Patho 3

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Author:
cgordon05
ID:
17662
Filename:
Patho 3
Updated:
2010-05-03 23:30:11
Tags:
Respiratory kidney acid base
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Description:
Respiratory Kidney Acid Base
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  1. Regulation of acid/base by Lungs
    • metabolism of CHO, fat, proteins --> CO2
    • CO2 + H2O <--> H2CO3 <--> H+ + HCO3-
    • H+ buffered by proteins (esp. Hgb and HCO3-) is transported to lungs --> CO2 --> exhaled
  2. Regulation of acid/base by Kidneys
    • primary organs responsible for replenishing bicarb and keeping it at proper level to maintain acid/base
    • renal damage and non-working renal tubules = ammonia not excreted to bind with H+ to produce ammonium (NH4+) --> remain acidotic
    • if not excreting ammonium --> not getting rid of acid load due to not adding bicarb to the body
  3. Be able to identify urinary buffers
    • 1) ammonia (NH3) = most important
    • 2) phosphate (HPO4)
    • ** react with H+ to produce new bicarb
  4. Disease processes that increase pCO2 levels and cause respiratory acidosis.
    (p.6)
    • 1) oversedation
    • 2) obstructive lung diseases:
    • a) COPD
    • b) emphysema
    • c) chronic bronchitis
    • d) asthma
    • e) cystic fibrosis
  5. Respiratory Acidosis
    • caused by inadequate alveolar ventilation
    • CO2 retention --> increased pCO2 --> decreased acid/base --> decreased pH
  6. Oversedation
    • decreased respiratory rate --> retain CO2 --> acidosis
    • Occurs even with normal lungs
  7. COPD
    • airflow limitations or obstruction
    • not fully reversible
    • associated with abnormal inflammatory response (airway narrowing)
  8. Emphysema
    • alveolar enlargement with destruction of elastic tissue in alveolar walls
    • destroyed elastic tissue --> decreased recoil to exhale CO2 --> CO2 retention --> enlarge alveoli --> rupture
    • causes:
    • = hereditary deficiency of alpha-1-antitrypsin (elastase inhibitor)
    • = smoking --> chemicals and particles --> macrophages and PMNs phagocytize --> release proteolytic granules (elastase) --> breaks down elastic tissue
    • = free radicals from smoking --> inactivate/decrease levels of alpha-1-antitrypsin
  9. Chronic Bronchitis
    • defined as persistent cough at least 3 consecutive months in at least 2 consecutive years
    • irritants (smoke, air pollution) --> hypersecretion of mucus beginning in large airways
    • hypersecretion of bronchial mucus glands --> hypertrophy of mucus glands --> metaplastic formation of mucin-secreting cells in surface epithelium of bronchi --> outflow obstruction with hypercapnia, hypoxemia, and cyanosis
  10. Asthma
    • inflammation increases airway reactivity to stimuli --> episodic bronchoconstriction --> SOB, chest tightness, coughing, wheezing
    • trouble getting air in then getting it out
  11. Status Asthmaticus
    • associated with CO2 retention, respiratory acidosis, and severe hypoxia
    • Medical Emergency
  12. Cystic Fibrosis
    • inherited disorder occurring most frequently in white population
    • defect in secretory process of all exocrine glands
    • involves secretion of pancreatic enzymes, bile flow, and reproductive duct system
    • most serious consequence is pulmonary disease

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