Respiration part 1

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  • Cartilage & smooth muscle . Graps like clusters
  • O2 utilization = cellular ventilation : ins & expiration
  • Gas exchange
  • Flat cells + capillary = resp. mem 0.2 u, 100m2
  • Dec volume ………………..> inc pressure
  • 760, 759, 761
  • Recoil due tosurface tension & elasticity : the attractive force Bn molecules
  • Normal lt lung : capillaries
  • Diaphragm 75 % of resp. drive
  • Reduces attractive forces of hydrogen bonding by becoming interspersed between H 2 0 molecules
  • L / S ratio from amniotic fluid: licithin/ shyngomyeline :2-2.5
  • 100 x more distensible than a balloon.
  • Recoil by elasticity 1/3 & ST 2/3
  • No ST so recoil by elsticity only
  • ++++ C : difficult expiration
  • No work in normal exp. Due to elstic recoil of lungs. Forced expiration in exercise or asthma
  • High altitude has less Po2 i.e less diffusion, so large lungs means large area 4 diffusion. 10 % less in females.
  • Best of 3 trials RV = 20 % TLC.
  • More with age: closure of smalll airways.
  • When he is born and takes a deep breath, his Eustachian tubes open and air enters through them to the middle ear . So if you find a small bubble in the middle ear, you can be quite sure, the baby was born alive . On the contrary if you find just jelly like material in the middle ear, the baby was most probably born dead . 
  • To detect physical fitness . Static : RV- ERV- VC-TLC –VP RATIO- COMPLIANCE- DS
  • Obstructive lung disease : asthma & COPD ( reduced diameter + damage of tissues like emphysema) Prediction FEV1 : FEV1 OF PATIENT DIVIDED BY that of normal population of same character (age ,sex …etc..) In obstructive: FEV1 much reduced than FVC ( DIFFICULT expiration > inspiration). But in restrictive, both FVC & FEV1 are reduced in equal proportionate.
  • FEF - Forced Expiratory Flow - Forced expiratory Flow is a measure of how much air can be expired from the lungs . It is a flow rate measurement . It is measured as liters / second or liters / minute . The FVC expiratory curve is divided into quartiles and therefore there is a FEF that exists for each quartile . The quartiles are expressed as FEF25%, FEF50%, and FEF75% of FVC . FEF25% - This measurement describes the amount of air that was forcibly expelled in the first 25% of the total forced vital capacity test. FEV 1 < 65-80 %  mild obstruction FEV 1 < 50-65% moderate obstruction FEV 1 < 50%  severe obstruction       .
  • Respiration part 1

    1. 2. RESPIRATION <ul><li>External respiration (Lungs): </li></ul><ul><li>Pulmonary ventilation </li></ul><ul><li>Gas exchange (lungs # blood # tissues) </li></ul><ul><li>Gas transport </li></ul><ul><li>Internal respiration (Mitochondria): </li></ul><ul><li>- O2 utilization. </li></ul>
    2. 3. Non respiratory functions of the lungs <ul><li>Acid base balance </li></ul><ul><li>ACE (Activation : ATI ATII). </li></ul><ul><li>Airway protection </li></ul><ul><li>Vapor loss </li></ul><ul><li>VR help </li></ul><ul><li>Vocalization </li></ul>
    3. 4. Conducting & Respiratory Zones
    4. 5. Pneumocytes Types
    5. 6. Visceral & parietal pleura
    6. 7. Boyle’s Law
    7. 8. Pulmonary Pressures Diaphragm
    8. 9. Pulmonary Pressures
    9. 11. Importance of Negative IPP <ul><li>Lung expansion </li></ul><ul><li>Venous & lymph return </li></ul><ul><li>IPP become +ve in: </li></ul><ul><li>- Pneumothorax </li></ul><ul><li>- Valsalva manouver </li></ul>
    10. 12. Pneumothorax
    11. 13. Respiratory Muscles Abdominal ms
    12. 14. Mechanism of Inspiration
    13. 15. Mechanism of Respiration Pause Recoil Distention Lungs +++ _ _ _ IAP Rushes out Rushes in Air Less - ve More - ve IPP _ _ _ +++ Thorax Passive Active Process Expiration Inspiration
    14. 16. Surfactant <ul><li>Lipoprotein (phospholipid, apoproteins & Ca++). </li></ul><ul><li>produced by alveolar type II cells. </li></ul><ul><li>ST so prevents: </li></ul><ul><li>- collapse of small alveoli in expiration. </li></ul><ul><li>- pulmonary edema. </li></ul>
    15. 17. Surfactant deficiency <ul><li>RDS </li></ul><ul><li>100 % O2 inhalation. </li></ul><ul><li>Occlusion of pulmonary artery or major bronchus. </li></ul><ul><li>Smoking. </li></ul><ul><li>Hyperinsulinism e.g baby of diabetic mother. </li></ul><ul><li>Myxedema (hypothyroidism). </li></ul><ul><li>Hypocorticism </li></ul>
    16. 18. Physical Properties of the Lungs <ul><ul><li>Elasticity. </li></ul></ul><ul><ul><li>Surface tension. </li></ul></ul><ul><ul><li>Compliance (Distensibility). </li></ul></ul><ul><li> </li></ul>
    17. 19. Lung Compliance <ul><li>Definition </li></ul><ul><li>change in lung volume/change in distending pressure: </li></ul><ul><ul><li>C=  V/  P ml/cm H2O </li></ul></ul><ul><li>Types : </li></ul><ul><li># Static C ( lungs only, 200). </li></ul><ul><li># Dynamic C (lungs + thoracic wall, 110) </li></ul>
    18. 20. Static Lung Compliance <ul><li>200 ml / cmH2O </li></ul><ul><li>Hysteresis loop </li></ul><ul><li>Surfactant conc. during deflation </li></ul>Inflation Deflation
    19. 21. Static Lung Compliance
    20. 22. Lung Compliance obesity Poliomyelitis RDS Edema Emphysema Congestion Atheletes Lung fibrosis Aging - - - - - - - - - - - - - - ++++++++
    21. 23. Breath Work <ul><li>During inspiration or forced expiration. </li></ul><ul><li>3 parts: </li></ul><ul><li>1- Elastic work (or compliance). </li></ul><ul><li>2- Air resistance work (medium bronchi). </li></ul><ul><li>3- Tissue resistance work (viscosity). </li></ul><ul><li>Air way resistance 1/a diameter of bronchi. </li></ul><ul><li>Breath work increases in : Surfactant Compliance & Airway resistance. </li></ul>
    22. 24. Factors affecting bronchi diameters Histamine,adenosine VIP Chemicals Cold Warm Temp. Max. at 6 AM Max. at 6 PM Circadian rhythm Expiration Inspiration (Lung expansion) Respiration - - - - - - - - - - - - - ++++++++++ PCO2 Parasymp. (Muscarinic R) Symp. (B2 receptors). ANS Bronchoconstriction Bronchodilation Factors
    23. 25. Pulmonary Ventilation <ul><li>it is the air exchange (atmosphere & alveoli). </li></ul><ul><li>Normally: air vol. in insp. = air vol. in exp. </li></ul><ul><li>Spirometer measures lung volumes & capacities. </li></ul><ul><li>High volumes in tall </li></ul><ul><li>people, high altitude </li></ul><ul><li>low volumes in female, </li></ul><ul><li>pregnancy, short & </li></ul><ul><li>smokers </li></ul>
    24. 27. <ul><li>The amount of air remaining in the lungs at the end of a maximum expiration. </li></ul><ul><li>1200 ml (30% TLC) during rest ( in exercise). </li></ul><ul><li>in aging & obstructive lung diseases. </li></ul><ul><li>Measured by Helium dilution method </li></ul><ul><li>( NOT spirometer). </li></ul>Residual Volume
    25. 28. Helium Dilution Method <ul><li>RV = FRC – ERV </li></ul><ul><li>TLC= FRC + IC </li></ul>
    26. 29. <ul><li>Continuous gas exchange in between breathes. </li></ul><ul><li>Prevent alveolar collapse. </li></ul><ul><li>D of asthma & emphysema ( 70%). </li></ul><ul><li>Medicolegal importance: lost in pneumothorax but minimal air w is sufficient for floatation of lung in water & absent in stillbirth. </li></ul>RV Significance
    27. 30. Vital Capacity <ul><li>Max. vol. of air can be expired after max. inspiration. </li></ul><ul><li>Measured by spirometer. </li></ul><ul><li>4600 ml ( 2 - 2.5 L/m2). </li></ul><ul><li>Index of pulmonary function & physical fitness. </li></ul>
    28. 31. Factors Affecting VC Chest/ lung diseases ______ Pathological Recumbency Standing Pregnancy Athelets Females Males Physiological - - - - - - - - - - +++++++++
    29. 32. Dead Space <ul><li>The part of res. system with no gas exchange. </li></ul><ul><li>TYPES: </li></ul><ul><li>Anatomical DS </li></ul><ul><li>Alveolar DS </li></ul><ul><li>Physiological DS :Anatomical + Alveolar DS </li></ul><ul><li>Normally: Physiological = Anatomical DS </li></ul><ul><li>Lung diseases: Physiological > Anatomical DS </li></ul>
    30. 33. DS Importance <ul><li>Warms,filters & moistens inspired air. </li></ul><ul><li>Causes difference in composition between expired air & alveolar air (more CO2 & less O2). </li></ul><ul><li>Shallow rapid breath hypoxic hypoxia. </li></ul>
    31. 34. DS Measurement <ul><li>Anatomical DS : Fowler method (single breath N2 test). </li></ul><ul><li>Physiological DS:Bohr equation. </li></ul><ul><li>150 – 167 ml. </li></ul><ul><li>ANS can +++ or - - - - DS </li></ul>
    32. 35. Pulmonary Ventilation Tests <ul><li>Pulmonary ventilation ( minute respiratory volume): </li></ul><ul><li>RR X TV </li></ul><ul><li>Alveolar ventilation: </li></ul><ul><li>RR X (TV – DS) </li></ul>
    33. 36. Pulmonary Function Tests Pulmonary function tests Static lung volumes Dynamic lung volumes
    34. 37. Dynamic lung volumes Volume/unite time Maximum breathing capacity Breathing reserve Timed vital capacity Maximum flow rate
    35. 38. Maximum breathing capacity (Maximum ventilatory volume) <ul><li>Max. vol. of air inspired/expired using the deepest & fastest respiratory effort /min. </li></ul><ul><li>Males: 80-180 L /min </li></ul><ul><li>Females: 60-120 L /min </li></ul><ul><li>Spirometer is used for 15 sec. to avoid fatigue & resp. alkalosis. Then X 4. </li></ul><ul><li>Better index for physical fitness than VC. </li></ul>
    36. 39. Breathing Reserve <ul><li>BR = MBC - MV </li></ul><ul><li>BR/MBC > 90 %. </li></ul><ul><li>Dyspnic index : BR/MBC < 70 %. </li></ul><ul><li>Max. velocity of expired air. </li></ul><ul><li>10 L/m (by peak flowmeter). </li></ul><ul><li>--- in obstructive lung diseases . </li></ul>Maximum flow rate
    37. 40. Timed vital capacity (Forced expiratory volume) <ul><li>% vol. of expired air at end of 1 st sec. </li></ul><ul><li>FEV1 (FEV/FVC) = 80 %. </li></ul><ul><li>Measured by spirometer. </li></ul><ul><li>Differentiates between restrictive & obstructive lung diseases. </li></ul>
    38. 41. FVC > 80 % Normal < 80 % FEV1/FVC ratio > 80 % Restrictive < 80 % Obstructive
    39. 42. Spirometer Tests Normal:70 % Small air ways obstruction <70 % FVC > 80 % Normal < 80 % FEV1/FVC ratio > 80 % Restrictive < 80 % Obstructive Forced expiratory flow FEF 25% FEF 50% FEF 75%
    40. 43. Is the Obstruction Fixed or Reversible? <ul><li>In some obstructive airways diseases, a part or all of the obstruction will be reversible with bronchodilators .   Therefore in all cases where the technician notes obstruction, two inhalations of a bronchodilator will be given to the subject .   An improvement of 12% in the FEV 1  or FVC is considered a significant response with an increase of at least 200ml .   Asthma is considered the prototypical disease reactive to bronchodilators .   However, more &quot; fixed &quot; types of obstruction such as emphysema and chronic bronchitis may also show reversibility .   In addition, because asthma is a variable disease, at times pulmonary function tests may appear entirely normal .   One will therefore make the diagnosis by clinical history or attempt to provoke obstruction using a &quot; bronchoprovocational &quot; agent such as methacholine or cold air which can illicit bronchoconstriction which might not otherwise be seen . </li></ul>

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