L06, L07- Mechanisms of Breathing Flashcards Preview

MBBS I CPRS > L06, L07- Mechanisms of Breathing > Flashcards

Flashcards in L06, L07- Mechanisms of Breathing Deck (101):
1

Definition of Airway?

passageways through which air flows between external environment and alveoli

2

Definition of Alveoli?

site of gas exchange

3

Definition of elasticity?

property of matter that causes it to return to its original shape or size after being deformed by
an external force

4

What two criteria are there for an elastic structure?

1. Deformation of the structure must be caused by an external force
2. When the external force is removed, the structure recoils to its resting position (e.g. original
length)

5

What is another term for distending pressure?

Distending pressure = recoil pressure

6

Higher elasticity= higher or lower distending pressure?

High elasticity= high distending/recoil pressure

7

Does recoil pressure act in the same direction to distending pressure?

No, recoil is opposite in direction to distending pressure, but EQUAL in magnitude

8

What are the recoil tendencies of the chest wall and the lungs?

Chest wall= outward
Lungs= inwards

9

How do the recoil pressures of lungs and chestwall interact?

Lungs' inward recoil tendency is countered by the chest wall's outward recoil tendency and vice versa

10

At End-Expiratory-Position, what in the INTRApleural pressure?

Negative at -4mmHg
when 0mmHg is atmospheric

11

What happens to chest wall and lungs during pneumothorax?

air leaks into pleural cavity
Pleural pressure raised to atmospheric (but pV = constant)
Lung collapses inward (recoils)
Chest wall springs outward / enlarges (recoils)

12

At EEP require energy to maintain?

No
Inward recoil pressure of the lung balances outward recoil pressure of the chest wall (opposite in
direction, equal in magnitude)

13

What links the recoil pressures of the lungs and the chest wall?

Thin layer of fluid (intermolecular force of water) helps adhering inner surface of chest wall to
outer surface of lung

14

What are the fundamental pressures? e.g. PB

 PB = barometric pressure
 PA = Palv = (intra-)alveolar pressure
 PPL = Pip = (intra)pleural pressure

15

Derive pressures? (3)

PTP = transpulmonary pressure = Palv - Pip (=
distention of lungs)

PCW = transchestwall pressure = PPL - PB (=
distention of chestwall)

PTT = transthoracic pressure = PA - PB (=
distention of lungs + chestwall)

16

What is the Palv/PA at EEP?

At the end of expiration: Palv = 0 because interior of
alveoli is continuous with outside

17

During inspiration, what muscles contract leading to what?

Diaphragm and inspiratory
intercostal muscles contract

volume of thoracic cage
increases

Intrapleural pressure
becomes more
subatmospheric (-4 > -6 > -7)

18

What happens to transpulmonary pressure as intrapleural pressure becomes more negative?

Transpulmonary pressure
is increased (= lung
distending pressure)
(4 > 5 > 7)

lungs expand > alveolar pressure becomes subatmospheric
(-1 at mid-inspiration, 0 at end of inspiration)

Pressure difference between inside and outside drives airflow into lungs until no pressure gradient
Palv = 0

19

Inspiration vs Expiration. Which one is active?

Inspiration

20

During expiration what happens to intrapleural pressure?

Diaphragm and Inspiratory intercostal muscles cease contracting

chest-wall returns passively to original size (preinspiration position)

Pip back to preinspiration value (-7 > -5 > -4)

21

As lungs coil during expiration, what happens to transpulmonary pressure?

Transpulmonary pressure (same as distention of the lungs) back toward preinspiration value (7 > 5 > 4)

22

What happens to Palv during expiration?

Air in alveoli becomes compressed >
raises alveolar pressure (Palv (= 1 at mid-expiration) > Patm (= 0))
air flows out of lungs

23

When is Palv= PB

During End of inspiration and end of expiration

24

When is lung distending pressure largest?

Lung distending pressure = Transpulmonary Pressure
Largest at end of inspiration

25

Run through the entire sequence of inspiration.

Intercostal muscles and diaphragm contract
Increase thoracic volume so intrapleural pressure decreases
Causes the Palv to become negative/ more sub-atmospheric and transpulmonary pressure (Palv-Pip)/ lung distending increases
Air rushes into lungs until Palv= Pb = 0, Pip is largest at end of inspiration

26

Run through the sequence for expiration.

Diaphragm and intercostal muscles stop contracting
The thorax volume decreases.
Transpulmonary pressure (lung distending pressure) returns to preinspiration value.
Intrapleural pressure decreases back to preinspiration value
Palv becomes above atmospheric (+1) during mid-expiration and air becomes compressed
Air rushed out of lungs until Palv= PB= 0

27

What does statics involve?
What does dynamics involve?

Static= change in volume
Dynamics= airflow

28

Definition of Statics? (2)

-Study of the stationary properties of breathing apparatus (change in vol.)
- properties INDEPENDENT of movement during breathing

29

When is lung recoil pressure at maximum?

Total Lung Capacity

30

What is the volume-pressure slope like in the distention of lungs?

Non-linear slope (due to mixture of tissues having different elasticity):
 Steep at 40- 50 %VC
 Gentle near TLC

31

At Residue Volume, is the pressure zero?

No, very small pressure exist because the natural position of lungs is total collapse

32

Pressure required to inflate air-filled lung is larger or lower than that needed to inflate saline filled lungs?

pressure required to inflate air-filled lung > pressure required to inflate saline-filled lung

33

What are the components of lung recoil pressure?

1/3 = tissue elasticity (elastance) of the lung

2/3 = surface tension of the fluid lining the alveoli

34

What is tissue elastance due to?

tissue elasticity (elastance) of the lung
 Due to presence of elastin, collagen
 Obeys Hooke’s Law: volume change pressure
applied

35

Explain surface tension in contribution to lung recoil pressure?

Due to presence of air-liquid interface= intermolecular force between water molecules

36

Surface tension at the air-liquid interface causes what?

Increase in the pressure needed to push against the surface tension because surface tension minimizes/ contracts the surface to the smallest size

37

What is the resolved direction of surface tension?

Inward

38

What law applies to Surface Tension?

Laplace’s Law: P = 2T/r
 P = distending pressure
 T = surface tension
 r = radius of alveolus
 Need to apply bigger pressure if high T or small r

39

If surface tension is constant, what happens?

assuming T is constant
P=2T/r
If there is a difference in radius between two alveoli arranged in parallel, the smaller alveoli with smaller radius would have higher pressure than the larger alveoli

Air would empty from the smaller to the larger alveolar until the smaller one collapses

Causes Alveolar instability

40

Explain what happens when surface tension is overcome?

When surface tension is overcome:
1. Surface area of lung increases > gas exchange
2. Lengthens tissues > increases volume

41

In reality how does surface tension vary with volume?

Small alveolar = low T
Large alveolar= high T

42

How is varying surface tension achieved?

Pulmonary surfactant = protein-carbohydrate-phospholipid complex produced by:
1. Type II pneumocytes and/or
2. Clara cells

43

Name the 3 advantages of having surfactant.

1. Lowers the surface tension force (increases lung distensibility), decreases work of breathing (spend less energy)
2. Reduces difference between tension in large and small alveoli = promotes alveolar stability
3. Prevent transudation of fluid into alveoli

44

Explain the varying surface tension due to surfactant.

Small alveolar = high surfactant conc. = reduce intermolecular force between fluid lining alveolar wall = surface tension decreases

Large alveolar = lower surfactant conc. = surface tension decreases

45

explain the advantage surfactant has for transudation of fluid into alveolar.

Prevents the transudation of fluid into the alveoli
If low [S] > high T > greater tension to contract air-liquid
interface > more fluid is sucked into alveolus from
capillaries > thicker film of fluid > more work needed to distend lungs

46

Premature babies has insufficient surfactant. Explain consequences and treatment.

Loss of surfactant =
Infant Respiratory Distress
Syndrome
or
Hyaline Membrane Disease:

1. Stiff lungs (high surface tension to overcome)
2. Areas of collapse
3. Alveolar filled with transudate

Treatment: add surfactant

47

Tissue elastance. What is the volume- pressure relationship of chest wall?

recoil pressure at 0 at relaxed/ natural position at 60% Vital Capacity (higher than at EEP VC)

48

Explain change in size causing change in recoil pressure.

Decrease size= compress to RV = chest wall recoil outwards to resting pos.

Increase size = inhale to TLC = chest wall recoil inward to resting pos.

49

Chest wall recoil due to?

Tissue elastance ONLY, not fluid forces

50

What are the pressures of CW and L during EEP/ FRC?

Pcw = PL
zero overall recoil pressure

51

At 60% VC what is the overall recoil pressure?

Pcw= 0
PL = positive
therefore overall recoil pressure only involves inward lung recoil

52

Inhalation beyond EEP/FRC depends on which pressures?

To inhale beyond EEP (can be normal breath):
 Needs to spend energy to overcome inward recoil of the lungs
 Helped by outward recoil of chest-wall

53

Inhalation beyond 60% VC requires what?

To inhale beyond 60% VC (> normal breath, e.g. to TLC

requires muscle contraction to overcome BOTH lung and chest wall recoil pressures

54

Exhale down to RV requires what?

Needs to spend energy to overcome outward recoil of
chest-wall
Helped by inward recoil of lungs

55

Explain changes in FRC/EEP in emphysema patient.

Emphysema = loss of lung tissue elasticity

decreased inward lung
recoil pressure (steeper, shifted to left, easier to
distend)

balances outward chest-wall recoil pressure at a higher volume

increased EEP and FRC
(breathe at higher lung position)

No change in chest-wall recoil pressure

56

Explain changes in FRC/EEP in pulmonary fibrosis.

Pulmonary fibrosis (e.g. after inflammation) = increased lung tissue elasticity

Increased inward lung recoil pressure (flatter, shifted to
right)

balances outward chest-wall recoil pressure at a lower volume

decreased EEP and FRC

57

Explain changes in FRC/EEp in pneumothorax.

both lung and chest recoil to natural position:
 Chest bulges out
 Lung collapses
 ↓ FRC

58

Why does airway obstruction e.g. astham lead to higher FRC?

Expiration is passive (depends on lung elastic recoil)

Energy loss in overcoming Raw (high airway resistance)

Air-trapping inside lungs (lesser energy to drive flow)

59

What 2 definitions are there for compliance?

1) = slope of static volume-pressure curve (∆V / ∆PTM)

2) = volume change per unit change in transmural
pressure (distending pressure)

60

Relate compliance to elastance.

Compliance= 1/elastance (reciprocal of elasticity / elastance)

so 1/C = elasticity (elastance) or resistance to distension

E.g. stiff lungs have low compliance but high elasticity > harder to distend

61

Forumula for total compliance (Ct) ? therefore formula for total elastance ?

change in volume / transthoracic pressure GRADIENT
or
Ct= CL + Ccw

1/Ct = 1/CL =1/Ccw

62

At EEP, what is Ct, Ccw and CL?

Ct= 0.1 L/cm H20
CL= Ccw = 0.2 L/cm H20

63

How is compliance affected by Lung Volume?

- At very low or very high lung volumes: ↓CL
(flat slopes of PV curve)

- At moderate lung volumes: ↑CL (steep slope of PV curve)

64

Compliance affected by Lung Size?

Lung size:
 CL (children) < CL (adult)
because adult has more alveoli than children = overall larger change in volume
 Specific compliance = compliance / FRC = 0.08/cm H2O (normally)

65

Posture and Compliance?

Upright to supine position:
 ↓ lung volume (due to gravity)
 ↑ pulmonary blood volume = less air volume
 Diaphragm pushed forward (because abdominal contents no longer pulled down)
 ↓CL (less space to distend)

66

Pulmonary blood volume and compliance?

pulmonary vascular congestion (e.g. left heart failure (does not pump well), or alveolo-capillary
membrane becomes thicker and stiffer

more blood stays in
pulmonary circulation)

↓CL (harder to distend)

67

Age and compliance?

aging (loss of elasticity in emphysema) = ↑CL

68

Diseases and compliance?

 Emphysema (loss of elasticity) = ↑CL

 Fibrosis (↑elasticity) = ↓CL

 Edema (fluid in alveoli or interstitial space = higher surface tension; stiffer lung or membrane respectively) = ↓CL

69

Transpulmonary, Transchestwall and trans thoracic pressures equal what distension?

Transthoracic = distension of lungs
Transpulmonary= distension of both lungs and chest wall
Transchestwall= distension of chest wall

70

What factors affect chest wall compliance? Explain each of the 3 factors.

1. Posture: supine to upright posture = displacement of diaphragm (part of chest wall) and viscera = ↑CCW

2. Skeletal muscle disease: spasticity, rigidity (hard to distend chestwall) = ↓CCW

3. Deformation of chest-wall (e.g. obesity (thick chest = hard to distend), old age,
kyphoscoliosis) =↓CCW

71

Formula for chest wall compliance?

change in vol. / transchestwall pressure gradient

value is Calculated, hard to measure

72

Define airway resistance (Raw)

= Trans- airway Pressure difference divided by flow rate (cm H2O.sec/L)

= (Palv – PB) / V.

V.= instantaneous airflow



73

Explain the Distribution of airway resistance.

1. Upper airways (nose,
mouth, pharynx and
larynx): 50% Raw
2. Medium-sized airways
(trachea, bronchi): 40% Raw
3.Small airways (bronchioles): <10% Raw

74

Decrease in diameter of airway correlates with resistance and cross section area how?

decrease in diameter= decrease cross sectional area= increase resistance

75

Explain silent zone of small airway disease.

Small airways (bronchioles): <10% Raw
Tremendous dichotomous branching of respiratory tract = enormous combined cross-sectional area in small airways = contribute very little to total airway resistance
hard to feel / pick up = silent zone of small airway disease (can be present before detecting abnormal airway resistance)

76

What is radial traction?

retracting action of surrounding alveoli on the wall of small airways e.g. alveolar ducts

77

What is radial traction caused by? How does it work?

lung recoil pressure

Always toward centre of alveoli > pull on wall of small airways > keep them open

Similar to upper airways: shape maintained by cartilage

78

Low lung volume= high or low radial traction? High Lung volume causes increase of decrease in Raw?

Low lung volume > low lung recoil pressure > low
radial traction on airway wall

High lung volume = increase radial traction = low Raw

79

High Lung volume causes increase of decrease in Raw?

High lung volume > high lung recoil pressure >
inflated alveolar means high radial traction on airway wall > ↓Raw

80

Emphysema or other obstructive lung
disease . How does it affect Raw? (think elasticity and radial traction)

Emphysema = due to destruction of alveolar
wall
↓ lung elasticity = ↓ radial traction = partially collapse = ↑ Raw

81

Asthma changes Raw. How?

asthma –
smaller lumen due to:
1) Increased mucous glands 2) mucus in airway > mucosal edema
3) Contracted hypertrophied bronchial smooth muscle during asthma attack

82

How does pulmonary fibrosis change Raw?

↑ lung elasticity > ↑ radial
traction > ↓ Raw

P. Fibrosis = restrictive lung disease: hard to inflate / distend

83

What is Bronchomotor tone?

↑ bronchial smooth muscle tone (constriction) > ↑
Raw

84

What 2 reflexes cause bronchomotor tone?

Reflex (autonomic):
1) Parasympathetic overactivity (ACh): ↑ tone

2) Sympathetic overactivity (Noreadrenaline), β2 agonists : ↓ tone = ↓ Raw

85

Asthma drugs can work via 2 pathways on bronchomotor tone. Explain.

Either Anti-Cholinergic to inhibit Ach and inhibit parasympathetic overactivity

or B2 agonist to cause sympathetic overactivity

both lower bronchomotor tone

86

What 2 LOCAL factors affect bronchomotor tone?

1) decrease in PCO2 in alveolar > increasing pH > affect electrolyte balance> increase in AP in bronchial smooth muscle tone > increase tone > increase Raw

2) Inflammatory mediators e.g. histamine release after inhaling allergen > cause increase tone > increase Raw

87

How does lumen obstruction affect Raw?

Lumen obstruction (e.g. bronchial mucus secretion, edema, vascular congestion

↑ mucosal layer = ↑ Raw

88

How does increase in air density affect Raw?

↑ density (e.g. deep dive, surrounding pressure increases) = ↑ Raw

89

In small tubes flow is? in large tubes flow is?

Small tube= laminar flow
Large= turbulent flow with eddy currents

90

Laminar flow equation and turbulent flow equation?

Laminar flow: R= 8ηl/πr^4
Turbulent flow: Re=2rvd/η

η is viscosity

91

What is transmural pressure across wall of intrathoracic airway?

relative pressure between alveoli compared with that in intrapleural space

92

How does transmural pressure affect Raw?

End-inspiration: ↑ PTM (= 10 cm H2O) > ↑ airway lumen >
↓ Raw

End-expiration: ↓ PTM (= 5 cm H2O) > ↓ airway lumen > ↑Raw

93

What is work of breathing?

product of pressure and volume (simultaneous measurements of intrapleural pressure and change in volume during a breath)

94

2 types of work during breathing. Explain.

1) Elastic work (EBIDOE): against elastic forces (= energy stored in alveolar wall without airway)

2) Resistive work: against viscous forces (airway and tissue resistances)

95

Resistive work 2 subtypes. explain.

 Inspiratory resistive work (ECIBE): against airway resistance during inspiration (need extra energy to
overcome)
 Expiratory resistive work (EBIAE): against airway resistance during expiration

96

What other type of work is done during a breathing cycle?

 Work dissipated as heat (EAIDOE)

97

2 factors affecting work of breathing?

1. Frequency of breathing (normal = 12-18 breaths per min)
2. Tidal volume

98

Total work is lowest during what?

Normal breathing rate 12-18 breathes per minute at rest

99

Work is high during what?

Slow deep breathes or fast shallow breathes

100

How does resistive work change with increasing breathes per min?

keeps increasing

101

How does elastic work change with increasing frequency of breathing?

decrease: steep slope then gentle slope

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