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Physiotherapy > PHTY 142 Respiration > Flashcards

PHTY 142 Respiration Flashcards

1
Q

anatomical position of the lung

A

diaphragm to clavicles

lie against ribs anteriorly and posteriorly

base is concave and fits over the convex diaphragm

Apex is upwards above the 1st rib and into floor of the neck

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2
Q

What is the hilum

A

Medial surface of each lung

bronchi, blood and lymphatic vessels , nerves enter or exit

Held together by pleura and connective tissue

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3
Q

Cardiac notch

A

Located in the left lung medially

Where the apex of the heart lies

Due to heart - left lung is 10% smaller than right

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4
Q

Differences between the right and left lung

A

right - 3 lobes
Left - 2 lobes

Right - 2 bronchi
Left - 1 bronchus

Right - heavier

Right - shorter and wider
Left - long and narrow

Right provides space for liver
Left provides space for the heart

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5
Q

How to fissures separate lobes

A

Both lungs have oblique fissures
They extend inferiorly to anteriorly

Left - Separates inferior and superior lobe

Right has Horizontal fissure

Right - Oblique fissure superiorly separates inferior lobe from superior lobe
Inferiorly the oblique fissure separates inferior lobe form the middle lobe
Middle lobe is bordered superiorly by the horizontal fissure

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6
Q

Lobes in right and left lung

A

Right:
Superior, inferior and middle

Left:
Superior and inferior

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7
Q

Airways that supply lobes

A

Each has lobar bronchus

Right - 3, the superior, inferior, middle lobar bronchus

Left - 2, The superior and inferior lobar bronchus

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8
Q

Segments in the lung

A

There are 10 Segmental (tertiary) bronchi in each lung

Each portion of tissue that the segmental bronchi supplies is called Bronchopulmonary segments

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9
Q

What does the Hilum consist of

A

Bronchi
Pulmonary artery and vein
Nerves
Lymph nodes and lymphatic vessels
Pulmonary ligament

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10
Q

The 2 pleura

A

Parietal pleura
Superficial layer
Lines wall of thoracic cavity

Visceral pleura
Deeper layer
Covers lungs

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11
Q

What is the pleural cavity

A

Space between pleura

Contains lubricating fluid

Reduces friction between membranes allowing the membranes to slide over each other

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12
Q

Muscles involved in quiet inspiration

A

Diaphragm - flattens increases thoracic volume and lowering pressure. 75% of the energy

Abdominal wall relaxes - abdominal contents displaced

Intercostals are involved - forward movement of sternum and upward&outward movement of ribs

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13
Q

Muscles involved in quiet expiration

A

No direct muscle action

During inspiration lungs expand against elastic recoil which is sufficient to drive air out

Expiration : Controlled relaxation of intercostal muscles and diaphragm

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14
Q

Muscles involved in forced expiration

A

diaphragm
Scalene muscles and sternocleidomastoids (accessory muscles) raise ribs

Intercostal muscles

quadratus lumborum - force downward movement of diaphragm

Erector spinae

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15
Q

Muscles for Forced expiration

A

muscles of abdominal wall to move diaphragm

Quadratus lumborum

intercostal muscles prevent deformation of tissue

Use of accessory muscles – respiratory distress

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16
Q

Surface anatomy of the lung

A

Apex - medial third of the clavicles

lower borders - T6, T8, T10

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17
Q

Tidal Volume

A

Volume of air breathed in and out in a single breath

0.5L

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18
Q

Inspiratory reserve volume
Expiratory reserve volume

A

Volume of air breathed in by maximum inspiration at end of normal inspiration

Volume of air that can be expelled by a maximum effort at the end of normal expiration

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19
Q

Residual Volume

A

Volume of air remaining in lungs at the end of maximum expiration

Not measured using spirometry

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20
Q

Inspiratory capacity

A

Volume of air breathed in by maximum inspiration at the end of normal expiration

Tidal Volume + Inspiratory reserve volume

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21
Q

Functional residual capacity

A

Volume of air remaining in the lungs at the end of normal expiration.

Expiratory reserve volume + residual volume

Not measured using spirometry

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22
Q

Vital Capacity

A

Volume of air that can be breathed in by maximum inspiration following maximum expiration

Inspiratory reserve volume + Tidal volume + Expiratory reserve volume

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23
Q

Total Lung capacity

A

Only a fraction of TLC is used in normal breathing

VC + RV

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24
Q

Functional significance of residual volume

A

A fully deflated lung requires a lot more energy to inflate

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25
Q

Obstructive disorder

A

obstruction of normal air flow caused by airway narrowing

Residual volume is increased as gas cannot leave the lung

RV: TLC ratio increases

Severe: Vital capacity can decrease

Example : COPD

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26
Q

Restrictive disorder

A

Stiffer lungs so cannot expand to normal volumes

subdivisions of volume are decreased

RV:TLC would be normal or increased

Example: Idiopathic pulmonary Fibrosis

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27
Q

FEV1

A

Forced expiratory volume in 1 second

Volume of air expelled in the first second of forced expiration starting from full inspiration

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28
Q

FVC

A

Forced Vital Capacity

A measure of total lung volume exhaled with maximal effort after full expiration

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29
Q

FEV1/FVC ratio

A

FEV1 is 80% of FVC in normal

measure of airway limitation and allows us to differentiate between obstructive and restrictive lung disease

Restrictive: Both FEV1 and FVC are decreased , often in proportion to each other

Obstructive: FEV1 is reduced much more than FVC so the FEV1/FVC ratio is reduced

30
Q

Respiratory pathway

A

Mouth/nose
Pharyx
Larynx
Trachea
Bronchi (main, lobar, segmental)
Bronchioles
Lungs
Alveoli

31
Q

nose

A

Has external nose and nasal cavities separated by the nasal septum

Lateral wall of nasal cavity: Bony ridges called conchae providing large surface area

Nose - humidifies and warms inspired air

Mucus secreting goblet cells with microvilli propels mucus to the pharynx where it is swallowed

32
Q

Pharynx

A

Base of skull to inferior border of cricoid cartilage

Divided into 3 parts: nasopharynx, oropharynx and laryngopharynx

33
Q

Trachea

A

Cartilaginous and membranous tube

10cm in length and Extends from larynx to carina

Supported by c shaped rings of hyaline cartilage

Epithelium sits on basement membrane separating it from lamina propria
Lamina propria lies a loose submucosa

Relations: Thyroid gland, carotoid arteries, oesophagus

34
Q

Bronchus

A

divided into left and right at the carina

right - shorter and more vertical

Primary bronchi within each lung is divided into secondary or lobar

Fewer goblet cells than the trachea

35
Q

Bronchiole

A

no cartilage and rely on parenchymal tissue for support

Surrounded by smooth muscle and have few alveoli so is a site for gaseous exchange

divide up to 20 or more generations before meeting the terminal bronchiole

Terminal bronchiole supplies the end respiratory unit

36
Q

Alveoli and alveolar duct

A

Ducts: Rings of smooth muscle, collagen and elastic fibres

Open into 2 or 3 alveolar sacs

Alveoli: Blind ended terminal sac where gaseous exchange occurs
Lined with type 1 and type 2 pneumocytes

37
Q

Type 1 and 2 pneumocytes

A

Type 1 : Cover 95% of the internal surface of each alveoli. They share a basement membrane with pulmonary capillary to form a blood brain barrier

Type 2 : Synthesising cells of the alveolar surfactant. It maintains alveolar and airway stability by reducing surface tension

38
Q

Pore of Kohn

A

epithelial lined opening s between adjacent alveoli

Usually contain fluid an usually only open in response to high pressure gradient

Between 13-21 pores in each alveolus

39
Q

Channel of lambert

A

Communications from respiratory bronchioles to alveolar ducts

Have muscular wall with possible regional airflow control

40
Q

Channel of Martin

A

Diameter of 30um

found between respiratory bronchioles and terminal bronchioles

41
Q

Alveolar macrophage

A

Most numerous of cells in the lungs

They clear up dust debris through phagocytosis

They are found in the mucociliary escalator

42
Q

The mucociliary escalator

A

Deals with large particles trapped in bronchi and bronchioles brought up by alveolar macrophages

Has mucus film which is divided into 2 layers
Periciliary fluid layer about 6um deep – this reduces viscosity and allows movement of cilia
Superficial gel layer about 5-10um deep – viscous layer forming a sticky blanket which traps particles

Superficial gel layer with trapped particles can be continually transported upwards towards the mouth

43
Q

pathway of MCE

A

Connective tissue
Cartilage
submucosa
lamina propria
Basement membrane
Cilia
Mucus blanket

44
Q

How can MCE clearance be inhibited

A

Smoking
cold air
Drugs like general anaesthetics
Sulphur oxides
Nitrogen oxides

45
Q

Cough reflex arc

A

Initiated by cough receptors which send information to afferent nerves. These receptors are found in the trachea, carina, pharynx

Sensory information to NTS of the medulla
Motor neurons to effector muscles

Respiratory muscles contract to allowing cough reflex
Diaphragm flatterns
Laryngeal muscles close vocal cords
E intercostals contract
Rectus abdominus contracts to depress ribcage

46
Q

3 main phases of the cough reflex

A

Inspiratory phase
Irritation of cough receptors

Compression phase
epiglottis and Vocal cords close

Expiratory phase
internal intercostals contract to depress thoracic cavity
Vocal cords relax and epiglottis opens

47
Q

physical defences

A

Preventing entry
filtering of nose
Prevention of aspiration while swallowing
Cough reflex
mucocililary clearance
Alveolar macrophages

48
Q

Humoral defences

A

Antimicrobial peptides
Surfactant
Immunoglobulins
Compliment
Antiproteases

49
Q

Cellular defence

A

Alveolar macrophages neutrophils

50
Q

Process of gaseous exchange

A

O2 diffuses from alveolar air at 105mmHg to capillaries where PO2 is 40mmHg

O2 diffuses from alveolar air to capillaries CO2 is diffusing in the opposite direction from 45mmHg to 40mmHG

Exhalation keeps CO2 at 40mmHg in alveolar

51
Q

What influences rate of gas exchange

A

Partial pressure of gases

Surface area available

Diffusion distance

Molecular weight and solubility of the gases
O2 has lower weight than CO2 but solubility of CO2 is greater. Outward of CO2 faster than O2 in

52
Q

Oxygen binding to heamoglobin

A

only 1.5% of O2 inhaled is dissolved in blood plasma

98.5% is bound to heamoglobin
Each RBC contains a heam group with 4 irons
4 molecules of oxygen and bind

53
Q

Haemoglobin and oxygen partial pressure

A

The higher the PO2 the more O2 that binds

When reduced heamoglobin is completely converted it is said to be fully saturated

Hb and Hb-O2 mix is partially saturated

54
Q

How CO2 is transported

A

Dissolved CO2 - 7% dissolved in blood plasma

Carbamino compounds - 23% combines with amino groups. The main CO2 binding site are terminal amino acids in the two alpha and beta globin chains of haemoglobin

Bicarbonate ions - 70%. As CO2 diffuses into capillaries it reacts with water in the presence of CA enzyme to form carbonic acid

55
Q

Oxygen dissociation curve

A

Where PO2 is high like in pulmonary capillaries oxygen saturation is high. High affinity

Where PO2 is low like in tissue capillaries, unloading happens and saturation is less. Low affinity

56
Q

Factors that influence affinity of Hb for oxygen

A

pH - Low PH the less saturation as acidity increases unloading

Partial pressure of CO2 - As it rises O2 is released more readily as more carbonic acid so more H+. More acidity means less affinity

Temperature - Heat produces more acids

BPG - produced from break down of glucose. Decreases affinity

57
Q

Bohr effect

A

PH decreases

Curve shifts to right

Increase in H+ - more acidity - more unloading

Contrastingly increases affinity increases and curve shifts to left

58
Q

Normal range valves for arterial blood gases

A

pH: 7.35-7.45
pO2: 10-14kPa
pCO2: 4.5-6kPa
Base excess: -2-2mmol/l
HCO3: 22 - 26mmol/l

59
Q

Respiratory control

A

Sensors (chemoreceptors and mechanoreceptors)

Respiratory control centre (medulla and pons)

Effectors (respiratory muscles and diaphragm)

60
Q

Chemoreceptor

A

Responds to chemical compounds

Oxygen receptors - peripheral NS
Carbon dioxide - peripherally and centrally

61
Q

Stretch receptor

A

Respond to stretch of muscles sending impulses to CNS

62
Q

Where is the medulla and pons

A

Part of the brain stem

63
Q

pneumotaxic centre

A

Upper aspect of the pons

Controls fine tuning of respiratory rate and depth

Sends signals to influence the VRG and DRG

64
Q

Apneustic centre

A

Lower aspect of the pons

Controls prolonged breathing

Sneds signals to VRG and DRG to trigger inspiration

65
Q

Dorsal respiratory group

A

DRG

Medially in aspect within the medulla

Receives peripheral stimulus from stretch receptors, proprioceptors and juxtacapillary receptors

Sends signals to external intercostals and diaphragm for inspiration

66
Q

Ventral respiratory group

A

VRG

Anterior aspect of medulla

Controls expiration via sending expiratory signals

67
Q

Central chemoreceptors

A

when inactivated respiration ceases

Located in brainstem on ventrolateral surface of the medulla

Respond to hydrogen ion concentration and low partial pressure of oxygen

when carbonic acid increases Chemoreceptors promote increased ventilation

68
Q

Peripheral chemoreceptors

A

Located in cartoid sinus and aortic arch

sensitive to
PaO2
PaCO2
pH
Blood flow
Temperature

69
Q

Factors affecting rate and depth of breathing

A

Increase:
Voluntary hyperventilation
Increase in PCO2 above 40mmHg
Decrease in PO2 from 105mmHg to 50mmHg
Increased proprioreceptor activity
Increase in body temperature
Prolonged pain
Decrease in blood pressure
Stretching of anal sphincter

Decrease
Voluntary hypoventilation
decrease in PCO2 below
Decrease in PO2 below 50mmHg
Decrease Proprioreceptor activity
Decrease body temperature
Severe pain
Increase in blood pressure
Irritation of pharynx or larynx

70
Q

Normal ranges for body components

A

Temperature 37 degrees c
Heart rate 60-99 per minute
Blood pressure 120/80 mmHg
Respiratory rate 12-16 breaths per minute
Oxygen saturation 95%-100%
pH 7.3-7.5

71
Q

what is auscultation

A

Technique to listen to internal sounds of the body

Heart:
Aortic area
Pulmonic Area
ERB’s point
Tricuspid area
Mitral area

Lung
Check bronchial, bronchovesicular, vesicular
Abnormal sounds
Bronchial - loud, high pitched
Bronchovesicular - medium pitched
Vesicular - soft, low pitched sounds
Diminished lung sounds, adventitious breath sounds

72
Q
A

Physiotherapy (8 decks)

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