
105
Q

CO2 diffusion rate is ? than O2

A

2x bigger

106
Q

do O2 and CO2 equilibrate at similar rate

A

yes

107
Q

at rest blood spends ? sec in the capillary

A

0.75

108
Q

normal O2 and CO2 equilibrium within how much time in capillary transit

A

1/3 (0.25 sec)

109
Q

O2 and CO2 diffusion process affected by

A
  • exercise (risk of exercise induced arterial hypoxemia in highly trained athletes)
  • thickening of blood-gas barrier
110
Q

pulmonary oedema

A
  • fluid accumulation in alveoli and/or interstitial space
  • impairs diffusion (higher distance from alveoli to blood)
  • leakage in unprotected capillaries
  • increases breathing work (decreased
  • in arterial blood: lower PO2 and higher PCO2
111
Q

causes of pulmonary oedema

A
  • increased capillary pressure (via left heart failure)
  • reduced atmospheric pressure at altitude
112
Q

pulmonary oedema treatment

A

administering oxygen and diuretics

113
Q

2 forms of oxygen transport

A
  • 1.5% dissolved in plasma
  • 98.5% bound to hemoglobin
114
Q

hemoglobin (Hb)

A
  • found only in red blood cells
  • tetrameric globular protein with 4 hem groups
  • cooperative reversible binding of up to 4 O2 molecules, 4 CO2 molecules (normally 2 at most in venous blood)
  • transports 98.5% of O2 in blood
  • function: greater oxygen carrying capacity
115
Q

changes in affinity of hemoglobin for oxygen

A
  • describes changing affinity of Hb for O2
  • right shifted = decreased oxygen affinity (wants to give oxygen away)
  • left shifted = increased oxygen affinity (reluctance to release oxygen)
116
Q

3 forms of CO2 transport

A
  • 10% dissolved
  • 30% bound to Hg
  • 60% bicarbonate (HCO3-) mostly in plasma
117
Q

hypoxia definition

A

insufficient cellular O2

118
Q

types of hypoxia

A
  • hypoxic hypoxia
  • anemic hypoxia
  • circulatory hypoxia
  • histotoxic hypoxia
119
Q

hypoxic hypoxia

A
  • low PaO2 (hypoxemia) -> reduced Hb saturation
  • inadequate gas exchange
  • low PB
  • cyanosis (skin bluish tint) = <70% Hb saturation
120
Q

anemic hypoxia

A
  • reduced total blood O2 content with normal PaO2
  • reduced circulating rbcs; reduced rbc Hb content
  • CO poisoning (no cyanosis - HbCO is pink, pale skin)
121
Q

circulatory hypoxia

A
  • reduced supply of oxygenated blood with normal O2 content and PaO2
  • vessel blockage, congestive heart failure
122
Q

histotoxic hypoxia

A
  • O2 delivery to tissue normal but cells unable to use it
    = cyanide poisoning (cyanide blocks essential enzymes for cellular respiration)
123
Q

hyperoxia

A

above normal arterial O2 (O2 toxicity)

124
Q

effect of hyperoxia on a healthy person

A

no big effect

125
Q

effect of hyperoxia with other diseases with reduced PaO2

A
  • can improve gradient but can be dangerous as high O2 can damage brain (cause blindness)
  • when O2 is the main driver of ventilation: high O2 can increase the risk of decreased peripheral chemoreceptor sensitivity
126
Q

types of abnormal PaCO2

A
  • hypercapnia
  • hypocapnia
127
Q

hypercapnia

A
  • excess PaCO2
  • via hypoventilation
  • occurs with most lung diseases
  • occurs in conjunction with reduced PaO2
128
Q

hypocapnia

A
  • below normal PaCO2
  • via hyperventilation
  • occurs with anxiety and fear
  • no impact of PaO2 (except at low PB where low PaO2 stimulates hyperventilation)
129
Q

hyperpnea

A

increased breathing/ventilation to match metabolic demand (exercise)

130
Q

basic respiratory control centers in the brain stem

A
131
Q

peripheral chemoreceptors location

A
  • carotid bodies (near baroreceptors in carotid sinus)
  • aortic bodies (aortic arch)
132
Q

peripheral chemoreceptors function

A
  • respond to reduced PaO2 (<60 mmHg)
  • respond to increased PaCO2 and hydrogen (provide 20% respiratory drive)
  • aortic bodies rarely respond to reduced total arterial O2 content (anemia, carbon monoxide poisoning)
133
Q

central chemoreceptors location

A

the medulla

134
Q

central chemoreceptors function

A

detect changes in pH

135
Q

effects of arterial O2 on ventilation

A
  • not much of a change until PO2 </= 60 mmHg
  • response due to activation of peripheral chemoreceptors only
136
Q

effects of arterial CO2 on ventilation

A
  • large effects of PCO2 on ventilation
  • effects mediated through both central and peripheral chemoreceptors but CO2 must be converted to H+ first
137
Q

hypoventilation negative feedback

A
138
Q

hyperventilation negative feedback

A
139
Q

increasing altitude __________ respiration

A

increases

140
Q

cause of hyperventilation as an adaptation to altitude

A

reduced PaO2 acting on carotid body peripheral chemoreceptors

141
Q

adaptation to altitude (hyperventilation)

A
  • CO2 clearance increases
  • blood pH increases
  • respiratory alkalosis reduces ventilation
  • to prevent alkalosis: kidneys excrete bicarbonate ions, more acid remains in the blood, alkalosis reversed, pH normal in 2-3 days
  • ventilation increases again
142
Q

polycythemia

A
  • body’s reaction to high altitude
  • RBC and Hb content increase in order to increase O2
  • hypoxemia stimulates EPO from kidney after 3 hours (stimulates reticulocytes reticulocyte maturation and release)
  • despite reduced PaO2 and Hb saturation
  • total O2 content may be normal or elevated
  • elevated blood viscosity (increased cardiac work)
143
Q

other adaptations to altitude

A
  • right shifted O2-Hb dissociation curve moderate altitude (better unloading at tissue level, caused by increase in 2,3-DPG)
  • left shifted O2-Hb dissociation curve high altitude (better loading at pulmonary capillaries, caused by respiratory alkalosis)
  • improved diffusion capacity (expanded surface area via greater lung volume on inflation, angiogenesis or increased tissue capillarisation)
  • endothelial cells release up to 10 times more nitric oxide
  • reduced skeletal muscle fiber size with increased oxidative capacity and mitochondria numbers
144
Q

acute mountain sickness symptoms

A
  • headaches, loss of appetite, insomnia, nausea, vomiting, dyspnea
  • 6 hours to 48 hours after arrival to altitude (most severe days 2 and 3)
  • worse at night (respiratory drive reduced)
  • 15% higher in women
  • physical condition has no effect
  • higher altitude = more severe
145
Q

high altitude pulmonary/cerebral oedema

A
  • linked to pulmonary vasoconstriction (hypoxia), high protein oedema fluid from damaged capillaries
  • fluid accumulation leads to persistent cough, shortness of breath, cyanosis of lips and fingernails and loss of consciousness
  • could lead to high altitude cerebral oedema (fluid accumulation in cranial cavity)
  • treatment: descending to lower altitude and supplemental oxygen
146
Q

altitude training strategies to maximize sea-level performance

A

live high and train high
- benefit: increase rbcs
- problem: difficult to train at same volume/intensity as at sea level

live high and train low
- most effective
- problem: logistics and finances
- new modalities (hypoxic sleeping devices/houses)

live low and train high
- weak effect

intermittent hypoxia at rest
- wear effect

147
Q

respiration at depth

A
  • total pressure increases
  • gas partial pressures increase
  • problems: gas cavities (lung and middle ear) compress with descent and over-expand with ascent, behavior of gases
148
Q

nitrogen narcosis

A
  • at sea level: N2 is poorly soluble, low N2 dissolved
  • at depth: increased nitrogen partial pressures leads to increases nitrogen solubility; high nitrogen dissolved in blood and fatty substances (influences ion regulation and neurons); increased depth = increased nitrogen dissolved
  • increased nitrogen solubility leads to reduced neuron excitability leads to nitrogen narcosis
149
Q

nitrogen narcosis at 50 m (150 ft)

A

euphoria and drowsiness

150
Q

nitrogen narcosis at 50-90 m (150 - 300 ft)

A
  • fatigue and weakness
  • loss of coordination
  • clumsiness
151
Q

nitrogen narcosis at 100-120 m (350-400 ft)

A

lose consciousness

152
Q

nitrogen narcosis prevention

A
  • use nitrogen free gas
  • helium substitute
  • 100% O2 not appropriate (O2 toxicity)
153
Q

decompression sickness in diving

A
  • during rapid ascent and decreased pressure
  • N2 less soluble, N2 comes out of solution (bubble formation = champagne cork effect)

effects depend on size and location of bubbles
- gas embolus in circulation (tissue iscaemia) may be critical in brain, coronary, or pulmonary circulations, avascular necrosis common in head of femur
- bubble formation in the myelin sheath (compromise nerve conduction in dizziness or paralysis)
- bubble/gas expansion (the bends in muscle and joints, ear: vestibular disturbances and deafness, lung: tissue rupture with increased bubble dispersal and multiple emboli)

154
Q

decompression sickness prevention

A
  • slow ascent (depends on depth, time, N2 wash in and wash out times, tissue types)
  • N2 gas replacement (half solubility of N2)
  • exhale during ascent
155
Q

decompression sickness treatment

A

recompression

physiology allied health (6 decks)

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