Resp 110: Chapter 8

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Resp 110: Chapter 8
2013-07-17 22:40:10
Respiratory System

The Respiratory System
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  1. External Respiration
    the absorption of Oxygen and excretion of Carbon Dioxide
  2. Internal Respiration
    gas exchange between tissue cells and systemic capillary blood
  3. Cystic Fibrosis
    a defect on chromosome 7 that results in pulmonary, gastrointestinal, and endocrine dysfunction
  4. Emphysema
    genetic mutation that can result from an α1 - antitrypsin deficiency due to a mutation on chromosome 14
  5. Asthma
    may be associated with multiple gene alterations - affects about 10% of the population
  6. 3 Stages of Embryonic Development
    • Prenatal - Formation of major airways and lung structures
    • Peri-natal - Respiratory tract prepares for extrauterine life
    • Post-natal - after birth, hypertrophy and increase in number and size of respiratory structures
  7. Hypertrophy
    A nontumorous enlargement of an organ or a tissue as a result of an increase in the size rather than the number of constituent cells
  8. Embryonic Stage of Development
    conception to 5 weeks gestation (lung buds begin to form and pulmonary arteries perfuse lung tissue - all major organs begin development)
  9. Fetal Period of Development
    Composed of four stages: Pseudoglandular stage, canalicular stage, fetal lung development, terminal secular stage, and alveolar stage
  10. Pseudoglandular Stage (Weeks 6-16)
    Branching continues, muscles, elastic tissue and cartilage forms, mucus glands, cilia and goblet cells form, respiratory smooth muscle and diaphragm forming
  11. Canalicular Stage (Weeks 16-26)
    Airways increase in length and diameter, alveolar ducts form, Type 1 and Type 2 cells form
  12. Type 1 Cells (Alveolar Cells)
    Thin cells that allow for gas exchange... 95% of lung is type 1 cells
  13. Type 2 Cells (Septal Cells)
    produce surfactant
  14. Surfactant
    • a phospholipid composed of lectin and sphingomyelin (L:S ratio) of 2:1 (by 35th week, fetus should have L:S ratio of 2:1)
    • decreases surface tension
  15. Lectin : Sphingomyelin Ratio
    determines pulmonary maturity, tested with sample of amniotic fluid
  16. Terminal Secular Stage (Weeks 27-31)
    thinning of Type 1 cells, Type 2 cells mature and produce surfactant
  17. Alveolar Stage (32 Weeks - 8 Years)
    mature alveoli/capillary membranes appear
  18. Phrenic Nerve
    innervates the diaphragm - left and right are actually separate, so half can be damaged but person cacn still breathe
  19. Intercostal Muscles
    elevate the ribs and stabilize the chest wall
  20. Scalenes
    assist in respiration when diaphragm can't do any more work. Elevates first and second ribs, supports apex of lungs, move active with larer lung volumes
  21. Sternocleidomastoids
    on either side of neck - support neck - elevate sternum to increase AP diameter of chest. Recruited after 3/4 of vital capacity has been inspired.
  22. Pectoralis Major-Bilateral Anterior Chest Muscle
    usually used for hugging action - pulling inward - used to pull outward if arms or shoulders in a fixed position
  23. Costophrenic Angle
    formed where parietal pleural departs chest wall to diaphragm
  24. Nasopharynx
    from nasal cavity to uvula
  25. oropharynx
    from uvula to tip of epiglottis
  26. Laryngopharynx
    tip of epiglottis to larynx
  27. Glottis
    narrowest part of adult airway
  28. Epiglottis
    supports, covers glottis during swallowing
  29. Thyroid
    Adam's apple here, largest, vocal chords attach here
  30. Cricoid Cartilage
    narrowest part of infant airway, this is the only cartilage that goes all the way around - the others are "C" shaped cartilages
  31. Functions of Larynx
    • participates in speech
    • cough
    • airway protection from aspiration
  32. Respiratory Airways
    microscopic airways distal to conducting zone, participate in gas exchange with the blood
  33. Lobar Bronchi
    2nd Generation - Go to the lobes of lungs
  34. Segmental Bronchi
    3rd Generation - right lung has 10 bronchopulmonary segments, left lung has 8 bronchopulmonary segments
  35. Subsequential Bronchi
    4th - 9th Generation - airway diameter is decreasing, minimal cartilage now
  36. Non Cartilagenous Airways
    10th - 15th Generations - NO GAS EXCHANGE YET! still conducting airways - no goblet cells yet unless patient is a smoker
  37. Terminal Bronchioles
    16th - 19th Generations - no more conducting airways! No cilia here!
  38. Respiratory Bronchioles
    20th - 23rd Generations - GAS EXCHANGE HERE! - Alveoli are here!
  39. Alveolar Ducts
    24th - 27th Generations, Arise from Resp. Bronchioles
  40. Alveolar Sacs
    The final Generation!
  41. Type 1 Alveolar Cells
    for gas exchange, comprises 95% of lung surface area
  42. Type 2 Alveolar Cells
    make Surfactant, highly metabolic
  43. Type 3 Alveolar Cells
    pulmonary macrophages = ameboid movement to get rid of foreign substances (like asbestos)
  44. Pores of Kohn
    holes in between alveolar walls (septa) to provide for colateral ventilation
  45. Canals of Lambert
    connection between bronchioles to allow for collateral ventilation
  46. O2 Molecules from Nose to Hb Molecule!!!
    Nose --> Pharynx --> Larynx --> Trachea --> right or left Mainstem Bronchus --> Lobar Bronchus --> Segmental Bronchus --> Bronchiole --> Terminal Bronchiole --> Respiratory Bronchiole --> Alveolar Duct --> Alveolus --> Surfactant Layer --> Alveolar Epithelium --> Lamina Propria --> Capillary Basement Membrane --> Plasma RBC Membrane --> Cytoplasm --> Hb Molecule!
  47. Macrophages
    phagocytosis, inhibition of tumors, manufacture of interferon
  48. Tidal Volume
    Volume of air that is inhaled or exhaled during quiet breathing AVERAGE IS 500 mL (+/- 100 mL)
  49. Minute Volume
    Total amount of air moved in or out for one minute
  50. Forced Vital Capacity
    deep breath in and blow out as hard and fast as you can
  51. Peak Expiratory Flow
    maximum flow at which a patient can exhale during a forced exhalation.  Expressed as L/sec or LPM
  52. Deadspace Ventilation
    that portion of ventilation that does not participate in gas exchange - wasted ventilation.  (Ventilation without Perfusion)
  53. Anatomic Deadspace
    volume in the conducting airways, including nose, [harynx, etc. AVERAGE IS 1 mL/Lb OF BODY WEIGHT!
  54. Shunting
    PErfusion without ventilation
  55. Alveolar ventilation
    that portion of gas available for gas exchange.
  56. Alveolar Deadspace
    volume of gas that ventilates unperfused alveoli.  If this becomes high, usually indication of pathologic state like a pulmonary embolus
  57. Physiologic Deadspace
    sum of the anatomic and alveolar deadspace.  Total amount of wasted ventilation  NORMAL IS 20%-40% OF TOTAL VENTILATION
  58. Respiratory Centers (Medullary Centers)
    located in medulla oblongota, responsible for normal breathing
  59. Pontine Centers
    in pons, pneumotaxic - regulates apneustic centers, sets a balance between inspiration and exhalation.  Stimulated by medullary inspiratory centers.  Ends inspiration with negative feedback to stimulate expiration
  60. Apneustic Center
    Promotes continuous inspiration.  controlled by pneumotaxic center and stretch reflex in lung (Hering-Breuer) when uncontrolled, creates looong inspiratory time
  61. Hering-Breuer Reflex
    stretch reflex - located in smooth muscles in conducting airways - stimulated by inflation of the lung, then inhibits further inhalation because feels stretch
  62. Juxtapulmonary
    J Receptors - located in tissues between alveoli and pulmonary capillaries - stimulated by pulmonary edema, microembolism, rapid, shallow respiratory rate (restrictive)
  63. Irritant Receptors
    in trachea, bronchi, and bronchioles - produce deep breath, bronchospasm, and cough
  64. CO2 Effects on Ventilation
    Stimulates central chemoreceptors, which send impulses to inspiratory center, which promotes stimulation of diaphragm, which sends impulse to phrenic nerve to take a deep breath.