M2-C9-L09 --> Pulmonary Circulation

Front 1

PULMONARY ANATOMY

- Bronchial vessels are several arteries representing what?

Back 1

- 1 to 2% of cardiac output

Front 2

PULMONARY ANATOMY

- Bronchial vessels empty into what vessels?

- going into what?

Back 2

- Pulmonary veins

- Left atrium

Front 3

PULMONARY ANATOMY

- huge numbers of LN ultimately drain into?

Back 3

- Right Lymphatic duct

Front 4

PULMONARY PRESSURES

- Systemic systolic & diastolic pressures

- Pulmonary systolic & diastolic pressures

Back 4

120 / 75

25 / 8

Front 5

PULMONARY PRESSURES

- Left Atrial Pressure can be estimated by measuring what?

Back 5

- Pulmonary Wedge Pressure

Front 6

LUNG BLOOD VOLUME

- Lung Blood Volume is what?

- Lung Blood Volume is what % of total blood volume?

Back 6

- 450 mL

- 9%

Front 7

LUNG BLOOD VOLUME

- Lung blood volume is what?

- Capillary volume is what?

- where is the rest of the lung blood volume?

Back 7

- 450 mL

- 70 mL

- between the arteries and veins

Front 8

LUNG BLOOD VOLUME

- Lung Vascular Bed may act as a ?

- Lung vascular beds pump how much volume in to what?

Back 8

- Reservoir

- Pump > 250 mL
(into)
- Systemic circulation

Front 9

LUNG BLOOD VOLUME

- may increase up to how much with pathology?

Back 9

- up to 100%

Front 10

LUNG BLOOD FLOW

- Blood flow through the lungs is essentially equal to what?

- Lung blood flow control mechanisms are similar to what other control mechanisms?

Back 10

- Cardiac output

- Cardiac output

Front 11

LUNG BLOOD FLOW

- Local control takes over if?

- Local control causes what to occur?

- Thus, allowing what to happen?

Back 11

- O2 concentration falls below 70% of normal

- Constriction of local blood vessels

- Shunt blood to where oxygen is

Front 12

LUNG BLOOD FLOW

- describe Sympathetic control in small vessels

- describe Sympathetic control in large vessels

Back 12

- limited

- significant

Front 13

LUNG BLOOD FLOW

- Blood flow is greatest where in the lung?

- what happens with exercise to the Blood Flow curve?

Back 13

- Bottom > Middle > Top

- shifts up

Front 14

LUNG BLOOD FLOW

- describe the blood flow in Zone 1

- why?

Back 14

- No flow

- Alveolar pressure > Arterial pressure

Front 15

LUNG BLOOD FLOW

- describe the blood flow in Zone 2

- why?

Back 15

- Intermittent flow

- Systolic Arterial Pressure > Alveolar pressure
(but)
- Diastolic Pressure < Alveolar pressure

Front 16

LUNG BLOOD FLOW

- describe the blood flow in zone 3

- why?

Back 16

- Continuous flow

- Arterial Pressure > Alveolar Pressure

at ALL TIMES!!!!!!!

Front 17

LUNG BLOOD FLOW

- when would you expect Zone 1 blood flow?

Back 17

- occurs abnormally

(i.e. - Hypovolumic states when BP is lower than normal)

Front 18

HEAVY EXERCISES

- does what to Cardiac Output

- what happens to capillaries? x2

Back 18

- increases CO

- Increases Number of Open Capillaries (~ 3 fold)

- Distends ALL Open Capillaries
( ~ 2 fold)

Front 19

LEFT-SIDED HEART FAILURE

- when Left Atrial Pressure is > 7 to 8 mmHg, what happens? x2

Back 19

- Pulmonary Arterial Pressure goes up

- Load on the Right side of Heart goes up

Front 20

LEFT-SIDED HEART FAILURE

- when Left Atrial Pressure is > 30 mmHg, what happens?

Back 20

- Pulmonary Capillary Pressure causes Pulmonary Edema

Front 21

PULMONARY CAPILLARY DYNAMICS

- what does it mean that capillary blood flows as a "sheet?"

Back 21

- there are so many capillaries in the lung that they nearly touch each other

Front 22

PULMONARY CAPILLARY DYNAMICS

- how do you measure Pulmonary Capillary pressure?

- what is the value of Pulmonary Capillary Pressure

Back 22

- can NOT measure it directly

- approximately 7 mmHg

Front 23

PULMONARY CAPILLARY DYNAMICS

- Blood passes through the capillary in how many seconds at rest?

- Blood passes through the capillary in how many seconds during exercise?

- therefore, what happens to the blood in the capillaries in less than 1 second? x2

Back 23

~ 0.8 sec

~ 0.3 sec

- becomes Fully Oxygenated
- loses its Excess Carbon Dioxide

Front 24

PULMONARY INTERSTITIAL FLUID

- there is a balance of forces where?

- when fluid moves outward from the capillaries, it goes into?

Back 24

- Capillary membrane

- Pulmonary interstitium

Front 25

PULMONARY INTERSTITIAL FLUID

- what are the 3 forces tending to cause movement of fluid outward from the capillaries and into the pulmonary interstitium?

Back 25

(NCI)

- Negative Interstitial Fluid Pressure

- Capillary pressure

- Interstitial Fluid Colloid Osmotic Pressure

Front 26

PULMONARY INTERSTITIAL FLUID

- Capillary pressure contributes how much mmHg to the total outward force?

Back 26

7 mmHg

Front 27

PULMONARY INTERSTITIAL FLUID

- Negative Interstitial Fluid pressure contributes how much mmHg to the total outward force?

Back 27

8 mmHg

Front 28

PULMONARY INTERSTITIAL FLUID

- Interstitial Fluid Colloid Osmotic pressure contributes how much mmHg to the total outward force?

Back 28

14 mmHg

Front 29

PULMONARY INTERSTITIAL FLUID

- what is the total outward force?

- what is the total inward force?

- what is the difference?

- what is the above difference called?

Back 29

+ 29 mmHg

- 28 mmHg

+1 mm Hg

Net Mean Filtration Pressure

Front 30

PULMONARY INTERSTITIAL FLUID

- which is higher, the normal outward forces or the normal inward forces?

Back 30

- normal outward forces

Front 31

PULMONARY INTERSTITIAL FLUID

- what is the forces contributing to Total Inward Force

Back 31

Plasma Colloid Osmotic Pressure

Front 32

PULMONARY INTERSTITIAL FLUID

- Inward forces tend to cause what?

Back 32

- absorption of Fluid into capillaries

Front 33

PULMONARY EDEMA

- what 2 heart conditions may cause Pulmonary Edema?

- what is the consequential effect in pressure?

Back 33

- Left sided Heart failure
- Mitral Valve disease

- Increase in Pulmonary Capillary Pressure

Front 34

PULMONARY EDEMA

- you can also cause Pulmonary edema by damaging what structure?

Back 34

Pulmonary Capillary Membrane

Front 35

PULMONARY EDEMA

- Damage to the Pulmonary Capillary Membrane can occur by what 2 ways?

Back 35

- Pneumonia infections

- Breathing in noxious substances
(chlorine gas or sulfur dioxide gas)

Front 36

PULMONARY EDEMA

- you can damage the pulmonary capillary membrane by breathing in noxious substances such as what? x2

Back 36

- Chlorine gas

- Sulfur Dioxide gas

Front 37

PULMONARY EDEMA

- Interstitial edema nearly always does what?

- why?

Back 37

- enters the Alveoli

- Fragility of the epithelial lining

Front 38

PULMONARY EDEMA

- Pulmonary Edema is normally prevented by what 3 ways usually?

Back 38

(NFL - Nip Fo Lymph)

- Normal Negative Interstitial Fluid Pressure of the lungs

- Fluid Osmosis increases into the Pulmonary capillaries

- Lymphatic pumping of fluid out of Interstitial places

Front 39

PULMONARY EDEMA

- one of the Pulmonary edema safety factors involves lympahtic pumping of fluid where?

Back 39

- pumping of fluid OUT of the interstitial spaces

Front 40

PULMONARY EDEMA

- one of the Pulmonary Edema safety factors involves increased Fluid Osmosis of fluid where?

Back 40

- fluid INTO the Pulmonary capillaries

Front 41

PULMONARY EDEMA

- Pulmonary edema prevention by moving Fluid Out of the Interstitial space is due to?

- Pulmonary edema prevention by moving Fluid Into pulmonary Capillaries by?

Back 41

(FOIL)

- Lymphatic Pumping

(FICO)
- Osmosis increase

Front 42

PULMONARY EDEMA

- one of the Pulmonary Edema safety factors involves increased osmosis of fluid into the pulmonary capillaries caused by what?

- when does this happen?

Back 42

- decreased Protein in the Interstitial Lymph

- when flow is high

Front 43

PLEURAL CAVITY FLUID

- when the total amount of fluid in each pleural cavity is slight, it yields what?

Back 43

- Potential space

Front 44

PLEURAL CAVITY FLUID

- excess fluid is pumped out through what?

Back 44

- Lymphatics

Front 45

PLEURAL CAVITY FLUID

- what keeps the lungs expanded?

Back 45

- Negative Pressure

in the Pleural Fluid

Front 46

PLEURAL EFFUSION

- Pleural effusion can be caused by a blockage of?

Back 46

- Lymphatic drainage of pleural cavity

Front 47

PLEURAL EFFUSION

- Pleural effusion can be caused by what failure?

- this leads to what?

Back 47

- Cardiac failure

- Excessive Transudation of Fluid into Pleural cavity

Front 48

PLEURAL EFFUSION

- Pleural effusion can be caused by what change in pressure?

- this leads to what?

Back 48

- Greatly reduced Plasma Colloid Osmotic Pressure

- Excessive Transudation of Fluid into Pleural cavity

Front 49

PLEURAL EFFUSION

- Pleural effusion involving Excessive Transudation of Fluid into the Pleural cavity can be caused by what 2 events?

Back 49

- Cardiac failure

- Plasma Colloid Osmotic Pressure is greatly reduced

Front 50

PLEURAL EFFUSION

- Pleural effusion may be caused by the breakdown of what anatomic feature?

- what may cause the above etiology of Pleural effusion? x2

Back 50

- breakdown of Capillary Membranes

- Infections
or
- Inflammation causes

Front 51

PLEURAL EFFUSION

- Pleural effusion caused by infection or other inflammatory causes allow a breakdown in capillary membranes, thus causing what to happen?

Back 51

Dumping of

- Plasma protein
&
- Fluids

into the pleural space

Front 52

MISCELLANEOUS

- what is a diagnostic characteristic of pneumonia?

Back 52

- fluid accumulation in the lungs

Front 53

MISCELLANEOUS

- what does Hydrostatic pressure do to the fluid?

Back 53

- moves fluid out of the capillaries into pulmonary interstitium