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2018/2019

2018/2019. Respiratory Teaching. Phase 1 Revision Session Helia Ghahremani nezhad Evelyne Kiu 22.11.18. The Peer Teaching Society is not liable for false or misleading information…. Things we are covering today. Anatomy Equations Hypoxia & hypercapnia Respiratory pump

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2018/2019

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  1. 2018/2019

  2. Respiratory Teaching Phase 1 Revision Session Helia Ghahremani nezhad Evelyne Kiu 22.11.18 The Peer Teaching Society is not liable for false or misleading information…

  3. Things we are covering today • Anatomy • Equations • Hypoxia & hypercapnia • Respiratory pump • Lung physiology • Gas exchange • Foetal circulation • Oxygen transport • Spirometry • Restriction vs obstruction • Acid/base balance The Peer Teaching Society is not liable for false or misleading information…

  4. The nose The nose: • •Functions • –Warming • –Humidifying • –Filtering • –Defence The Peer Teaching Society is not liable for false or misleading information…

  5. Chonchaes create: • Superior meatus: has olfactory epithelium, olfactory nerve penetrates into superior meats through pores in the cribriform plate, sphenoid sinus drains here • Middle meatus: more sinuses drain here • Inferior meatus: nasolacrimal duct drain here The Peer Teaching Society is not liable for false or misleading information…

  6. Paranasal sinuses • These are pneumatised areas (a bone that is hollow or contains many air cells) of the frontal, maxillary, ethmoid & sphenoid bones They are arranged in pairs • Frontal sinuses: • Within the frontal bone Lie over the orbit • Innervation: Ophthalmic division (V1) of Trigeminal nerve (CNV) The Peer Teaching Society is not liable for false or misleading information…

  7. Maxillary sinuses: • Located within the body of the maxilla • Pyramidal shape • Innervation: Maxillary division (V2) of Trigeminal nerve (CNV) Base - lateral wall of the nose • Apex: zygomatic process of the maxilla • Roof: floor of the orbit • Floor: alveolar process • Open into the middle meatus The Peer Teaching Society is not liable for false or misleading information…

  8. Ethmoid sinuses: • Between the eyes Labyrinth of air cells • Innervation: Ophthalmic (V1) & Maxillary (V2) branches of the Trigeminal nerve (CNV) • Open into the middle meatus The Peer Teaching Society is not liable for false or misleading information…

  9. Sphenoid sinuses: • Medial to the cavernous sinus (which contains the internal carotid artery, oculomotor nerve (CNIII), trochlear (CNIV), trigeminal (CNV), abducens (CNVI) - contains many important structures, nerves for eye movement & head blood supply, thus defects in the cavernous sinus can be catastrophic • Inferior to optic canal, dura & pituitary gland • Empties into the sphenoethmoidal recess, lateral to the attachment of the nasal septum The Peer Teaching Society is not liable for false or misleading information…

  10. pharynx • •Nasopharynx • –Respiratory epithelium= pseudostratified ciliated columnar epithelium • –Contains Eustachian tube • •Oropharynx • –Inferior border is epiglottis • •Laryngopharynx • –Inferior border is cricoid cartilage (C6) The Peer Teaching Society is not liable for false or misleading information…

  11. Lung physiology Types of airways: • Conducting: top of trachea to beginning of respiratory bronchioles: no alveoli and does not exchange gases with blood • Respiratory zone: extends from respiratory bronchioles down. This zone contains alveoli and is the region where gas exchange occurs with blood • Dead space: where air is supplied but no gas exchange takes place. This is the volume of air not contributing to ventilation • Approx 500ml • Where is airways resistance higher? The Peer Teaching Society is not liable for false or misleading information…

  12. Gas Exchange In what order does air move through these structures? • Respiratory bronchioles → terminal bronchioles → alveolar duct → alveolar sacs • Terminal bronchioles → respiratory bronchioles → alveolar duct → alveolar sacs The Peer Teaching Society is not liable for false or misleading information…

  13. Gas Exchange Layers of gas exchange • Layer of alveolar epithelium • Basement membrane of epithelial cells • Interstitial space • Basement membrane of capillary endothelium • Capillary endothelial cells • Red blood cell The Peer Teaching Society is not liable for false or misleading information…

  14. Foetal Circulation • Respiratory system does not carry out physiological function of gas exchange until after birth • Umbilical vein = oxygenated, from placenta to foetus • Umbilical artery = deoxygenated, from foetus to placenta Foetal circulation: Shunts to bypass the lungs • Foramen ovale: connection between R and L atria to bypass pulmonary circulation so blood goes from RA to LA • Ductus arteriosus connects pulmonary artery and aorta to direct blood away from lungs/skip circulation in lungs • Oxygenated blood passes from placenta via umbilical vein to foetus • Ductus venosus: shunt blood in umbilical vein to inferior vena cava • Foramen ovale, ductus arteriosus close after birth The Peer Teaching Society is not liable for false or misleading information…

  15. Foetal Circulation The Peer Teaching Society is not liable for false or misleading information…

  16. Airway Tone The Peer Teaching Society is not liable for false or misleading information…

  17. Oxygenation and dissociation curve • Oxygen binds reversibly to ______. • Each haemoglobin molecule can carry up to _______ oxygen molecules. • Haemoglobin is an allosteric protein, meaning the binding of oxygen to one ______ group increases/decreases the oxygen affinity within the remaining haem groups. The Peer Teaching Society is not liable for false or misleading information…

  18. Dissociation Curve The Peer Teaching Society is not liable for false or misleading information…

  19. Equations and lung compliance • Dalton’s law: pressure exerted by each gas in a mixture of gases is independent of the pressure exerted by the other gases. This is because gas molecules are normally so far apart that they do not affect each other. Each gas in a mixture behaves as though no other gases are present, so the total pressure of the mixture is simply the sum of the individual pressure known as partial pressures which are directly proportional to its concentration The Peer Teaching Society is not liable for false or misleading information…

  20. Boyle’s law: pressure of a fixed amount of gas in a container is inversely proportional to container’s volume; • Henry’s law: amount of gas dissolved in a liquid is proportional to the partial pressure of gas with which the liquid is in equilibrium - at equilibrium the partial pressures of the gas molecules in the liquid and gaseous phases must be identical The Peer Teaching Society is not liable for false or misleading information…

  21. •Alveolar gas equation • –PAO2 = PiO2 - PaCO2/R • –Allows calculation of alveolar partial pressure of oxygen • •Laplace’s law & action of surfactant • –The pressure within an alveolus is directly proportional to the surface tension and inversely proportional to the radius • –P = 2T/r • –Surfactant increases stability of alveoli by decreasing the surface tension The Peer Teaching Society is not liable for false or misleading information…

  22. Lung compliance (CL): the change in lung volume caused by a given change in transpulmonary pressure; the greater the lung compliance, the more readily the lungs are expanded • DETERMINANTS OF LUNG COMPLIANCE: • Stretchability of the lung tissues: a thickening and thus a loss in stretchability of the lungs elastic connective tissues results in a decrease in lung compliance The Peer Teaching Society is not liable for false or misleading information…

  23. Surface tension of the air-water interfaces of the alveoli: • Thus, the expansion of the lungs, requires energy not only to stretch the connective tissue of the lung but also to OVERCOME the surface tension of the water layer lining the alveol The Peer Teaching Society is not liable for false or misleading information…

  24. Spirometry Learn the definitions! The Peer Teaching Society is not liable for false or misleading information…

  25. Spirometry definitions FEV1: Forced expiratory volume in the first second. The volume of air that is forced out in one second after taking a deep breath. The Peer Teaching Society is not liable for false or misleading information…

  26. Flow-volume loop • PEF (Peak expiratory flow) is shown: person’s maximum speed of expiration, measured with a peak flow meter; effort-dependent

  27. Volume-time curve • FEV is shown over time • FEV6 ~ FVC

  28. Airway obstruction & restriction • Obstruction: Asthma, COPD • Restriction: Obesity, pulmonary fibrosis Learn this! • Airway diseases are defined as obstructive or restrictive using spirometry The Peer Teaching Society is not liable for false or misleading information…

  29. Airway obstruction & restriction Learn this! The Peer Teaching Society is not liable for false or misleading information…

  30. Hypoxia and hypercapnia • Hypoxia: deficiency of oxygen at the tissue level4 types of hypoxia Hypoxaemia Anaemia or CO hypoxia Ischaemic hypoxia Histotoxic hypoxiaHypercapnia: an increase in the PCO2 in the arterial blood The Peer Teaching Society is not liable for false or misleading information…

  31. -  The most common type of hypoxia is hypoxic hypoxia or hypoxemia: in which the arterial partial O2 pressure is reduced • -  The most common causes are: • 1. Hypoventilation - resulting in an increased arterial partial CO2 pressure: • -  Failure to ventilate the alveoli adequately • -  Caused by; muscular weakness (motor neurone disease), obesity & loss of respiratory drive (e.g. if you prevent the brain from accessing the lungs due to morphine for example) The Peer Teaching Society is not liable for false or misleading information…

  32. 2. Diffusion impairment: • - Results from the thickening of the alveolar membranes or a decrease in their surface area - causes the blood partial O2 pressure and alveolar partial O2 pressure to fail to equilibrate The Peer Teaching Society is not liable for false or misleading information…

  33. 3. Shunting : • - An anatomical abnormality of the cardiovascular system that causes mixed venous blood to bypass ventilated alveoli in passing from the right side of the heart to the left side e.g. ventricular septal defect (VSD) - Eisenmenger’ Syndrome • - An intrapulmonary defect in which mixed venous blood perfuses unventilated alveoli. Can occur in the bronchial arteries The Peer Teaching Society is not liable for false or misleading information…

  34. 4. -Ventilation-Perfusion mismatch - MOST COMMON CAUSE OF HYPOXEMIA: Occurs in chronic obstructive lung disease and many other lung disease • Arterial partial CO2 pressure may be normal or increased, depending on how much ventilation is reflexively stimulated • Can be caused by; a pulmonary embolus (blockage of an artery in the lung), asthma, pneumonia & pulmonary oedema The Peer Teaching Society is not liable for false or misleading information…

  35. TYPE 1 RESPIRATORY FAILURE • pO2 (partial O2 pressure) is low •          pCO2 (partial CO2 pressure) is low or normal • With Type 1 = 1 change = low pO2 then normal/low CO2 • Pulmonary embolism (form of ventilation-perfusion mismatch) most commonly causes Type 1 The Peer Teaching Society is not liable for false or misleading information…

  36. - TYPE 2 RESPIRATORY FAILURE: • •           pO2 is low •           pCO2 is high •  WithType2=2changes=lowpO2+highpCO2 • Hypoventilation causes Type 2 The Peer Teaching Society is not liable for false or misleading information…

  37. Acid/base balance • Our body functions on a pH range of ____? • Balance is maintained by mechanisms that generate, buffer, and eliminate acids and bases • LUNGS: CO2 predominantly controlled by respiration • KIDNEYS: HCO3- predominantly controlled in kidneys Can you classify acid-base disorders? Test yourself: https://abg.ninja/abg The Peer Teaching Society is not liable for false or misleading information…

  38. Common causes The Peer Teaching Society is not liable for false or misleading information…

  39. Things to cover • Control of respiration • Hypersensitivity • Host defence • Extreme conditions • Histology • Embryology The Peer Teaching Society is not liable for false or misleading information…

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