Renal Pulmonary pa/ph #1
About this set
Created by:
dourada Plus on September 30, 2011
Subjects:
Description:
1st half- pulmonary
Classes:
Sherman Class 2015, Boards Part I (NBCE), LCCW quarter 5, LCCW
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140 terms
Terms | Definitions |
|---|---|
 conducting zone | nose nasal cavity pharynx (naso-, oro-, laryngo-) larynx trachea bronchi (23 bifurcations total) bronchioles terminal bronchioles |
| respiratory zone | respiratory bronchioles alveolar ducts (stem) alveolar sacs (bunch of grapes) alveoli (grapes) |
| cartilagenous structures all hyaline except epiglottis(elastic) | cricoid (C-6) thyroid arytenoid carina (T-4) |
| hyoid | at level of C4 (when x-raying- put horizontal beam through level of hyoid) |
| cervical x-ray | must have all 7 cervicals in x-ray |
| carina | at division of trachea |
| right primary bronchi | shorter, wider, and more vertical (more likely to aspirate something into the right side-hot dogs, grapes and peanuts) |
| secondary bronchi | aka lobar bronchi 3 on rt 2 on lft |
| tertiary bronchi | segmental bronchi |
| bronchioles | <1mm no cartilage |
| terminal bronchiole | <0.5mm |
| alveolar ducts | smooth muscle, elastic fibers, and collagen fibers leads to alveolar sacs |
| alveoli | ~300 million in lungs -simple squamous=type I (gas exchange) -cuboidal=type II (secrete surfactant-decrease surface tension) -surrounded by elastic fibers |
| alveoli and capillaries | fused with basal lamina form respiratory membrane |
| alveolar pores | connect adjacent alveoli equalization of air pressure detour for air routes |
| alveolar macrophages | aka dust cells swallow approx 2 million dead mac's per hour |
| phases of respiration | inspiration expiration |
| atmospheric pressure | produced by air surrounding the body 760mmHg, 14.7 psi at sea level |
| Intrapulmonary pressure | pressure w/in alveoli/lungs rises and falls with phases of breathing (higher than intrapleural) |
| intrapleural pressure | pressure w/in pleural cavity ~4mmHg less than intrapulmonary pressure |
| elastic recoil | attempts to pull lungs away from inside of thoracic wall |
| lung recoil | caused by elasticity of lungs -always try to assume smallest size possible -and surface tension of alveolar fluid that constantly acts to draw the alveoli to their smallest dimension |
| elastic property of thoracic wall | -opposes elastic property of lungs -tends to pull outward this creating enlargement of lungs |
| surface tension b/t lungs and thoracic wall | creates negative 4mmHg intrapleural pressure |
| lung collapse -thorax (accumulations in pleural cavity) | equalizes the intrapleural and intrapolmonary pressure -common in chest wounds pneumo- (air) hemo- (blood) pyo- (pus-purulent exudate) |
| pneumothorax | abnormal presence of air in the pleural cavity resulting in the collapse of the lung |
| hemothorax | accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest) |
| pyothorax | presence of pus in the pleural cavity between the layers of the pleural membrane |
| Boyle's Law | P1V1=P2V2 (if temp is constant) the volume of the gas increases as the pressure of the gas decreases and the volume of the gas decreases as the pressure of the gas increases |
| greatest resistance to flow | occurs in medium sized bronchi direct result of drag or friction w/in passageways |
| surfactant | 80% phospholipids 10% neutral lipids 10% protein |
| forced inspiration | occurs with physical exertion or w disease process creates overall increase in volume of thoracic wall |
| inspiration | lowering of diaphragm creates increase in superior to inferior increase in container->air rushes into container |
| expiration | rise in intrapulmonary pressure ~1mmHg above atomospheric- forces air out -created by natural elasticity of lungs |
| forced expiration | active process recruitment of thoracic and abdominal muscles |
| tidal volume (TV) | the amount of air inhaled or exhaled under normal resting conditions ~500ml |
| inspiratory reserve volume (IRV) | amount of air forcefully inhaled after a normal TV inhalation ~3100ml |
| expiratory reserve volume (ERV) | amount of air forcefully exhaled after a normal TV exhalation ~1200ml |
| residual volume (RV) | amount of air remaining in lungs following a TV and ERV exhalation ~1200ml |
| total lung capacity (TLC) | TV+IRV+ERV+RV ~6000ml |
| alveolar surface tension | produced when liquid molecules are strongly attracted to each other |
| alveolar film | water and surfactant (water highly polar-too much surface tension-would cause collapse) surfactant-produced by Type II cells |
| IRDS | too little surfactant production-causes collapse of lungs |
| vital capacity | amt of air that can be inhaled/exhaled TV, forced inhalation, focred exhalation TV+IRV+ERV should be ~80% of TLC ~4800ml |
| inspiratory capacity | amount of air that can be inhaled following a normal T.V. exhalation (TV+IRV) ~3600ml |
| functional residual capacity (FRC) | volume of air remaining in lungs after TV exhalation ERV+RV ~2400ml |
| anatomical dead space | ~350ml reach alveoli ~150 in conducting zone, Includes air in the conducting respiratory passages, air not used in gas exhange |
| alveolar dead space pathology | emphysea ->loss of elastic tissue in lungs -can get air in- can't get air out (pink puffers and blue bloaters) |
| total dead space | alveolar +anatomical |
| anemic hypoxia | decrease RBC's - decrease hemoglobin decrease ability to deliver oxygen |
| ischemic/stagnant hypoxia | blockage or impairment to circulation to lungs: pulmonary embolism- often misdiagnosed as heart attack (golden hour-anti-coagulant)-symptoms severe chest pain, shortness of breath (left sided CHF-full body ischemia) |
| histotoxic hypoxia | cellular poisoning (cyanide/arsenic) decrease cellular oxygen uptake |
| hypoxic hypoxia | reduced arterial oxygen i.e. emphysema, COPD, carbon monoxide (200x greater affinity than oxygen-nausea, headache, vomiting, loss of consciousness, cherry red) |
| Dalton's law of partial pressure | total pressure exerted by a gas mixture is equivalent to the sum of the gases found in the mixture |
| partial pressure | the pressure exerted by a single gas (in a mixture) directly proportional to its percentage of the total gas mixture |
| atmospheric air | nitrogen 78.6% oxygen 20.9% CO2 0.04% H2O 0.46% (water vapor) |
| non "primary" respiratory air movement | -talking -coughing -singing -sneezing -hiccup -yawning -laughing -cry |
| external respiration | exchange in lungs |
| internal respiration | exchange in cells and tissues of body |
| amt of blood | 5-6L |
| temp of blood | 100.4 F |
| blood pH | 7.45-7.45 |
| PPO2 in lungs | 40mmHg in Pulm A to 104mmHg in Pulm V |
| PPCO2 in lungs | 45mmHg in Pulm A to 40mmHg in Pulm V |
| solubility of gases | CO2 ~20x more soluble than O2 in blood |
| CO2 transport in blood | bicarbonate (60-70%) bound to RBC (20-30%) dissolved in plasma (7-10%) |
| Hemoglobin | 4 polypeptide chains bound to iron-containing heme group capable of binding 4 O2 molecules (=oxyhemoglobin HbO2) |
| iron is | oxygen binding |
| Hb with no O2 | deoxyhemoglobin or reduced hemoglobin reverse binding is due to pH, PO2, PCO2, temp, and BPG |
| air composition comparison | atmos-mainly N2 and O2 alveolar-more CO2 and water vapor (less O2) -newly inspire air of tidal volume mixed with remaining gases w/in respiratory passages |
| humidification of air | in conducting passages |
| gas exchange equilibrium time | less than 0.25 sec |
| hypercapnia | high CO2 acidic condition (blood, CSF) slow respiration-emphysema, alcohol/drugs, head trauma |
| hypocapnia | too little CO2 -hyperventilation-faint, dizziness- use brown bag |
| hyper/hypo-ventilation | over/under breathing |
| Apnea | cessation of breathing anatomical: pharyngeal respiratory center |
| Dyspnea | difficulty breathing asthma emphysema, pneumonia |
| tracheal-esophageal anomalies | tracheal-esophageal fistula most common anomaly of larynx and trachea -swallowed food can be aspirated into bronchi |
| epiglottis infection | caused by haemophilus influenzae type B -air flow obstruction -most common in infants and young children -inspiratory stridor |
| croup | stridor, cough, and hoarseness -epiglottitis and laryngotracheobronchititis |
| laryngitis | inflammation of larynx causes hoarseness, normally viral |
| tracheitis | inflammation of the trachea causes coughing normally viral |
| laryngeal carcinoma | most are squamous cell carcinoma directly related to smoking |
| whooping cough | caused by Haemophilus pertussis S&S: fever, severe bouts of coughing and a whooping sound on inspiration |
| most common cause of cancer death in US | lung cancer (rare until 1945-now epidemic) |
| squamous cell carcinoma | normally slow growing found in major bronchi due to smoking |
| adenocarinoma | -most common primary malignant lung tumor -glandular appearance of lung -commonly found in lung periphery -assoc mucus secretion -faster growing than squam-cell carcinoma -may invade pleura |
| small/Oat Cell carcinoma | form in apex -Pancoast tumor -brachial plexus above cupola (P/T/N) -Horner's Syndrome(ptosis, meiosis, anhydrosis- loss of sympathetic to head and neck) -x-ray-> apical lordotic -highly malignant -sheets of small tumor cells -aka oat cell also intermediate cell carcinoma -early metastasis- makes them inoperable |
| metastatic tumors | most common malignant tumors of lungs typically appear multiple and well defined |
| strep Pn | middle aged adults alcohol abuse fever, chills, thoracic pain, pleuritis, rust colored hemoptysis, massive amts of PMN's |
| kb pn | alcoholism lobar pneumonia tissue necrosis abcess formation bronchopleural fistula |
| staph pn | following influenza many small lung abcesses infants-pneumaoceles" tension pneumothorax |
| gram negative pneumonia | -E.coli: pneumonia due mainly to GI surgery complication -or pseudmonas aeurigenosa: mostly seen in immunocompromised individuals, burn pts and cystic fibrosis |
| Legionell's Disease * | -legionella pneumophilia -named due to 1976 outbreak in Philly, PA American Legion convention -occurs in hotels, hospitals, nursing homes due to contaminated air circulation -S&S: fever, muscle ache, malaise and abdominal pain -most victims are immunocompromised -may result in alveolar pneumonia |
| Tuberculosis | mycobacterium tuberculosis -hardy bacteria -persist for long period of time -droplet inhalation-most common infective pathway -initial infection-> macrophage infiltration, caseous necrosis and granulmatous lesions -bacteria can still replicate even if ingested by macrophages |
| pulmonary edema | increase hydrostatic pressure decrease oncotic pressure obstruction of lymphatic system |
| hydrostatic pressure | force exerted by fluid in equilibrium due to the force of gravity (force exerted by fluid against capillary wall) increase causes: L sided heart failure and mitral stenosis |
| oncotic pressure | to maintain fluid w.in capillaries decrease causes: malnutrition, proteinuria, hypoalbuminemia, [The osmotic pressure in the blood vessels due only to plasma proteins (primarily albumin) --> causes water to rush back into capillaries at end.] |
| Edema due to microvascular injury | -infection in lungs -> inflammatory response -inhalation of substances- smoke, fluid, foreign particles, chemicals-tissue damage (i.e. O2 at too high concentrations is toxic and irritates tissues) -ingested substances -sepsis, shock, trauma, heat, embolism, radiation |
| edema treatment | diurectics |
| diffuse alveolar damage S&S | cyanosis, tachycardia, and respiratory insufficiency -result of diffuse capillary damage -collapsed leathery looking lung- difficult to inflate |
| causes of diffuse alveolar damage | viral, radiation, poison gases, overdoses of narcotics, oxygen |
| diffuse alveolar damage (DAD) microscopically | alveoli lining loss fluid exudation formation of hyaline membranes -fibrin, fluid filled protein, necrotic epithelial cells |
| DAD: hyaline membranes usually occur | in Infant Respiratory Distress Syndrome -caused by deficiency of pulmonary surfactant |
| pulmonary infarct | direct result of pulmonary embolism -leads to decrease or loss in circulation |
| pulmonary infarct | lower lobes 75% -most cases hemorrhagic -may extend to pleura producing fibrous exudates |
| obstructive pulmonary disease | increase in resistance to air flow w/in respiratory passages -asthma, pneumonia, COPDs, bronchitis |
| restrictive pulmonary disease | decrease in total lung capacity -DJD, DISH, scoliosis, ankylosing spondylitis, subluxation, rib fractures, pleuritis, pectus excavatum pectus carniatus |
| diffuse lung fibrosis: causes | -incomplete resolution of viral and bacterial infection -industrial lung disease |
| industrial lung diseases | asbestosis-mesothelioma coal miners lung-anthracosis cotton dust-byssinosis valley fever-histoplasmosis |
| carcinoma | cor pulmonale R ventricular hypertrophy due to vasoconstriction |
| bronchiectasis | -copious quantity of purulent sputum -infection of bronchi and bronchioles resulting in abnormal dilation |
| bronchiectasis: causes | bronchial obstruction hereditary- cystic fibrosis pneumonia |
| bronchial obstruction | tumor-squamous cell aspiration of substance causing inflammation |
| hereditary | cystic fibrosis (recessive) excess mucus in lungs and pancreas dx-sweat test treatments- salty air, postural drainage, vibration |
| chronic bronchitis | -at least 3 months of sputum production for 2 or more yrs -hypertrophy of mucus glands -squamous cell metaplasia |
| nosocomial | most common pneumonia in hospitals from staph 80-90,000 deaths per year |
| asthma | characterized by spastic contraction of the smooth muscle of the bronchioles |
| extrinsic asthma | -allergic reaction IgE mediated mainly attached to mast cells in lungs -foreign object inhaled-reaction w mast cell attached antibody -resulting dyspnea from reaction and contraction of smooth m w decreased expiratory rate |
| asthma | viral infections causing increase in symptoms most common in children <2yoa |
| ASA (aspirin) sensitivity: asthma | -recurrent rhinitis -nasal polyps -inhibits cyclo-oxygenase-1 enzyme [-which helps in formation of prostaglandins] |
| prostagladins | -regulate inflammatory response [Substances resulting from interactions involving arachidonic acid and acting as mediators in type I hypersensitivity reactions.] |
| asthma pathology | -mucus -thickening of BM -hypertrophy of smooth m in bronchi and bronchioles -Charcot-Leyden crystals (eosinophil membrane proteins) -increased residual volume and functional residual capacity -barrel chest occurs over time due to changes in breathing habits |
| intrinsic asthma | viral infection |
| Emphysema | destruction of alveoli 50% of all autopsies show emphysema destruction of elastic tissue in lungs -destruction of alveolar walls with enlargement of air spaces distal to respiratory bronchioles |
| panacinar | alveoli appear enlarged individual is able to get air into lungs cannot properly exhale -alveoli involvement |
| centriacinar | Type of emphysema caused by smoking -Involves alveoli and Respiratory Bronchioles |
| smoking | causes deficiency of alpha-1-antitrypsin elastic tissue is replaced by fibrotic "scar tissue" |
| alpha-1-antitrypsin | produced in the liver protects against elastase enzyem which breaks down elastic tissue |
| smoking | #1 cause of emphysema |
| emphysema complications | death hypoxia ventricular hypertrophy (R-mainly or first but could be both) polycythemia- increased RBCs |
| pneumoconiosis | disease process due to inhaled inorganic substances -asbestos -silicosis- silica sand- glass, sand blasting |
| rhinitis | inflammation of the nasal cavity |
| sinusitis | inflammation of the sinuses |
| laryngitis | inflammation of the larynx |
| tracheitis | inflammation of the trachea |
| epiglotitis | inflammation of the epiglottis |
| pleuritis | inflammation of the pleura |
| bronchitis | inflammation of the bronchi |
| pneumonitis | inflammation of the alveoli |
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