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CPR 2 > Flipped Class Respiratory System > Flashcards

Flipped Class Respiratory System Flashcards

1
Q

What are the functions of the respiratory system?

A
  1. Olfaction
    • Olfactory mucosa in nasal cavity
  2. Phonation
    • Vocal folds
  3. Conduction and conditioning of air
    • transport of air to respiratory portion
    • Warmth
    • Air clearance
  4. Gaseous exchange :
    • Respiratiry portion—> blood-gas barrier
  5. Endocrine—> hormones
    • Neuroendicrine cells
  6. Immune functions
    • Bronchial associated lymphoid tissue
    • Alveolar macrophages
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2
Q

Describe the vestibule of the nasal cavity

A 
Cartilage framework
Stratified squamous epithelium (skin)
   -short firm hairs(“vibrissae”)
   -sweat and sebaceous glands 
       -Glands and vibrissae trap large particles
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3
Q

Describe the respiratory region of the nasal cavity

A

-Respiratory epithelium (pseudostratified, columnar, ciliated, with Goblet cells)

-Lamina propria
-Vessels (capillaries) lined up perpendicular to the airflow—>warms the air.
Clinical correlate: nasal congestion
-Turbinates—> increase the surface area covered by respiratory mucosa

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4
Q

Summarize the olfactory region

A

Found at the roof of nasal cavity and the superior nasal conchae

Lined by psuedostratified columnar epithelium with four cell types

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5
Q

What are the effects of rhinitis?

A

Allergic reactions or viral infections (e.g. common cold)—> Rhinitis/coryza( inflammation of the nasal mucous membrane)

Capillaries that reside near the surface of the Lamina propria become engorged —> Lamina propria becomes distended with fluid—> marked swelling of the mucous membrane —> restriction of the air passage—> breathing difficult

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6
Q

What are the features of olfactory receptor cells?

A

Histolog8cql features:
-longboard thin nonmotile cilia with odor receptors

Axons from the olfactory nerve

Function: bipolar neurons

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7
Q

What are the features of Brush cells?

A

Histological features:
-Columnar and extend to the Apical surface (basal surface synapses with nerve fibers)) Short microvilli

Function- Sensory receptors

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8
Q

What are the features of supporting cells?

A

Histological features:

  • Apical microvilli
  • Mitochondria ++++, sER and rER
  • Secretory vesicles—> contain odorant binding protein OBP

Function: mechanical and metabolic support

Helps in odor perception

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9
Q

What are the histologicak features of the basal cell?

A

Histological features:
-nuclei form a row in close proximity to the basal lamina

Function: regenerate supporting and olfactory receptor cells

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10
Q

What are the structures of the olfactory regions?

A

Serous olfactory glands/ Bowman’s glands have their secretory units in the Lamina propria

  • Acinar cells have lipofuscin granules
  • Serous secretion—> lysozyme and IgA
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11
Q

What is the larynx ?

A

Skeleton of hyaline and elastic cartilages

Function: air condition and phonation

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12
Q

What are the layers of the trachea?

A
  1. Mucosa:
    - RE- respiratory epithelium
    - Lamina propria- loose connective tissue
    - Longitudinal elastic fibers in deep LP
  2. Submucosa:
    - loose connective tissue
    - seromucous glands
  3. Cartillaginous layer
    - C-shaped hyaline - open posteriorly “Gap” between free cartilage ends is completed by a fibroelastic membrane and Trachealis muscle (smooth)
  4. Adventitia
    - Connective tissue-binds trachea to adjacent structures
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13
Q

Describe respiratory epithelium

A

Pseudostratified

Lines most of the conducting part of the respiratory system and has five cell types: ciliated columnar, mucus, brush, small granule and basal

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14
Q

What are the features of ciliated columnar Cells?

A

Histological features:
Columnar and extend to surface about 250 cilia each

Function: sweeping motion helps expel particles trapped in mucus

Clin8cal notes: primary ciliary dyskenesis in Kartegener’s syndrome

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15
Q

What are the features of mucus?

A

Histological features: short blunt microvilli

Function: secretes mucin granules which forms a protective barrier

Clinical notes: increased in smokers and chronic inflammation

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16
Q

What are the features of small granule or Kulchitsky?

A

Most numerous at bifurcation of primary bronchi

Basal granules

Function: enteroendocrine cells

Secrete Catecholamines, ADH, ACTH, serotonin and bombesin

Clinical notes: primary cells affected in small cell carcinoma of the lung

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17
Q

What are the features of Basal cells?

A

Histological features: near basement membrane

Function: stem cells that regenerate all other cell types

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18
Q

What are the features of brush cells in respiratory epithelium?

A

Histological features:

Columnar and extend to the Apical surface short microvilli

Function: synapse with afferent nerves—> Sensiry function

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19
Q

What is the mucociliary escalator?

A

Ciliary beating moves particles trapped in mucus towards the pharynx

Clinical correlate: kartegeners syndrome

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20
Q

Give an overview of the bronchi

A

Primary or main bronchi are structurally like trachea

Primary bronchi—> 2-3 secondary/lobar bronchi—> total 8- 10 tertiary/segmental bronchi per lung

Segmental bronchi supply a bronchopulmonary segment

Bronchi can also be classified as:
A. Extrapulmonary

B. Intrapulmonary: surrounded by lung tissue

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21
Q

Summarize the structure of bronchi

A

Mucosa: respiratory epithelium

Muscular layer: Spirally oriented smooth muscles in—> regulates the airway diameter

Submucosa: loose connective tissue with sero-mucus glands (GI) in larger bronchi

Cartilage layer:

  • Extrapulmonary bronchi: cartilage rings
  • Intrapulmonary bronchi-cartilage plates

Adventitia: connective tissue in the extrapulmonary part then surrounded by lung tissue in intrapulmonary broncho

22
Q

What is chronic bronchitis?

A

-Associated with smoking, inhalation of toxic fumes and exposure to heavy air pollution

Clinical: chronic productive cough and positive history

On examination wheezing, cyanosis—> blue bloater

Chronic irritation—> inflammatory changes—> metaplasia

Shows thickened basement membrane

Hypertrophy of smooth muscle

Increased glands >50% of the wall

23
Q

Explain the squamous metaplasia of respiratory epithelium

A

Columnar to squamous metaplasia of the respiratory epithelium
-Basal cells generate squamous cell

  • Smoking: loss of ciliated cell activity—> cough —> metaplasia
  • Bronchitis, bronchiectasis—> chronic cough—> metaplasia
  • Metaplasia—> squamous cell carcinoma
24
Q

Give an overview of bronchioles

A

Diameter is 1 mm or less

Larger (regular) bronchioles—> terminal bronchioles —> respiratory bronchioles

Epithelium
-Large bronchioles: Ciliated, psuedostratified columnar that transition into simple ciliated columnar (Goblet cells present)

-Smaller bronchioles (terminal and respiratory ): simple cuboidal with secretory club cells interspersed among ciliated cells (No goblet cells)

No subepithelial cells

-Smooth muscle replaces cartilage plates (branching points may contain small elements of cartilage)

Widespread construction in the bronchioles, decrease diameter and increases resistance to airflow

25
Q

Explain the structure-function 9f club cells in bronchiol3s

A

Club cells (Cc) are bronchioles exocrine cells

  1. Secretes:
    - surfactant active agent
    - club cell protein - CC16–> marker for the disgn9sjs of chronic lung diseases
    • leaks across blood gas barrier in lung injury—> elevated in serum
    • decreases in bronchi-alveolar lavage
  2. Detoxification
  3. Stem cells
26
Q

Explain the pathophysiology of bronchial asthma

A

Inflammatory airway disease
-Main symptoms are short breath, wheezing and coughing

Pathophysiology-
Airway obstruction
   -increased mucus
   -increased smooth muscle contraction
   -Bronchiolar wall inflammation
27
Q

How is bronchial asthma?

A

Albuterol (B2 agonist), anti cholinergic medications which relax the smooth muscles

Corticosteroids—> anti-inflamnatory

28
Q

Explain cystic fibrosis (Mucoviscidosis)

A

Autosomal dominant disorder recessive disorder

Mutation in CFTR gene- encodes for epithelial Cl- ion channel protein (causing defective/absent Cl ion transport and abnormal exocrine gland secretion - typically increased viscosity of secretions with obstruction of excretory ducts)

In lungs leads to ‘mucociliary escalator’ dysfunction
-accumulation of unusually thick, viscous mucus

  • bronchiolar obstruction (with subsequent bronchiolar wall thickening and alveolar degeneration)
  • frequent respiratory tract infections
29
Q

What is the significance of respiratory bronchioles ?

A

Forest sites where gaseous exchange take place

Transitional zone (involved in BOTH ‘air comfuction’ and ‘gas exchange’)**

  • Supported by a small amount of smooth muscle and elastic fibers
  • Walls are interrupted by alveoli
  • Simple cuboidal epithelium with ciliated and Club cells proximal to TB but predominantly Club cells distally

Simple cuboidal epithelium with ciliated and club cells

Smooth muscle plates

30
Q

What is the significance of alveolar ducts?

A

Respiratiry bronchioles transition into alveolar ducts as the number of alveolar out-pouching’s increase.

Alveolar ducts are lined by numerous alveoli

Bundles of smooth muscle cells found between alveolar out-pocketing (interalveolar septum)

31
Q

What is the significance of alveolar sacs ?

A

Alveolar ducts terminate into alveolar sacs

Several alveoli will open into a single alveolar sac

Alveoli are thin-walled polyhedral terminal sacs where gaseous exchange takes place
-Alveoli are separated from each other by an interalveolar septum

-Cell types: Macrophages, type 1, and Type 2 pneumocytes
32
Q

What is the function of dust cells?

A

Alveolar macrophages or dust cells move freely between the interstitial tissue and alveolar surface

  • Phagocytosis of inhaled particles as well as degrade surfactant
  • In septum dust cells are frequently observed loaded phagocytizes material:
    • RBCs in heart failure-heart failure cells
    • asbestos particles in asbestos
33
Q

What is the function of type 1 pneumocytes?

A
  • Squamous cells which line 95% of alveolar surface
  • Terminal cells not capable of mitosis
  • Surface is covered by surfactant
  • Form tight junctions with adjacent type II and type 1 cells- firm part of the blood-air barrier
34
Q

What is the function of type 2 pneumocytes ?

A
  • Cuboidal cells which secrete surfactant
  • Found at the septal junctions—> AKA septal cells.
  • Most numerous but cover only 5% of alveolar surface
  • Apical lamellar bodies—> foamy appearance
  • Stem cells for both type 1 and type 2 cells
35
Q

What is the function of alveolar surfactant?

A

Reduces the alveolar surface tension at the air-epithelium interface (pr3vents alveolar collapse during exhalation)

36
Q

What is the composition of alveolar surfactant?

A
  1. Phospholipid- Dipalmitoyl phosphatidylcholine (DPPC)—> principal agent responsible for reducing surface tension
  2. Surfactant proteins (SP)
    SP-A: most abundant, regulates synthesis and secretion of surfactant and modulates immune response to microorganisms

SP-A and SP-D: regulates the allergic response to airborne antigens

SP-B and SP-C: regulates spreading of surfactant

Adequate amount of surfactant is produced after 35th week of gestation

Regulated by cortisol, insulin, thyroxin, and prolactin

37
Q

What is the clinical correlate of alveolar surfactant ?

A

Premature infants especially <28 weeks old

Management: exogenous surfactant at birth

Glucocorticoids to the mother with possible preterm delivery a few days prior

38
Q

Describe the interventricular septum

A

Contains
Collagen fibers
Elastic fibers—> pulmonary recoil

Continuous capillaries

Permanent and transient cells

Site of the air-blood barrier

Adjacent alveoli communicate through alveolar pores (of Kohn) which allows collateral airflow

39
Q

What is pneumonia?

A

Air spaces filled with exudate containing white blood cells (mainly neutrophils), red blood cells, fibrin

Capillaries in the interalveolar septum are enlarged and congested with red blood cells

40
Q

What are the parts of the thin portion of blood gas barrier?

A

Most. Effective blood-air barrier

  1. Surfactant
  2. Type 1 pneumocytes
  3. Fused basal lamina of P1 and capillary endothelium
  4. Endothelial cells
41
Q

What are the composition of the thick blood gas barrier?

A
  1. Surfactant
  2. Type 1 pneumocytes
  3. Basal lamina of P1
  4. Connective tissue elements
  5. Basal lamina capillary endothelium
  6. Endothelial cells
42
Q

Explain emphysema

A

Characterized by a permanent enlargement of respiratory spaces affecting airways distal to the term8nal bronchioles
-Neutrophils release proteases including elastance—> breaks down elastic fibers

Serum. Alpha 1 antitrypsin (AAT) counteracts elastase activity

Smoking elevates neutrophils activity—> elevated elastase—> destruction of elastic fibers—> permanent dilation of airways

43
Q

Give the pathophysiology of different lung cancer types?

A

Small cell lung cancer- associated with smoking

Non small cell lung cancer -small cell carcinoma- associated with smoking

Adenocarcinoma-most common in non smoking women

44
Q

Give the origins of lung cancer types

A

Small cell lung cancer (oat cell carcinoma)-Neuroendocrine cells. Cushing syndrome due to ACTH secretion

Non small cell lung cancer (SCC)- squamous metaplasia of respiratory epithelia. Eosinophilic keratin pearl lesions—> see SCC of larynx

Adenocarcinoma- bronchial, bronchiolar and alveolar epithelium—> bronchoalveolar carcinoma or bronchigenic. Glandular tumor

45
Q

What are the characteristic features of different types of lung cancers?

A

Small cell lung cancer (oat cell carcinoma)-central mass, aggressive often metastasized when diagnosed

Non small cell lung cancer- SCC-central mass

Adenicarcinoma-peripheral mass

46
Q

As conduction system becom3s respiratory zone…

A

Decrease in goblet cells

Support carried out by cartilage—> smooth muscle—> elastic and reticular fibers

47
Q

Where is respiratory epithelium found?

A

Nasal cavity, trachea, bronchi,

48
Q

Where are simple squamous epithelia (pneumocytes) found?

A

Anyth8ng that has alveolar in it, including capillaries

49
Q

What is the respiratory zone ?

A

Respiratory bronchioles

Alveolar ducts

Alveolar sacs

Alveoli

50
Q

What is the conducting zone?

A

Nasal cavity

Larynx

Trachea

Bronchi

Bronchioles

Term8nal bronchioles

CPR 2 (32 decks)

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