Test #2 for 306 Flashcards
(143 cards)
1
Q
TEF are also commonly associated with?
A
Esophageal Atresia
1
Q
Thyroid hormones T3 & T4
A
Increase the rate of production of surfactant due to increase rate of phospholipid synthesis
1
Q
When is the terminal sac period?
A
24 weeks to birth
2
Q
Primitive Pharynx>LT Groove envaginates >LT Diverticulum>Lung Bud & TE Folds>TE Folds> Laryngotracheal Tube (larynx, trachea, bronchi, Lungs) && Primitive Oropharynx & Esophagus
A
Formation of the Lower RESP TRACT
3
Q
Cartligage of the larynx is derived from Which pharyngeal arches
A
4th and 6th pharyngeal arches
3
Q
Other lipids in Surfactant
A
phosphatylinositoil sphingomyelin blah blah
3
Q
Oxygen Tension
PAO2: what is available or diffusion in the pulmonary capillary
A
PAO2:
1- partial pressure of O2 on the alveolar gas
2-actual number of Molecules available for diffusion into pulmonary capillary
3-Sum of pressures of all gases in alveoli=760mmHg
4-Formula: Barometric pressure - partial pressure of water vapor x Fi02 in the dry air
3
Q
Oxygen Tension
A
-Partial pressure of waterr vaopr in the lung is 47mmHG at 37 degrees when alveolar gas is fully saturated
-
- When in room air at sea level, the PAO@ is 150mmHg (760-47x.21=150mmHg)
- to get PAO2, need to also include PaCO2
- Resp quotient (R) : ratio of CO2 excretion to O@ uptake =.8
4
Q
in RDS, what is deficient?
A
Surfactant
5
Q
What do Type II Cells do?
A
Secrete surfactant an line the walls of the terminal sac
6
Q
What are the 4 stages of Lung Development?
A
1-pseudoglandular 2-canalicular 3-terminal sac 4-alveolar
7
Q
Minute Ventilation
A
Minute Vent = TV in ml x # of braths per minute or resp frequency
VE=vtxf
8
Q
To whom are we thankful for being in school?
A
God, ourselves and our spouses
9
Q
Esophageal atresia with BOTH proximal and distal TEF’s occurs more commonly in males or females?
A
Males (but only 1% of TEF’s)
10
Q
Where is surfactant produced?
A
Smooth and Rough ER or type II Cells
10
Q
What is the 3rd stage in lung development?
A
Terminal sac period
11
Q
the lungs have a glassy hyaline membrane which cover the alveoli with this:
A
RDS Hyaline Membrane Disease
12
Q
Oxygen in the blood
A
Forms:
1-plasma
2-Blood
13
Q
Resistence
A
amt of pressure needed to move resp gases thru the airway at a constant flow rate
-depends on lung resistence/viscosity,
flow or airway resistence
14
Q
On the left, the two secondary bronchi supply which lobe of the ling?
A
Upper and lower (only 2 lobes on the left)
14
Q
SP-B&C
A
FUNCTIONAL proteins of surfactant; maintains the integrity of the cell wall
14
Q
An adequate ratio of L/S is 2:1 indicating fetal lung
A
MATURITY
14
Q
Hemoglobin
A
Total amounto f O2 carried by Hg depends upon
1-Concentration of the Hg (is Hg normal)
2-degree of saturation (is there adequate O2 available to have adequate saturation)
14
Q
Clinical significance in low lung volumes
A
Compliance and FRC- indicators of severity of disease process (Low FRC=atelectasis)
- compliance decreases with worseningof disease
- compliance improves with onset of diuresis
- *diuresis-mobilization of interstitial fluid (but you can see a decrease in compliance with this)
15
True or False: Gastric contents cannot back up into the trachea when you have esophageal atresia with a PROXIMAL TEF?
True
15
Excretion of Surfactant occurs by
EXOCYTOSIS
15
Alveolar Minute Ventilation:
AVE= (vt-dead space) x f
16
what also seperates from the primitive pharynx and gives rise to Lung Buds and TE Folds?
Laryngotracheal diverticulum
16
Tidal Volume
6-9 ml/kg
Amount of gas drawn through nose or ETT during a single cyycle of ventilation is called a TV:
Amount of air taken in with a breath is a TV
FRC is greather than TV
17
What week does the development of the larynx, trachea, bronchi & Lungs occur?
4th week
17
Which TEF rusults in air NOT being able to to enter the distal esophagus and stomach?
Esophageal atresia with a PROXIMAL TEF (1%)
19
TEF's occur due to an incomplete separation during which week of development?
4th week
21
In an H-type TEF, what/where is the fistula?
Between the trachea and esophagus
22
When, in the terminal sac period, when does the epithelial lining sac become thin causing capillaries to bulge into them?
24-28 weeks
23
Where is surfactant stored?
Lamellar bodies
24
Also present in the terminal sac period are....
Type II Secretory Cells
24
What is the 2nd stage of lung development?
canalicular
24
Insulin will inhibit surfactant production
It inhibits the production of surfactant because there is no glucose available for use; seen in IDM: inhibits glycogen breakdown; insulin results in decrease lung maturation
24
Tissue Resistence
40% if resistance in newborns due to
icrease pulm interstitial fluid
cc/s (RLF)
early stage RDS
Pulmonary hypoperfusion
26
What are some complications from an H-Type TEF?
Gastric contents can enter the trachea (lungs)
27
Time COnstant
TC
TC in healthy infant
TC=0.15 sec
so in 1 TC 3% of the TV will be exhaled in 0.15 secs
3 TC 3x0.5=0.45 secs
5 TC=5x0.15 =0.75 seconds for 99% of TV to be exhaled
1 TC is defined as the time needed for alveolar pressure to reach 63% of the change in airway pressure
End of 3 TC 95% of the tidal volume is discharged
28
Glucosteroids (Betamethosone) do what to Surfactant?
Accelerates fetal lung development; increases the availibity of glucose, increases the surfactant production by type II Cells; Increases the beta adrenergic lining cells (increasing compliance)
29
Inspiration is
Active
30
the Laryngotracheal diverticulum consists of what?
Lung buds and the TE Folds
31
Hemoglobin is ReSTRICTIVE
Only so much, once it's sturated-can't go past 100%
NON-LINEAR
Amount of HG that binds to O2 increases sharply at LOW PO2's
Each Hg molecle binds up to 4 MOL of O2
Each GRAM of Hg carries 1.34 ml of O2
Hg will Bind more if Plasma O2 is low
33
How does the Laryngotracheal Groove Develop?
Outgrowth from the caudal end of the primitive phayynx
34
Type I Cells are used for what?
Gas exchange
34
What kinds of cells doe the alveoli contain?
A continious lining of TI& Type II Pneumocytes
35
Expiration
in normal breathing
Is a passive event
Resp muscles relax
lungs and rib cage return to a resting state
amt of gas drawn through the ETT during a single cycle of ventilation is called a TIdal Volume
35
Radial size of alveoli
1-Indicates how much pressure is needed to inflate the lungs
2-law of LaPlace: pressure need to inflate the lung is 2x the surface tension and is inversly proportional to the radius of the structure
P=2st/r
If radius is increased, there is less pressure needed to inflate the lung
If radius is decreased, you need more pressure to inflate the lung
36
In which period of lung development does the lumen of the bronchi and bronchioles become larger and more vascular?
Canalicular Period
36
MIGRATES to the surface of the liquid layer in order to be functional
Surfactant
37
True of false: in the alveolar stage of transformation, the lungs are transformed from secretory into gas exchange units?
TRUE
37
What is the Primary Lipid in Surfactant?
Lecithin (phosphatidylcholine)
37
Linear relationship of oxygen in the plasma
Increase in FiO2, there is an approximate increase in PaO2
38
Chemoreceptors, chest wall reflexes, lung relexes, respiratory center,
CONTROL respirations
39
Which bronchus is larger in the embryo and adult?
Right mainstem bronchus; it is larger and straighter
40
what other lipid in surfactant is unique to lung cells and is a good marker for surfactant in amniotic fluid?
Phosphatidlglycerol
40
PEEP or CPAP
High pressures neede to expand a non-compliant lung
-to decrease this high pressure-add PEEP or CPAP
41
Physilogical Dead Space
NOT AVAILABLE FOR RESP
3ml/kg
1-anatomic- portion of the air that never gets to the alveoli
2-alveolar-portion f tidal gas not perfused
3- Total of 1 & 2 = physiological dead space
4-wasted ventilation
42
Sphingomyelin levels remain constant
throughout gestation
44
What gives rise to the epithelium and glands of the larynx, trachea, bronchi & Pulmonary Epithelium?
Endodermal lining of the endotracheal groove
45
In Normal Breathing
INSPIRATION
Inspiration is contraction of the resp muscles
&
Enlargement of the intrathoracic space
46
Low lung Volumes
restrictive lung disease
1-restrictive lung disease
a) pulmonary hypoplasia (small lungs CDH)
b) surfactant defiency
c) extrinsic lung disease
d) instrisic lung restriction (liesions, PIE)
47
Gas Exhange
Gas echange occurs consistently due to FRC (Sizeable amount of gas in the lungs after inspiration and expiration; it is the source of ongoing gas echange
-VENTILATION in related to the concentration of CO2
FRC=30cc/kg
48
During which stage of lung development can the lung structures and cells support life?
During the terminal sac period at 26-28 weeks when the epithelium of the alveoli is thinned enough to allow for gas exchange (VQ Matching)
49
When is the terminal sac development?
24 weeks to birth
49
SP-A
Responsible for spreading surfactant, antioxidant, antimicrobial
49
Airway resistence
Low in newborn
Determined by:
flow rates
length of connecting tubing
inner diamater or airwy (wrong ETT size)
physical properties of the gas
50
51
When will the lungs increase in size due to the increase in the # of immature alveoli?
3 years of age
53
Type I Cells for during what stage of lung development?
The terminal sac period
54
TC
TC is critical when I-Time or E-Time is so short that it is insuffiient for pressure equilibration
If I-time is
If E-TIme is too short
56
what is formed with the Tracheoesophageal folds grow towards one another and fuse?
Trachesophageal Septum
57
Do the respiratory and other system remain immature during the canalicular period?
YES
58
When do mature alveoli form?
after birth (95% do not develop until after birth)
60
What week does the primitive main stem bronchus/connection of each bronchial bud beome enlarged?
5th
61
Respiratory Failure
RESP requires a lot of energy
1-Food Substrate-muscle fatigue from hypoglycemia
2- hypoxia
3- Elastic recoil (Passive in expiration)
a) surfactant interface
b) ability of resp muscles to relax (FRC) resting volume
62
Where is surfactant transported to once it is produced?
Golgi appartus
64
What is the first stage of lung development?
Pseudoglandular period
65
During the 4th week of development, the lungs divide to form what two structures?
Bronchial buds (from the primitive pleural cavity) and the BRONCHI
66
Ventilation
- Movement of gas convection through the airways
- Molecular diffusion into alveoli and pulmonry capillaries
- CO2 ELIMINATION is VENTILATION
O2 UPTAKE is OXYGENATION
67
Oxygen Tension
PaO2 is the BEST indicator of degree of O2 intake within the lungs
paO2 (oxygen concentration in arterial blood (ABG's))
1- Partial pressure of O2
2-amountof O2 dissolved in arterial blood (plasma)
3-Expressed in units or Torr or mmHg
4-Acceptable limits in newbornd is 50-80 mmHg
68
During reopening of the larynx, what forms from the fold of mucus membranes?
Vocal cords
69
Which cells are osmophillic?
Type II Cells because they produce surfactant
71
Most Common TEF fistula includes what deformations? This occurs 85% of the time
Superior part of the esophagus (blind pouch) with the inferior part being joined to the trachea via a fistula
73
In which week does the main bronchus subdivide into 2 more bronchial buds, forming secondary bronchi?
later in the 5th week
75
When is the psuedoglandular period?
5-17 weeks Not possible for survival
76
Clinical Significance:
HYPERVENTILATION Can decease PACO2 by 20-30 mmHg- Increasing the PAO2 by the same amount
- You get a higher paO2
- Live in Denver-barometric level is 600mmHg-ingants have 1/3 less available O2 in alveeoli when breathing room air
78
there is an increase in the number of alveoli as well as the size of the alveoli at what age?
8 years
78
When/where do hypoplastic occur?
Occurs with posterolateral CDH
80
SP-A is the predominant protein in surfactant
YES
82
Why does a TEF occur?
Because there is incomplete seperataion of the trachea and espghagus
83
A defect/atresia with both proximal and distal TEF's can causse gastric contents to enther the trachea?
Yep, it sure can
84
Surfactant
Breaks the surface tension at the air/liquid interface of alveoli; they are polar and line up
85
Fators that shift the curve to the right
Decrease affinity for O2
Decrease Ph
Increase PCo2
Increase H ions
87
What cells cover 95% f tge alveolar surfac & Are made up of Squamous epithelial cells?
Type I Pneumocytes
88
H-Type fistula occurs in ??? %%%%%?????
4%; people think it's the most common type, but it is not
89
Expiration is
Passive
90
TC is RDS
Lung isn't expanding; lung with decreased compliance will complete inflation and deflation quicker
92
Type II Pneumocytes are made up of what kinds of cells?
Made up of Cuboidal cells
94
At 24 weeks, what kind of squamous epithelial cells line the sac?
Type I Cells
95
As the lungs develop, what kind of pleura is acquired?
Visceral pleura
97
Epiglottis forms from what pair of pharyngeal nerves?
3rd & 4th
98
The 4th stage of lung development is the?
Alveolar Period
99
What is the second stage of lung development?
Canalicular Period
100
When do tertiary bronchi develop?
7th week
101
Lecithin increases from
34 weeks
102
On the Right, the superior bronchus will supply which lobe of the ling?
Upper (superior)
104
Laryngeal Muscles are derived from what?
myoblasts of the 4th & 6th pharyngeal arches
105
When are Type II Pneumocytes detected?
25-30 Weeks BUT potential for alveolar stability does not occur intil 3-36 weeks
107
The larynx is closed primarily, but it reopens again during which week of development?
10th
108
When does the the endotracheal groove envaginate to form the laryngotracheal Diverticulum?
end of the 4th week
109
In the Alveolar period, what does each resp bronchial terminates into?
thin-walled terminal sacs
110
where does the epithelial lining of Larynx develop from?
The cranial end of the laryngotracheal tube
111
Clinical uses for Peep/CPAP
corrects stelectasis
Increasess FRC
improves V/Q mismatch
Improves Pulm edema
113
What is the 3rd stage of lung development?
Terminal Sac Period
114
PEEP or CPAP
1- PEEP mechanical ventilation
2- CPAP baby is breathing spontaneouosly
-breaks the following cycle:
reduces the amount of pressure needed to ventilate; also imporved by adding surfactant
116
Why does Laryngeal web form?
it forms if there is an incomplete opening of the larynx in the 10th week
117
what findings would you expect from a TEF with esophageal atresia?
Rapid abdominal distention; the stomach and intestines rapidly fill up with air
118
What is the ratio of Lipids to protein in Surfactant?
9:1 90% Lipids 10% Protein
119
when does the canalicular period of lung development occur?
16-25 weeks of gestation
120
A L/S ratio of
Fetal lung immaturity
121
Factors that influence compliance
1-number of alveoli (if not enough, decrease in compliance)
2-surfactant
3-interstitial changes (scars/PIE/Pneumonia)
4-V/Q Mismatch
5-lung volume
CO2 moves faster than O2
122
Time Constant
Time Constant = resistance x Compliance
How long it takes for the lung to inflate and deflate
or
measure of how ling is takes for the lung to inflate and deflate
depends of compliance and resistanve
124
Concentration of surfactant in amniotic fluids occurs at a 2:1 ratio at about what week indicating lung maturity?
34-34 weeks
125
Terminal bronchioles divide to form smaller bronchioles during the canalicular peiord
There are 3-6 alveolar ducts at about 24 weeks
127
By 24 weeks, about how many orders of branches have formed and about how many respiratory bronchioles have formed?
about 17
128
VQ Matchiing
Capillary touhing the alveolar surface to have exchange
1-matching of ventilation and perfusion
2: ratio reflects the correlation between alveolar ventilation and capillary perfusion for lung as a whole
3-when ventilation is matched to perfusion-the ratio is 1
VQ mismatch is defective of gas exchange
130
95% of these cells cover the alveolar surface. These cells are interconnected by tight junctions......
Type I Cells
131
On the right, the inferior bronchus subdivides into two bronchi to form?
1- Middle lobe of the right lung & the other to the lower (inferior lobe)
132
Rib Cage in NN
1- More cylindrical than elipsoid
2-ribs more horizontal than oblique
3- Reuslts
a) Muscles are shorter
b) less mechanical advantage
c) angle of the diaghragm is different (more horizontal so air move inward rather than upward)
d) ribcage is pliable and unstable
e) retractions
133
Pulmonary ad systemic circulation is established in what period?
Alveolar period
134
When is the alveolar period?
Late fetal to 8 years of age
135
Factors that shift the Curve to the LEFT
Hg has an INCREASD affinity of O2
Presence of Hgf
decrease 2,3 DPG
Alkalosis
Decrease PCO2
Decrease Temp
136
In the pseudoglandular period:
Resembles an endocrine gland all major parts of the lung form except alveoli
137
Can air enter the esophagus if you have an Esophageal atresic with a PRXIMAL TEF?
No, so there is NO abdominal distention
138
Where does the trachea come from/differentiated from?
The distal end of the laryngotracheal tube
139
Surfactant is diffused/dispersed by
PROTEINS
140
when does adequate production of surfactant occur?
During the alveolar period
141
Oxygen Tension
FiO2:
1- Fraction of inspired O2
2-Measured in %%%%
3-RA has .21% O2
(In air trasnport: Altitude increases % oxygen availaible in ambient air; O2 availability is decreased because the MOLECULES are smaller and are harder to analyze
142
Is some respiration possible in the canalicular period?
Yes......16-25 weeks, if born between 22-25 weeks, there is a chance but some still die
143
Factors affecting Hg Affinity for O2
% of fetal and adult Hg
1-95% HGf
2- Hgf does not bind to 2,3 DPG
a) Result: Hgb holds onto O2 tightly
b) Left shift in Oxyhgb Curve
