Respiratory Disorders: Emphysema

Question 1

What is emphysema?

Answer 1

Destruction of alveolar walls and capillary beds

Question 2

Alveolar wall and capillary are involved with __________ _________

Answer 2

capillary exchange or GE

Question 3

What 2 things can destruction of alveolar wall and capillary cause?

Answer 3

1. l/o compliance

2. enlarged distal airspaces

Question 4

How does l/o compliance impact filling/emptying of alveoli?

Answer 4

l/o compliance–> decrease elastic tissue and recoil of alveoli–> increase residual volume –> filling/emptying of alveoli is impacted

Question 5

Elastic tissue provides _____ and recoil ______ out the ____

Answer 5

compliance

pushes

air

Question 6

How are enlarged distal airspaces formed?

Answer 6

by destroying wall of adjoining millions of little alveoli–> fewer and larger alveoli are created–> decrease SA for GE

Question 7

Etiology of Emphysema (2)

Answer 7

1. smoking

2. genetic deficiency of alpha-1 anti-trypsin (~1%)

Question 8

What is Trypsin? Function

Answer 8

enzyme that breakdowns protein in the gut and aging structures for regeneration of tissue

Question 9

Alpha-1 is the _____

Answer 9

subclass

Question 10

Alpha-1 Anti-trypsin Function? What does it protect the lung from?

Answer 10

oppose the breakdown of proteins so useful tissues are not excessively broken down

It protect the lung from breakdown

Question 11

What happens in deficient alpha-1 anti-trypsin?

Answer 11

Trypsin are freely breaking down functional tissues of the walls of alveoli and capillaries

Question 12

Patho: Alpha-1 anti-trypsin regulates ______. Why must be regulated? What happens if there is deficient alpha-1 anti-trypsin?

Answer 12

proteases–> breaks down structural proteins

Proteases must be regulated otherwise it continuously break down protein structures

If there is a deficient of alpha-1 anti-trypsin–>proteases fxn freely and cause destruction of lung structures (alveoli, bronchi, etc)

Question 13

Patho: Deficiency of alpha-1 anti-trypsin is damaging to the ____ and cause what (2)?

Answer 13

lungs

1. irreversible destruction resulting in distended air spaces where there is no GE
2. air become trapped in alveoli–> increase work of breathing

Question 14

Patho: What are 2 effects of smoking in Emphysema?

Answer 14

1. inhibits alpha-1 antitrypsin –> regulation of proteases is lost causing destruction in lung
2. attracts inflm cells–> releasing more proteases and cause inflammatory damage –> more destruction

Question 15

Patho: How do proteases impair ventilation?

Answer 15

proteases destroy alveolar walls –> alveoli merge –> decrease SA–> distended air space develop–> ventilation impaired

Question 16

d/t damage, air coming in move into spaces between _______ creating large ______ of ___ between _______. This is also known as ______ _____.

Answer 16

alveoli

pockets

air

alveoli

dead space

Question 17

In dead space, there is no ____ ______, and air will not _____ or _____ the pocket or within alveoli. What result from this?

Answer 17

GE

leave or enter

increase respiratory effort (increase work of breathing) d/t compromised GE and ventilation

Question 18

What membrane surrounds the lung and which airspaces are pushed into?

Answer 18

pleural membrane

Question 19

Patho: Destruction of capillary causes ____ ______.

Answer 19

impaired perfusion

Question 20

Give an example of a physiological dead space in the respiratory tract?

Answer 20

trachea

Question 21

Which variable of V:P ratio is compromised? How is perfusion impacted?

Answer 21

both ventilation and perfusion

b/c capillaries are damaged

Question 22

In destructions of capillaries, which is associated with the capillaries?

Answer 22

terminal a/w

Question 23

Fig. 29.11: In a view of the right lung with emphysema, what are the black areas of the lungs? What are they referred as?

Answer 23

Black area = collection of air trapped in alveoli

referred to as blebs or bullae

Question 24

Whats the difference between bullae and bleb?

Answer 24

Bullae are large collection of air trapped in dead space

Bleb is a small collection

Question 25

Fig. 29.11: What is the acinus?

Answer 25

the functional unit of gas exchanging structure of the lung distal to the terminal bronchiole

Question 26

Fig. 29.11: What does the acinar consist of? Explain in right order.

Answer 26

respiratory bronchioles--> alveolar ducts--> alveolar sacs--> alveoli

Question 27

Fig. 29.11: What is centrilobular emphysema? What part of the acinus is damaged?

Answer 27

destruction in the terminal and respiratory bronchioles proximal acinar

Question 28

Fig. 29.11: What is panacinar emphysema? What is another name for it?

Answer 28

the acinus is uniformly damaged (everything distal to the respiratory bronchioles) panlobular

Question 29

Fig. 29.10: Smoking inhibits ____ ____-______ and attracts ________ ____ and favours the recruitment of which 2 defense cells?

Answer 29

alpha-1 anti-trypsin and inflm cells favours the recruitment of macrophages and neutrophils (and elastase)

Question 30

Fig. 29.10: As a result of decreased ___ ___-______, proteases are free to cause damage specifically the _____ tissue. What kind of protease cause this damage?

Answer 30

elastic tissues elastase

Question 31

Manifestations of Emphysema (10)

Answer 31

1. dyspnea 2. cough 3. activity intolerance 4. xs sputum prod. 5. wheezing and crackles 6. hypoxemia and hypercapnia 7. barrel chest (emphysema)

Question 32

Several mnfst are following an initially ________ onset

Answer 32

insidious

Question 33

What cause dyspnea in emphysema?

Answer 33

prob w/ ventilation and GE--> hypoxemia--> hypoxia --> dyspnea

Question 34

What triggers the cough? How is it described?

Answer 34

inflm --> xs mucus secretion--> exudate --> irritation of alveoli and a/w--> trigger coughs productive and dry at times

Question 35

Why is there activity intolerance? How is it displayed? When age is this mnfst most pronounced?

Answer 35

d/t lack of oxygen in cells to metb and produce ATP --> inadequate energy difficulty getting up a flight of stairs and bus 50-60--> seek medical attention

Question 36

What contribute to xs sputum (2). What is this function?

Answer 36

continuous prod. of mucus and exudate from inflm to clear the a/w and alveoli

Question 37

Wheezing and crackles are caused by _____ ____ in ______ ____. Wheezing is a result of compromised ______. Crackles are ____ d/t air passing over ______ in resp tract.

Answer 37

forceful air narrow tubes a/w wet fluids

Question 38

What is hypoxemia and hypercapnia? What lab values is used?

Answer 38

hypoxemia = deficiency of O2 hypercapnia = build up of CO2 ABGs changes in gas levels

Question 39

What is a barrel chest? Causes (2)

Answer 39

chest become fixed in an inspiratory position b/c air is trapped between alveoli increase respiratory effort and use of accessory muscles

Question 40

Give 5 examples of accessory muscles?

Answer 40

1. sternocleidomastoid 2. scalene muscles 3. Pectoralis major and minor 4. Latissimus Dorsi 5. Serratus Anterior

Question 41

What does APD and TD stand for and what is the ratio normally and in barrel chest? Explain location.

Answer 41

APD = anteroposterior diameter --> vertical, front to back TD = transverse diameter --> horizontal side to side Normal = APD:TD --> 1:2 Barrel Chest = APD is equal or twice the size of TD --> 1:1 or 2:1