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Ventilation and lung mechanics Flashcards

1
Q

What is ventilation?

A

the process of inspiration and expiration

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2
Q

What occurs in the respiratory centre of the brain?

A

neurones generate automatic rhythmic impulses which are responsible for the normal involuntary rhythmic breathing patter

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3
Q

How do the impulses travel in the body to initiate breathing?

A

via the spinal cord and peripheral nerve to the inspiratory muscles

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4
Q

How is air drawn in the airways in tidal breathing?

A

air is draw into the airways by active expansion of the external intercostal muscles which expands the lungs

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5
Q

What is necessary in quiet inspiration (pressure)?

A

-pressure in the alveoli must be lower than atm pressure

-

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6
Q

Just before you breathe in, what is the pressure inside your lungs?

A

it is atmospheric pressure (then when you breath and increase volume, pressure drops below atm pressure drawing air in)

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7
Q

Why do the lungs move with the chest wall? (surface tension)

A

-normally want to recoil but because of pleural fluid found between visceral and parietal pleura in the inter pleural space and forms a seal between the lungs and thoracic wall so lungs expand with the thoracic cavity

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8
Q

What does the diaphragm do in tidal inspiration?

A

contracts and flattens

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9
Q

Why do the intercostal muscles need to contract in tidal breathing inspiration?

A

to overcome the forces of the lung recoil that are creating an inward force

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10
Q

What is the resting expiratory level?

A

a state of equilibrium where you have just expired and before you inspire again

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11
Q

In the resting expiratory level, what forces are acting on your thoracic cavity?

A

-lung recoil inwards
-chest wall recoil outwards
-diaphragm pulls down due to passive stretching
therefore you get no movement of the chest wall

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12
Q

What is the pressure in the intrapleural space?

A

negative (relative to atm)

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13
Q

Why is the pressure in the intrapleural space negative?

A

due to elastic recoil of lung pulling the visceral pleura in and the chest wall pulling the parietal pleura out

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14
Q

What happens if the integrity of the pleural seal is broken?

A

lungs will tend to collapse because the fluid surface tension is lost and lungs will recoil

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15
Q

How could the integrity of the pleural seal be broken?

A

-air in intrapleural space due to chest wound - due to negative pressure in intrapleural space, air would be drawn in from the atm

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16
Q

What is tidal volume?

A

the volume of air entering and leaving the lungs in a single breath during quiet inspiration and expiration

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17
Q

Whta is IRV?

A

Inspiratory Residial Volume - The extra volume of air that can be breathed in when effort in applied

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18
Q

What is ERV?

A

Expiratory Residual volume - The extra volume of air that can be breathed out when effort is applied

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19
Q

What is RV?

A

Residual volume - The volume of air left in the lungs after maximal expiration *RV = FRC-ERV

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20
Q

What is VC?

A

Vital capacity - The biggest breath than can be taking in fro the maximal inspiration to the maximal expiration (5L)

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21
Q

What is TLC?

A

Total Lung Capacity - vital capacity plus residual volume

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22
Q

What is IC?

A

Inspiratory Capacity - volume of air breathed with maximal inspiration after quiet expiration

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23
Q

What is FRC?

A

Functional residual capacity - The volume left in the lungs at the end of quiet expiration

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24
Q

What is FRC also known as?

A

the resting end expiratory level

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25
Q

How is the FRC determined?

A

the balance of elastic forces of the chest wall (outwards), elasticity and surface tension of the lung (inwards)

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26
Q

What is the net effect of these elastic forces in FRC?

A

the forces balance each other and crate a negative pressure within the intrapleural space relative to atm

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27
Q

How is quiet inhalation done?

A
  • diaphrgam (70%) contracting and flattening

- external intercostal muscles

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28
Q

How is quiet exhalation done?

A

passive due to elastic recoil and pleural seal

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29
Q

How is forced inhalation done?

A

require accessory muscles - SCM, scalene, serrates anterior and petoralis major

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30
Q

How is forced exhalation done?

A

no longer passive - requires internal and innermost intercostals and abdominal wall muscles (external and internal oblique muscles and the rectus abdominus)

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31
Q

What volume of pleural fluid if found in the intrapleural space?

A

10ml (not much at all)

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32
Q

What does “work of breathing” refer to?

A

Energy is expended during inspiration to stretch the lungs and overcome airways resistance

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33
Q

What is compliace?

A

the stretchiness of the lungs (the volume changer per unit pressure change)

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34
Q

What does high compliance mean?

A

the higher the compliance, the easier the lungs stretch

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35
Q

How does compliance relate to lung volume?

A

the higher the lung volume, the higher the compliance

36
Q

How is compliance of the lung determined?

A
  • elastic tissue in lung

- surface tension forces of fluid lining alveoli

37
Q

What forces need to be overcome in order to stretch the lungs?

A

elastic recoil forces on the lungs inwards

38
Q

What could cause lower compliance? (think about how compliance is determined)

A

-high surface tension will make the lungs harder to stretch - due to making it harder for the alveoli to expand and therefore lungs to expand

39
Q

How is surface tension created?

A

alveoli lined by fluid (limits their expansion)

40
Q

What is surfactant secreted by?

A

type 2 pneumocytes in the alveoli

41
Q

When does surfactant production start?

A

24 weeks

42
Q

When is surfactant production adequate?

A

at 35 weeks!

43
Q

What does surfactant do?

A

reduces surface tension which increases lung compliance

-stabilises the lung preventing small alveoli collapsing into big ones

44
Q

Why are smaller alveoli more favourable than larger alveoli?

A

In larger alveoli, the surfactant molecules are spread further apart making them less effective at disrupting the surface tension so the surface tension will increase as the alveoli size increases and an increased surface tension decreases compliance making it harder to do forced inspiration rather than quiet inspiration

45
Q

What is surfactant?

A

complex mixture of phospholipids and proteins with detergent properties

46
Q

THE HYDROPHILLIC ENDS OF THESE MOLECULES LIN IN THE ALVEOLAR FLUID

A

THE HYDROPHOBIC ENDS PROJECT INTO THE ALVEOLAR GAS therefore they float of the surface of the lining fluid

47
Q

Why is the resistance to air flow through the bronchioles great in expiration that inspiration?

A

In inspiration, as the alveoli expand, the radial traction on the bronchioles is greater. During expiration, the radial traction will be less and the lump of the bronchioles will be smaller increasing the resistance to air flow in expiration

48
Q

How does surfactant stabilise the lungs?

A

smaller alveoli have higher pressure than larger alveoli so more likely to collapse in to them but as surfactant removes the ST in small alveoli they have equal pressure to large ones and don’t collapse in

49
Q

What part of the respiratory tract has the least resistance?

A

upper tube as larger tubes

50
Q

So why are the smaller alveoli low resistnace too?

A

they are connected in parallel

51
Q

What is radial traction?

A

(the parenchyma exerted an outwards pull on the small bronchioles to keep them open - radial traction)

52
Q

What is elasticity?

A

the ability of the lungs to return to their normal shape after being stretched (elastic recoil)

53
Q

How is lung elasticity determined?

A

by the amount of elastin in the elastic fibres int he connective tissue of the lungs and the surface tension of the fluid lining the alveoli

54
Q

What is the difference between the structure of the bronchiole and a small bronchus?

A

Small bronchus has small islands of cartilage and glands in the submucosa - bronchioles have none of that

55
Q

What keeps the bronchiole lumen open?

A

surrounding alveoli and the radial traction (outward tugging of the surrounding alveolar walls on the bronchioles)

56
Q

What keeps the bronchiole lumen open?

A

surrounding alveoli and the radial traction (outward tugging of the surrounding alveolar walls on the bronchioles)

57
Q

What are obstructive disorders?

A

group of disorders characterised by obstruction of normal airflow due to airway narrowing

58
Q

What are the obstructive disorders?

A 
Asthma
COPD
Bronchiectasis
CF
Tumours
59
Q

What are restrictive disorders?

A

A condition resulting in stiffer lungs which can’t expand to normal volumes

60
Q

What are the restrictive disorders?

A

Pulmonary fibrosis
interstitial lung disease
Sarcoidosis
Asbestosis

61
Q

What conditions would make airway resistance increase?

A
  • chronic bronchitis
  • asthmas
  • emphysema
62
Q

What is interstitial lung disease?

A
  • a disorder characterised by stiff lungs
  • end result is tissue injury and fibrosis
  • due to fibrous tissue in the interstitium
63
Q

What is the pathophysiology of interstitial lung disease?

A
  • the lungs are stiffer and harder to expand due to the deposition of collagen fibres which are less stretchy than elastin fibres
  • this decreases lung compliance
  • the elastic recoil is increased (as considers both elastin and collagen fibres)
  • lungs become smaller due to increase elastic recoil
  • causing restrictive type defect
64
Q

On examination, what would you find with someone with interstitial lung disease?

A
  • reduced chest expansion
  • IC and VC is reduced
  • end inspiratory lung crepitations
  • pleural effusion
  • clubbing
  • tachypnoea (increased resp rate)
  • bilateral reduced chest movement
65
Q

What symptoms would a patient with interstitial lung disease present with?

A
  • dry cough
  • SOB
  • Dyspnea on exertion
  • fatigue
  • gradual symptoms
66
Q

What is the diffusion problem with interstitial lung disease?

A

Thickening of the alveolar walls increases the distance oxygen has to diffuse from alveolar air to the blood (or CO2 from the blood)

67
Q

What are some causes of interstitial lung disease?

A
  • asbestos
  • drugs (methotrexate)
  • Connective tissue disorders
  • sarcoidosis
  • idiopathic
68
Q

What is respiratory distress syndrome in the new born?

A

-caused by deficiency of surfactant in premature babies

69
Q

Why does surfactant deficiency cause RDS?

A

no surfactant means surface tension is increased

  • makes it harder for the lungs to expand and some alveoli will remain collapsed after birth so no gaseous exchange can occur
  • lung compliance is decreased
  • increased effort to breath
70
Q

What are the signs of RSD?

A
  • grunting
  • nasal flaring
  • intercostal and subcostal retractions
  • rapid resp rate
  • cyanosis
71
Q

How is RDS treated?

A
  • steroids to promote surfactant production

- surfactant replacement via an endotracheal tube

72
Q

What is emphysema?

A

-loss of elastin and breakdown of alveolar walls due to chronic inflammation of cells and neutrophils releasing elastase which breaks down the elastin

73
Q

What is the effect of loss of elastin?

A
  • lung compliance is increased

- reduced elastic recoil

74
Q

What is the most noticeable sign of emphysema?

A

-barrel chest

On CXR will get flattening of diaphragm too

75
Q

Why does barrel chest occur?

A

due to the loss of elastic recoil, the lungs (at rest) are more expand than normal (hyper inflated)

76
Q

Why are airways narrowed in emphysema?

A

due to loss of elastic fibres exerting an outward pull on the small bronchioles (radial traction)

77
Q

What is a rarer cause of emphysema?

A

alpha 1 anti-trypsin deficiency (inherited condition)

78
Q

What does A1ATD lead to?

A

an imbalance in proteinases and antiprloteinases leading to destruction of elatin and emphysema

79
Q

What is asthma?

A

a chronic inflammatory process which may be triggered in susceptible individuals by allergic/non-allergic stimuli

80
Q

What does this chronic inflammation cause?

A

causes airway narrowing due to bronchial smooth muscle contraction, thickening of airway walls by mucosal oedema and excess mucus production partially blocking the lumen

81
Q

What is a pneumothorax?

A

condition where air enters the pleural space with the loss of the pleural seal and lung collapse

82
Q

Why does a lung collapse if air gets into the pleural space?

A

pleural seal is broken so the elastic recoil of the lung causes it to collapse inwards as the -ve pressure of the of the intrapleural space and the outward record of the chest wall no longer counteract it

83
Q

What are some other causes of a collapsed lung?

A
  • atelectasis (incomplete expansion of the lungs (neonatal)) - alveoli don’t expand at birth
  • pleural effusion (fluid in the cavity)
  • abdiminal distention (compresses alveoli)
  • airway obstruction
84
Q

How is a pneumothorax treated?

A

drain the air from the pleural space using a chest drain with an underwater seal (this prevents fluid or air from entering the pleural cavity

85
Q

What can cause hypoventilation?

A
  • due to poor expansion of the thoracic cavity or lungs
  • injuries to brain stem (ventilation is controlled by impulses in the respiratory centre)
  • severe thoracic wall deformities
  • resp failure
  • phrenic nerve injury

Resp (8 decks)

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