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Clin Sci IMS, Respiratory, Renal, Cardiovascular, Nutrition & Energy > Week 11 - Respiratory > Flashcards

Week 11 - Respiratory Flashcards

1
Q

Describe the respiratory system

A
  • Supplies body with oxygen and removes CO2
  • Goblet cells and cilia o the trachea remove foreign particles
  • Large surface area for gas exchange created by the bronchi - bronchioles to then form the alveoli
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2
Q

What is pulmonary ventilation?

A

Inhalation and Expiration

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3
Q

Describe Breathing

A
  • Involuntary and voluntary control

Voluntary = cortical control - input from cerebral cortex

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4
Q

Describe regulation of breathing

A

Trachea, bronchial tree and lungs are innervated by autonomic nervous system
- Respiratory control centre located in the brainstem within the reticular formation through medulla oblongata and the pons

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5
Q

What are the reticular formation and the pons in the brainstem?

A

Reticular formation = interconnected nuclei localised in brainstem
Pons = largest part of brainstem above medulla oblongata and below mid brain - group of nerves connecting between cerebrum and cerebellum - acts as a bridge

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6
Q

What are the DRG and VRG?

A

Dorsal respirator group - influencing diaphragm which is the primary respiratory muscle
VRG- ventral respiratory group controlling expiration

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7
Q

What is the Hering Breuer reflex? (Inflation)

A

Prevent over inflation or excessive deflation of lungs controlled by two reflexes - inflation reflex and deflation reflex

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8
Q

Describe the inflation reflex

A

When lungs are inflated to maximum during inspiration, pulmonary stretch receptors send action potential to the medulla and pons in the brain through the vagus nerve
PRG - pontine respiratory group inhibits diaphragm to stop overinflation

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9
Q

Describe the deflation reflex

A

As inspiration stops expiration begins and lungs deflate

  • as the lungs deflate stretch receptors are deactivated and compression proprioreceptors are activated
  • Inhibitory signals stop and inhalation can begin
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10
Q

Describe proprioreceptors

A

Present in muscle and detect movements of the body which input into the respiratory centres playing a role in stimulating the increase in ventilation that occurs in exercise

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11
Q

Describe the conducting and respiratory zones

A 
Conducting = branches air into and out of the site of gas exchange 
Respiratory = lined with alveoli where gas exchange occurs
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12
Q

Describe the airway divisions

A

Divided into two functional zones
First generations of 16 branches conducting zone and conducts air into deeper lung
Second generation 7 branches participate in gas exchange and comprise as the respiratory zone

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13
Q

Describe the conducting zone composition

A

Airways lined with mucus secreting ciliated cells that remove inhaled particles
Trachea is 11cm long and begins at C6
At T4/5 trachea bifurcation and consists on c shaped cartilage rings

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14
Q

Describe the respiratory mucosa

A

Pseudostratified ciliated columnar epithelial cells that secrete mucus, found in nose, sinuses, pharynx, larynx and trachea

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15
Q

Describe bronchus positions

A

Left bronchus branches at an angle due to positioning of the heart so foreign bodies tend to go down right bronchus

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16
Q

What is the broncho pulmonary segment?

A

Discrete anatomical and functional unit of the lung that can be removed without disturbing the other lunch segments function
Right lung has 10 segments and left lung has 9-10 segments

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17
Q

Describe alveolar gas exchange

A

200 million alveoli, gas exchange occurs efficiently as alveoli walls are thin with a large surface area
Contains alveolar macrophages to carry debris to the upper airway and is 200um to 500 um

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18
Q

How thin is the alveolar capillary membrane?

A

0.5um

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19
Q

Describe the left and right lungs

A

Left lung - 2 lobes superior and inferior
Right lung - 3 lobes superior, middle lobe and inferior lobe
lobes separated by horizontal and oblique fissure in right lung and only oblique fissure in left lung

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20
Q

Describe the lobules of the right and left lung

A 
Left = 9-10 
Right = 10
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21
Q

Describe lung pleura

A

Pleural cavities formed by two serous membranes - Parietal pleura and Visceral Pleura
Pleural fluid lubricates the pleural space and prevents friction during respiration and holds membranes together

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22
Q

Describe the parietal Pleura innervation

A

Somatic fibres from intercostal nerves and phrenic nerves

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23
Q

Describe the visceral pleura nerve stimulation

A

Innervated by fibres from the cervical and thoracic sympathetic chain and parasympathetic fibres from the vagus nerve

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24
Q

Describe a tension Pneumothorax

A

Entry of air into the pleural cavity resulting from penetrating wound of the parietal pleura results in collapse of the lung

  • Air is sucked into the pleural cavity due to negative pressure
  • Surface tension adhering visceral to parietal pleura will be broken and the lung will collapse
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25
Q

What are the blood circulations that supply the respiratory system?

A

Pulmonary Circulation

Bronchial Circulation

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26
Q

Where does the phrenic nerve originate?

A

C3-C5 Spine

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27
Q

What are the main respiratory muscles?

A
  • Diaphragm
  • Sternocleidomastoid
  • Trapezius
  • Scalenes
  • Pectoralis minor
  • External/ Internal Intercostals
  • Rectus abdominals
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28
Q

What is functional residual capacity of the lungs?

A

Volume of gas remaining in the lungs after normal expiration

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29
Q

What muscle further increases volume of the thorax?

A

Sternocleidomastoid

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30
Q

What is Boyles Law?

A

Pressure of gas is inversely proportional to the volume of gas

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31
Q

Describe a collapsed lung

A
  • Elastic recoils of the lung gives elastic properties of the alveolar walls
  • Surface tension - the formation of droplets in the alveoli can cause alveolar membranes to be drawn together resulting in alveolar collapse
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32
Q

What can collapsed lungs be prevented by?

A

Increase surfactant and intra pleural pressure

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33
Q

Describe surfactant

A

Secreted by alveolar epithelium and consists of a mix of lipoproteins
Attractive force with surfactant = 4mmHg
Attractive force without surfactant = 20 - 30 mmHg

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34
Q

Describe compliance of the lung and the thorax and how it is measured

A

The ability of the lung to expand, measured in increased lung volume per unit pressure change in intrapulmonary pressure
1 cm increase in intrapulmonary pressure increases volume by 0.13L

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35
Q

What is tidal volume for a healthy young male and female?

A 
Male = 500ml 
Female = 300ml
36
Q

What is expiratory volume?

A

Entire emptying of the lungs - forced

37
Q

What is the residual volume?

A

Air remaining after forced expiration

38
Q

What is inspiratory capacity?

A

Tidal vol + Inspiratory reserve vol

39
Q

What is inspiratory reserve volume?

A

The extra vol of air that can be inspired after normal quiet inspiration

40
Q

Where in the respiratory system does gas exchange not occur?

A

Dead Space

41
Q

What is the anatomical dead space?

A

Volume taken up by nasal cavity to terminal bronchioles (150ml)

42
Q

What is alveolar dead space?

A

Volume of alveoli with no blood flowing through their pulmonary capillaries - non functional alveoli (25ml)

43
Q

What is physiological dead space?

A

Anatomical dead space + Alveolar dead space = 175ml

44
Q

What sets the basic rhythm for respiration?

A

Medullary neurones in the medulla oblongata, however it can be influenced by other parts of the brain and peripheral sensory systems
- Negative feedback control

45
Q

Describe the apneustic area

A

Spontaneous action potential to stimulate inspiratory area which stimulates pneumotaxic area to inhibit apneustic area therefore inhibit inspiration area

46
Q

Where are the aortic bodies and peripheral chemo receptors?

A

Aortic bodies in aortic valves

Peripheral in carotid artery

47
Q

What is hypercapnia ?

A

Too much pCO2

48
Q

What is Hypocapnia?

A

Too little CO2

49
Q

Describe how increase and decrease in pH affects respiratory rate

A

Decrease pH = increase respiratory rate as hypercapnia

Increase pH = decrease in respiratory rate as hypocapnia

50
Q

Describe filtration in the upper respiratory tract

A

Turbulence in the upper respiratory tract and large surface area allows inhaled particles to become trapped in mucus lining in the mucosa

51
Q

Describe mucocillary transport

A

Cillia of mucosa beat in rhythmic ways to carry trapped particles to pharynx and digestive system

52
Q

What is the immunological tract within the respiratory system?

A

Tonsils and adenoids = rich in lymphatic tissue, macrophages inject particles and function as antigen presenting cells

53
Q

Describe alveolar macrophages

A

Special form, do not disintegrate alveoli, destroys any pathogenic material before it causes damage to the alveoli

54
Q

What are the bacterias causing tuberculosis and pneumonia ?

A

Tuberculosis - Myobacterium

Pneumonia - Streptococcus, virus or fungi

55
Q

Describe type 1 and type 2 alveolar cells / pneumocytes

A

Type 1 - squamous epithelial cells for gas exchange

Type 2 - produce surfactant to reduce surface tension of alveolar fluid

56
Q

Describe elastase and how it decreases elasticity

A

Elastase is a serine protease targeting extracellular matrix material elastin

57
Q

Describe elastase in neutrophils and macrophages

A

Deactivated by serine protease inhibitor alpha - 1 anti trypsin which can be inhibited by oxygen radicals

58
Q

What does a vitalograph look at?

A

Looks at change in force of vital capacity of the lungs

59
Q

What is a chylothorax?

A

Lymphatic fluid leakage into pleural cavity, lungs and chest wall

60
Q

What is empyema?

A

Pus gathers between lungs and inner surface of chest wall - pleural space

61
Q

What is the nerve supply to the parietal and visceral pleura?

A

Parietal - Phrenic nerve

Visceral - Vagus nerve

62
Q

What is in the right lung root / lung hilum ?

A
  • Right pulmonary arteries
  • Superior + Inferior pulmonary veins
  • Right superior lobular bronchus
  • Intermediate bronchus
  • Right inferior lobular bronchus - seen form posterior
  • Pulmonary ligament
63
Q

What is in the left lung root / hilum?

A
  • Pulmonary artery
  • Pulmonary veins
  • Superior bronchus
  • Inferior bronchus
  • Pulmonary ligaments
64
Q

What separates the lobes of the right and left lung ?

And what two things does the left lung have but right does not?

A

Right - Horizontal fissure and oblique fissure

Left - oblique fissure also cardiac notch and lingula

65
Q

What is the main blood supply to the lungs?

A

Bronchial artery stemming from the aorta

66
Q

Describe the pressures in the right lung split into lobes

A 
Due to gravity 
Right Lung
Superior lobe - 
alveolar >arterial>venous 
Middle lobe - 
Arterial pressure>alveolar>venous 
Inferior lobe
arterial>venous>alveolar
67
Q

What is the principle of gas exchange?

A

Gas molecules move randomly in a net direction from regions of high concentrations to low concentrations
High to low partial pressures

68
Q

Describe partial pressures

A

Atmospheric = 760 mmHg

Pressure exerted on each type of gas is calculated as total percent of air

69
Q

Describe gas diffusion into liquids

A

Gasses dissolve into liquids until equilibrium is met

70
Q

What is henrys law?

A

Dissolved gas concentration = partial pressure of gas x solubility coefficient

71
Q

Describe nitrogen narcosis

A

Nitrogen has a low solubility coefficient and increased diffusion of nitrogen can be induced in high pressure environments causing confusion, bright colours
Nitrogen permeates the membrane and changes the fluidity decreasing the functionality ion channels

72
Q

Describe decomposition sickness

A

Rapid changes from high to low pressure can cause dissolved gasses particularly nitrogen to come out of solution and cause bubbles to form in tissues

  • leads to joint pain, dizziness, shortness of breath, extreme fatigue, paralysis and loss of conscious
  • can counter effects by spending time in a decomposition chamber
73
Q

Describe hyperbaric oxygenation

A

When partial pressure of oxygen increases as does diffusion of oxygen
- many bacteria are anaerobic so treatment in a chamber with high O2 concentrations at pressures of 3-4 atmospheres can treat these infections
Also used for carbon monoxide poisoning

74
Q

Describe the order the of structures the gasses diffuse through from the alveoli

A 
Alveolar fluid 
Alveolar wall 
Basement membrane 
Interstitial space 
Basement membrane of capillary 
Capillary endothelium
75
Q

What are the 4 factors that effect diffusion of gasses across the respiratory membrane?

A
  1. Thickness of the membrane - 0.5mm without disease
  2. Diffusion coefficient - higher coefficient = for effective for thicker tissue caused by disease for example
  3. Surface area - larger = better respiratory membrane should be around 70m^2 - functional surface area changed with disease status
  4. Partial pressure of gasses difference across the membrane - PO2 = high in alveoli and low in alveolar capillaries
    PCO2 = high in alveolar capillaries and low in alveoli
76
Q

Describe blood flow and respiratory rate

A

Normally should be close matched

77
Q

Describe shunted blood

A
  1. when ventilation exceeds the ability of the blood to take up the oxygen this can be as a result of heart failure
  2. When blood supply to the lungs exceeds the ventilation rate twos results in the lungs not containing enough O2 to saturate the blood passing through the alveolar capillaries. This partially oxygenated blood = shunted blood
78
Q

What is a physiological shunt?

A

Deoxygenated blood combined with deoxygenated blood arising from bronchial artery

79
Q

Describe regional blood flow

A

Blood flow in different regions of the lungs varies depending on exercise
A person standing at rest will only ventilate using the lower portion of the lungs. pO2 within the alveoli of the upper lung will decrease and CO2 in alveoli will rise. causing vasoconstriction of arterioles supplying the effected alveoli with deoxygenated blood therefore decrease in blood flow to that region.

80
Q

Describe the oxygen and carbon dioxide diffusion gradients and partial pressures

A
  • O2 in alveoli pp104 mmHg moves down pressure gradient into capillaries with ppO2 of 40 mmHg
  • When the oxygenated blood reaches the pulmonary vein ppO2 = 95 mmHg due to addition of some deoxygenated blood from the bronchial veins
  • Interstitial fluid has ppO2 = 40 mmHg and cells have ppO2 = 20mmHg so O2 diffuses into cells
  • Cells produce CO2 and ppCO2 = 46 mmHg
  • ppCO2 in interstitial fluid = 40mmHg
  • deoxygenated blood pumped back to lungs ppCO2 = 45mmHg and CO2 diffuses into alveoli as ppCO2 in alveoli = 40mmHg
81
Q

Describe erythropoiesis stimulation

A

Stimulated by low ppO2 by increase formation of glycoprotein, erythropoietin in the kidneys - induces the bone marrow to make more RBC

82
Q

Describe how temperature effects haemoglobin

A

Increased temperature, haemoglobin undergoes further conformational changes so affinity decreases for oxygen so haemoglobin releases 90% of O2
- Lower temp in lungs O2 affinity increases so more o2 in exercise

83
Q

Describe 2,3-bisphosohoglycerate

A

Modifies affinity of haemoglobin for O2, produced by erythrocytes and decreases affinity for haemoglobin for O2.

84
Q

What are the three ways CO2 is transported?

A

Dissolved in plasma 8%
Combined with blood 20%
Bicarbonate ions 72%

85
Q

Describe the chloride shift

A

CO2 diffuses into erythrocytes and reacts with water to form carbonic acid, this dissociates into H+ and carbonate ions.
Bicarbonate ions diffuse out of erythrocytes into blood plasma chloride ions move into erythrocytes from blood to maintain the charges
- System reverses occurs as CO2 is exhaled then repeated again and again

Clin Sci IMS, Respiratory, Renal, Cardiovascular, Nutrition & Energy (17 decks)

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