Physiology - Respiratory

Front 1

How does increased CO2 increase hydrogen ion concentration in the blood. What is the chemical formula

Back 1

Front 2

Transmural pressure is..
Transpulmonary pressure...
trans chest wall...
trans respiratory system...

Back 2

tranmural pressure = pressure inside - pressure outside
transpulmonary pressure gradient across the lung
trans chest wall pressure gradient across the chest wall
trans respiratory system = gradient across the entire respiratory system

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Superior aspect of epiglottis (low mag)

*Both anterior and posterior surfaces are lined by stratified squamus, incompletely kertatinized at this level
*epiglottis is layered
*epiglottis is the only portion of the conducting airways that contains ELASTIC CARTILAGE

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epiglottis (higher mag)

* layers of epiglottis
*lamina propria (aka tunica propria) consists of dense irregular FECT
* submucosa has larger collagen fibers and are less densely packed (compared to lamina propria)
*

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ANTERIOR surface of the epiglottis

*anterior because lined by stratified squamous epithelium that varies little
*non-cornfied (surface cells are nucleated)
*anterior <- lack of glands within submucosa

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elastic cartilage in the central portion of the epiglottis

*surrounded by dense irregular FECT perichondrium
* elastic cartilage <- chrondrocytes lie in spaces within the extracellular matrix called lacuna
* elastic cartilage <- matrix appears fibrous because of elastice fibers (eosinophilically staned materail in beteween the cells.)
* (elastic cartilage exists in the pinna of the external ear and the epiglottis)

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POSTERIOR surface of epiglottis

*lamina propria apepars quite cellular (large number of lymphocytes and other immune system cells)
*posterior surface <- larger blood vessels and glands in submucosa
*transition in epithelium

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lower posterior surface of epiglottis

*lower posterior <- no longer stratified squamous, is becoming pseudostratified columnar
* pseudostratified columnar <-thing overall epithelial thickness, no longer oriented parallel to the basement membrane
* this transition does not occur on the anterior surface

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Elastic cartilage

* chrondrocytes lie within spaces called lacuna
* chrondrocytes <- rather dark staining nuclei with minor amounts of surrounding cytoplasm
* elastic cartilage <- presence of elastic fibers

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elastic cartilage

*elastic fibers are black
* elastic fibers are found in ethe spaces in between lacuna

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coronal section of larynx

* true and false vocal folds
* false volcal fold <- lined with a typical respiratory epithelium
* true vocal fold <- lined by stratified squamous and lacks glands

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true and false vocal folds

* false vocal fold <- pseudostratified columnar, abundant excrocrine glands (contain both serious and mucous acini and mucous acini with serous demilunes)

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false vocal fold showng exocrine gland

* false vocal volds drain to larynx ventricle or main larynx lumen)
*exocrine gland <- epithelium becomes lower in height as you move toward the secretory acinia
* mucous acini<- light staining, serous acini<-darker staining

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True vocal vold at low magnification

* vocalis ligament visible (region of dense FECT subajacent to epithelium composed of elastic connective tissue)
*vocalis muscle (skeletal muscle) benearth the vocalis ligament
* true vocal fold <- pseudostratified columnar except tip which is stratified squamous incompletely keratinized

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true vocal vold (higher mag)

* epithelium is stratified squamous, incompletely keratinized
* lamina propria below this layer
* no submucosa or glands

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laryngeal cartilages (include thyroid/cricoid cartilages)

*hyaline cartilage - chrondrocytes found within lacuna BUT extracellular matrix appears smooth because of lack of elastic fibers
*cartilage is surrounded by a layer of dense irregular fect forming perichondrium
*sketical muscle located ourside perichondrium (is one of the lryngeal muscles)

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hyaline cartilage within one of the larynegeal cartilages

* chrondrocytes inside lacuna
* hyaline cartilage <- presence of isogenous groups which allows one to distinguish territorial and interterritoral matrix
* yyaline cartilage <-extracellular matrix is not fibrous (no elastic fibers)

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Trachea at low magnification

*one continuous piece of hyaline cartilage
*between cartilage and epithelium are two layers: submucosa (deep), tunica propia (just deep to epithelium)
* pseudostratified columnar epithelium

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trachea (higher mag)

*subajacent to epithelium is lamina propria -- layer of loose FECT which is highly cellular and contains a number of small blood vessels and nerves and wandering cells
*submucosa has secretory acini of the exc=ocrine glands
* hyaline cartilage surrounded by dense irregular FECT perichondium

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trachea (very high mag)

*lamina propria contains a number of blood vessels (arterioles, venules, capillaries) and nerves
*very cellular region

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trachea (high mag showing submucosa)

*submucosa <- secretory acini (serous acini/mucous acini, mucous acini with serous demilunes)
* these secretory unites pass to a series of ducts which drain to the lumen of the trachea

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trachea deep to submucosa

*cartilage covered by a layer of dense irregular FECT representing he perichondrium
*hyaline cartilage of trachea consists of isogenous groups of chrondrocytes surrounded by territorial matrix

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bronchus at low mag

* layers: pseudostratified columnar epithelium-> lamina propria-> tunica muscularis-> submucosa-> cartilage->adventitia
* cartilage consists of plates connected by dense irregular FECT
* bronchi <- additional smooth muscle layer between lamina propria and submucosa

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bronchi at higher mag

* lined by pseudostratified columnar (like trachea) with four basic cell types: cill=iated cells, goblet cells, brush cells, and basal cells
* lamina propria lies beneath the basement membrane
*lamina propria is highly cellular layer of loose FECT

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below epithelium of bronchus

*lamina propria and submucosa separated by layer of smooth muscle (called tunica muscularis)
*excrocrine glands define submucosa layer which consists of dense irregular FECT situated between the tunica muscularis and cartilage

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bronchus

* the region subjacent to submucosa may or may not containt hyaline cartilage regions which lack this cartilage plate would consist of dense irregular FECT which links cartilage plates

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outer portoin of the lung

*outer layer of connective tissue which forms a capsule
* connective tissue of the capsule invaginates to form distinct regions called lung lobules
* each lung lobule is suplied by a single terminal bronchiole

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terminal bronchiole

*lumen highly convoluted (occurs due to contraction of the smoother muscle upon exposure to tissue processing)
*terminal bronchiole is surrounded by long structures such as alveoli

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terminal bronchiole

* unlike bronchi terminal bronchioles do not possess cartilage plates nor exocrine glands
* epithelium is simple columnar
* have a thin layer of lamina propria subadjacent to epithelium and tunica muscularis deep to this layer
*postmortem smooth muscle contraction -> characteristic folds
*outside smooth muscle is dense irregular FECT called peribronchiolar tissue

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terminal bronchiole epithelial lining

*epithelium is simple collumnar
*no longer any goblet cells present
* majority of cells are ciliated (for mucus clearing)
* some appear non-ciliated -> possess microvilli
* lamina propria between epithelium and tunica muscularis and outside all layers is peribronchiolar tissue

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respiratory bronchiole along with associated pulmonary arterial branch

* respiratory bronchioles are lined by epithelium that varies from simple cupoidal to simple squamous
*minor amount of smoother muscle along with connective tissue in walls

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respiratory bronchiole

*epithelium varies from simple cuboidal to simple squamous
* smooth muscle cells (tunica muscularis)
*connective tissue located subjacent to smooth muscle which is peribronchiolar tissue

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alveolar structures at low mag

*alveolar duct branches off alveoli on either side
*alveolar sacs represent a common space which has terminal alveoli branches (cul-de-sac-like)
*individual alveolus varies in size and shape but is roughly circula
*all these structures are lined by a simple squamous epithelium

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several alveoli

*lined by a simple squamous epithelium
*interalveolar septum seperates two alveoli
*series of pulmunary capillaries in the septum interior
* small spaces joing alveoli called alveolar pores

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alveolear structures with blood vessel

*fairly substantial in size
*not associated with a terminal or respiratory bronchiole-> likely a portion of pulmonary venous system
*in lung sections in which one sees an isolated blood vessel it is likely a portion of the venous system

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two types of squamous cells which are associated with alveoli

*squamous cells lining the alveolar lumen are called type I pneumocyte
*when the nucleus is in the middle of the septum is is likely an endothelial cell, when the nucleus borders the lumen it is liekly a type I pneumocyte
*more cubodial type II pneumocyte also form aportion of the epithelial lining of alveoli but are less common than endotheali cells or type I pneumocyte

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lung alveoli

following the rule
*cuboidal-> type II pneumocyte
*inside septum->endothelial cell
*outside septum type I pneumocyte

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alveolar septum

*macrophages are larger, tend to have darker staining nucleus, more granular cytoplasm and often appear to be only peripherally associated with intralveolar septa

Front 39

What is the equation for the pressure in a spherical bubble (alveoli)

Back 39

P = 2T/r

Front 40

Restrictive diseases (increase/decrease) the slope on a PV plot..what about Obstructive diseases

Back 40

Restrictive -> decrease the slope
Obstructive -> increases the slopw

Front 41

In Laminar flow the pressure drop from the beginning to the end of the tube is related mathematically how? for turblent flow?

Back 41

Laminar: P proportional to V
Turbulent flow: P proportional to V^2

Front 42

What is Poiseuille's law

Back 42

P = 8mu*L*Q/(pi*r^4) or R = 8mu*L/(pi*r^4)

Front 43

What are the factors governing resistance to airflow

Back 43

lung volume - as lung expands, caliber increases, reducing resitance
bronchial smooth muscle - contraction of bronchial smooth muscle narrows the airways and increases airway resistance

Front 44

Define the various lung volumes:
Tidal Volume
Inspiratory Reserve Volume
Expiratory Reserve Volume
Residual Volume
Functional Residual Capacity
Inspiratory Capacity
Vital Capacity
Total Lung Capacity

Back 44

Tidal Volume (VT) is the volume of gas inhaled (or exhaled) with each breath. VT increases with
exercise, fever, acidosis, and various diseases.
Inspiratory Reserve Volume (IRV) is the maximum volume of gas that can be inhaled at the end
of a spontaneous inspiration. It is available for increasing VT.
Expiratory Reserve Volume (ERV) is the maximum volume of gas that can be expired at the end
of a spontaneous expiration.
Residual Volume (RV) is the volume of gas remaining in the lungs after maximal exhalation.
Functional Residual Capacity (FRC) is the volume of gas remaining in the lungs at the end of
a spontaneous expiration. FRC varies with posture because the elastic recoil of the chest wall is
dependent on body position; thus, supine FRC is lower than upright FRC. FRC may decrease
with obesity or increase due to disease processes.
Inspiratory Capacity (IC) is the maximal volume of gas that may be inhaled from FRC. IC may
be reduced by lung disease.
Vital Capacity (VC) is the volume of gas that can be exhaled from TLC with a maximal expiratory
effort. Normal VC varies with height, age, and sex.
Total Lung Capacity (TLC) is the total volume of gas that the lungs contain after a maximal
inspiratory effort. TLC is a function of height, age, and sex, although various diseases of the
lung and chest wall may act to either increase or decrease TLC from normal.

Front 45

What are the three general types of obstructive diseases

Back 45

chronic bronchitis - airway resistance rises because of a decrease in airway diameter due to increases mucus production
Asthma - narrowing of the ariways due to an increase in tone of airway smooth muscle, usually in response to an antigen
Emphysema - loss of parenchyma that decreases airway tethering and increases airway resistance

Front 46

COPD is

Back 46

Chronic Obstructive Pulmonary Disease, a term that is often applied to patient who have emphysema, chronic bronchitis or a mixture of the two

Front 47

Name 4 classes of restrictive respiratory disorders..

Back 47

1) diseases of the lung parenchyma - interstitial pulmonary fibrosis, sarcoidosis, hypersensitivity pnumontitis, connective tissues diseases (lupus erythematosus and rheumatoid arithritis) and lympatic carcinomas
2) diseases of the plura - pneumothorax, pleural effusion, plural thickening
3) diseases of the chest wall -scoliosis and ankylosing spondylitis (immobility of the verebral joints and ribs)
4)Neuromuscular disorders -diseases affecting the muscles of respiration or their nerve supply (i.e. poliomyelitis, Guillain Barre syndrome, amyotropic lateral sclerosis, myasthenia gravis, muscular dystrophies)

Front 48

How does restrictive and obstructive disorders affect the various lung volumes

Back 48

restrictive - decreases volumes but relative proportions stay the same
obstructive diseases increases resistance to airflow and lead to greatly incrasesed TLC, FRC, and RV

Front 49

Forced Expiratory Volume is..

Back 49

measured by expiration from TLC rapidly and forceibly...I usually used in conjunction with Forced Vital Capacity, the ratio is sensitive to airway resistance

Front 50

Forced Expiratory Flow is...

Back 50

calculated from a forced expiration..FEF_25-75 is the volume in liters divided by the time in seconds... it is the solpe in the V-t curve

Front 51

What are the differences between normal, obstructive, and restrictive patterns in a flow-volume curve

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Front 52

Explain examples of Flow-Volume curves for normal COPD and fixed upper airway obstruction

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Front 53

Normal dead space in ___ is approximately equal to the _____ in ____

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ml, body weight, pounds

Front 54

what are anatomical, aveolar and physiological dead space

Back 54

physiological dead space = alveolar dead space+ anatomical dead space
*in a healthy individual physiological = anatomical

Front 55

How do you calculate Pulmonary vascular resistance PVR

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PVR= (MPAP -MLAP)/PBF

Front 56

Hows does pulmonary vascular resistance changes with increasing lung volume

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*for alveolar the resistance to blood flow (by the compressing of vessels between alveoli) increases
*for extraalveolar vessesl the resistance decreases, but increases at low lung volume (intrapleural pressure becomes very positive) it increases

Front 57

As arterial or venous pressure increases, pulmonary vascular resistance _____ . Why is this?

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decreases due to:

recruitment: opening up of previously closed vessels (dominates at low presures)
distension: increase in caliber of vessels (dominates at high pressures)

Front 58

How does blood flow change from the bottom to top of lung

Back 58

decreases

Front 59

What is Starling's equation

Back 59

Starling's equation calculates the net fluid across alveolar endothelium

Front 60

What are the two stages of pulmonary edema

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interstitial edema: engorgement of perivascular and peribronchial interstitial tissues
alveolar edema: fluid moves across into alveoli

Front 61

What is Fick's law

Back 61

Fick's Law describes diffusion across a membrane and is used most often in relative rates of diffusion

Front 62

What is the equation for Pulmonary Diffusing Capacity

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PA = alveolar pressure
PC = capillary pressure
V dot = flow rate

Front 63

What are the two forms in which O2 is carried by the blood and which is dominant

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*dissolved in blood and bound to Hb with the latter being much more dominant (0.003 ml O2/100 ml blood v.s. 20.1ml O2/100 ml blood)

Front 64

How does the following affect the Hb-O2 Dissociation Curve:
pH, PCO2, temperature, 2,3-DPG conc, anemia, CO

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Incr pH --> shift to left
Incr PCO2 (Bohr effect) -> shift to right
Incr Temp -> shfit to right
Incr 2,3-DPG -> shift to right
Anemia - does not affect (though the amount of Hb decreases but not saturation)
CO - shifts to the left (dashed line)

Front 65

What ways are CO2 transported in the blood

Back 65

1) Dissolved C02 2) carbamino compounds 3) as bicarbonate ion (plasma and red-cell component)

Front 66

what is the Haldane effect

Back 66

The lower the saturation of Hb with O2 the larger the CO2 concentration for a given PCO2 which allows blood to load more CO2 at the tissues

Front 67

What is the normal range of arterial PO2

Back 67

85-100 mmHg with an average of 95 in young adults and 85 at 60 yo

Front 68

What is the normal range of arterial PCO2

Back 68

35-45 mmHg unaffected by age

Front 69

The normal pH of arterial blood is...

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7.4. a decreases is called acidosis and increases is called alkalosis

Front 70

What are caues of hypoxemia

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hypoxemia (reduced arterial P02) 1) hypoventilation 2) diffusion impairment 3)shunt 4) ventilation-perfusion inequality

Front 71

Identify the types of respiratory groups in the brainstem

Back 71

DRG - dorsal respiratory group - related to phases of the respiratory cycle
VRG - ventral respiratory group - phases of the respiratory cycle
NRA - nucleus retroambiguus
NR - nucleus ambiguus
RFN - retrofacial nucleus
PRG - pontine respiratory group - phase-related activity

Front 72

Identify the respiratory neural sensors

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