Physiology #18: Resp physiology 4

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Physiology #18: Resp physiology 4
2013-11-25 00:27:52
UCVm 2017

resp phys
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  1. CO2
    is produced during...
    • CO2 is produced during cell metabolism
    • CO2 diffuses 20x more easily than O2- so readily crosses cell membranes and physical barriers
  2. Order of important mechanisms by which CO2 is transported *************
    • #1 bicarbonate ions in the plasma
    • #2 bound to Hb
    • #3 dissolved in Plasma
  3. What are the three forms of CO2 in the plasma?
    • dissolved in plasma: amount of CO2 dissolved in plasma is proportional to PaCO2 and its solubility coefficient. CO2 is 22x more soluble than O2
    • combined with plasma proteins: ie with albumin or glycoproteins
    •    -combine to form "carbamino compounds"
    •    -are relatively small number of aa groups on proteins that are able to do this
    •    -accounts for small fraction of transport
    •    -combined with water in plasma to form H2CO3 (carbonic acid)
  4. Are the three forms of CO2 in the plasma significant for CO2 transport?
    • Overall these 3 mechanisms (dissolved in plasma, combined with plasma proteins, combined with water in plasma to make carbonic acid) only account for ~10% of total CO2 transport in the body
    • this is not adequate for transporting the huge quantity that is produced from metabolism, so other mechanisms are required
  5. What contributes the most to CO2 transport?
    Reactions in RBCs are the most important for CO2 transport
  6. How does transportation of CO2 occur in the RBC's?
    • CO2 readily diffuses from plasma onto RBC's
    • RBC's have many more terminal protein groups that can react with CO2 to form carbamino compounds: has more buffering capacity
    • inside RBC's the hydration reaction with water is enhanced by carbonic anhydrase enzyme - once formed H2CO3 quickly dissociates into H+ and HCO3- ions inside the RBC
    • CO2 + H2O <->H2CO3 <-> HCO3- + H+
    • There is a high [enzyme] in RBC's so they can convert 90% of CO2 which keeps PCO2 low so CO2 can always diffuse into RBC
  7. How do bicarbonate ions transport CO2 in the plasma? and what is the "chloride shift"
    • As more and more HCO3- is formed from the hydration of CO2, it diffuses out of the RBC's along its diffusion gradient into the plasma
    • "chloride shift" --> Cl- diffuses into the RBC's to maintain electrical neutrality (Cl- draws water into cell)
    • water also diffuses into cells so RBC's in venous blood are slightly larger than those found in arterial blood
  8. CO2 in the lungs
    • when venous blood reaches the capillaries in the lungs, CO2 that was dissolved in solution (plasma) diffuses out of the blood along its gradient into the alveoli
    • ventilation of alveoli keeps CO2 levels low, maintaining the gradient for diffusion of CO2

    • Loss of CO2 in the plasma pulls CO2 out of the RBC
    • reactions in RBC now reverse: CO2 comes off proteins, dehydration of H2CO3 forms CO2 and water
    • Oxygenation (increase O2) of Hb helps reverse these reactions and enhances the release of CO2 into the alveoli for elimination form the body through ventilation
  9. What are the normal levels of CO2
    system is designed to maintain arterial CO2 levels around 40mmHg (35-45mmHg)
  10. What happens if CO2 levels are increased
    • If CO2 is increased it becomes a stressor on the body (stimulates a sympathetic response that increases heart rate, blood pressure, ventilation)
    • -"fight or flight" reflex to deliver more blood (and therefore more CO2) to the lungs
  11. How do you fix high CO2 or low O2?
    increase BP, increase blood flow and cardiac output, want blood to get to lungs to get rid of CO2
  12. How are CO2 levels measured?
    • 1. CO2 in the blood (artery, vein) with blood gas analyzer  (aspire blood sample and put in gas analyzer)
    • 2. expired air (end-tidal) with a capnograph (measure on intubated animal)
  13. What are the three parts of the respiratory control system that form the feedback loop?
    • 1. Sensors (peripheral and central) that gather info about CO2, O2, and pH, movement etc...
    • 2. central controller in the brain to coordinate info and determine what actions to take
    • 3. effectors (muscles) to induce a response and to ventilate the animal
  14. What is the main goal of the respiratory control system?
    to maintain normal levels of O2 (100mmHg) and CO2 (40mmHg) in arterial blood
  15. What afferent centers contribute to the control of breathing?******
    • peripheral chemo R's
    • central chemo R's
    • lung stretch R's
    • muscle and joint R's

    all feed into DRG inspiratory center
  16. What R's are sensitive to CO2 and O2?
    • peripheral chemo R's are sensitive to CO2, O2 and H+
    • while central chemo R's are sensitive to H+ only
  17. Central Chemo R's
    • located near ventral surface of medulla
    • sensitive to changes in H+ levels in the interstitial fluid of the brain (but the BBB is not permeable to H+ ions)
    • CO2 is freely diffusible and indirectly exerts a stimulating effect on respiration altering H+ levels in the brain
  18. What stimulates ventilation via central chemoR's
    • ventilation (increased tidal V and respiratory rate) is stimulated by increases in PaCO2-
    • CO2 combines with water in the brain and there is an increase in H+ so central chemoR's detect this
    • central chemo R's are excitatory to the inspiratory center (DRG) and cause increases in tidal V and resp rate
  19. Peripheral Chemo R's
    • located in areas that are highly diffuse with arterial (oxygenated) blood: aortic bodies (sensors) along arch of the aorta, carotid bodies at bifurcation of carotid arteries
    • respond to changes in H+, PaCO2, and PaO2 - responsive to partial pressures of O2 and CO2, not the amount/content (ie active at high altitude but not if patient is anemic)
  20. What stimulates ventilation via peripheral chemoR's
    • low O2 or High CO2
    • * O2 and CO2 are not dependant of content they are dependant of partial pressure
  21. What stimulates ventilation (increased tidal V and resp rate)?
    • increase PaCO2 (central chemo R's)
    • low O2 or high CO2 (peripheral chemo R's)
  22. How are peripheral chemoR's excitatory to the response center?
    • stimulate ventilation through:
    • vagus nerve (aortic bodies)
    • glossopharyngeal nerve (carotid bodies)
  23. what % if normal ventilator drive do each R set account for?
    • Peripheral chemo R's ~30% in response to changes in CO2
    • Central chemo R's ~70%
  24. Peripheral chemoR's are not normally to active when do they become active?
    • respond to changes in arterial CO2 levels
    • when arterial O2 levels decrease these R's become very active and stimulate ventilation as a last ditch attempt to bring O2 into the body
    • happens when PO2 is less than 50mmHg
  25. The "respiratory centers" of the brain
    • Dorsal Respiratory Group (DRG) in the medulla
    • ventral respiratory group (VRG) in the medulla
    • Pneumotaxic center in the rostral pons
    • Apneustic center in caudal pons
  26. What is the "central controller"
    • collections of neurons that are located in the brainstem - medulla and pons
    • generates the rhythmic, periodic pattern of regular breathing
    • allows for unconscious adjustments to breathing pattern with exercise, disease, and swallowing etc...
    • cortex also plays a role (ie conscious changes)
  27. functions of the DRG
    • Generates the basic rhythm of breathing
    • receives input from the glossopharyngeal and vagal nerves
    •    -mechanoR's in pleura (respond to stretch)
    •    -peripheral chemo R's (respons to O2, CO2 levels)
    • output is relayed via the phrenic nerve to the diaphragm  -stimulates contraction to initiate inspiration
    • generates tidal ie normal breathing
  28. functions of the VRG
    • (not active in most cases, only when need active component)
    • expiration is normally a process due to elastic recoil of the lungs and chest wall
    • VRG is not usually active with normal respiration
    • primarily responsible for expiration when there needs to be an active component (ie exercise)
  29. Pneumotaxic center
    • inhibits inspiration by regulating inspiratory rate and V
    • involved in "fine tuning" of respiratory rhythm since normal rhythm can still exist in absence of this center
  30. apneustic center
    • least understood of the four areas, no consensus as to its role in respiration
    • believed to be involved in deep breathing (apneustic breathing ie hold breath for a while then take exaggerated breath)
    • can be seen in certain situations: ketamine based anesthesia, brain injury or tumors (high ICP)
  31. in a cap refill what does anemia look like
    pale pink, have O2 but no RBC
  32. what 3 things does a cap refill time assess
    • O2
    • perfusion
    • RBC's
  33. What are the muscles of respiration
    • diaphragm
    • intercostal muscles
    • abdominal muscles
    • accessory muscles

    central controller ensures that they all function in a coordinated manner