Abhishek respiratory ANATOMY & PHYSIOLOGY , and ACUTE RESPIRATORY FAILURE
Respiratory anatomy and physiology faculty version
-
Upload
jonathan-downham -
Category
Health & Medicine
-
view
396 -
download
3
description
Transcript of Respiratory anatomy and physiology faculty version
![Page 1: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/1.jpg)
Respiratory Anatomy and Physiology
![Page 2: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/2.jpg)
![Page 3: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/3.jpg)
![Page 4: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/4.jpg)
![Page 5: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/5.jpg)
![Page 6: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/6.jpg)
![Page 7: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/7.jpg)
![Page 8: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/8.jpg)
![Page 9: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/9.jpg)
![Page 10: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/10.jpg)
![Page 11: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/11.jpg)
![Page 12: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/12.jpg)
![Page 13: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/13.jpg)
![Page 14: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/14.jpg)
![Page 15: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/15.jpg)
![Page 16: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/16.jpg)
![Page 17: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/17.jpg)
Broncioles branch many times and each division produces tubules which are smaller
Terminal bronchioles have a diameter of 0.5-1mm in diameter.They are too thick for air exchange and considered to be the last of the conducting zone structures
![Page 18: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/18.jpg)
![Page 19: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/19.jpg)
Type I cells account for gas exchange.Type II cells secrete surfactant
![Page 20: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/20.jpg)
Functions of the lung
• Main function is gas exchange– Allow passage of O2– Allow removal of CO2
![Page 21: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/21.jpg)
Functions of the lung
• Metabolic functions– Surfactant synthesis– Protein synthesis– Metabolism of vasoactive substances
• ACE/Bradykinins
• Blood reservoir– Volume = 450mls
• Allows phonation
![Page 22: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/22.jpg)
Functions of the lung
• Heat exchange• Immunological
– Alveolar macrophages– IgA production– Mucociliary escalator
![Page 23: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/23.jpg)
Ventilation MechanicsHow air gets to the alveoli.
Gas ExchangeHow gas crosses the blood gas interface.
Gas TransportHow they are carried
around the body.
![Page 24: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/24.jpg)
Ventilation MechanicsHow air gets to the alveoli.
Muscles
Inspiration
Expiration
Diaphragm
External Intercostal Muscles
Accessory muscles
Abdominal Muscles
Internal Intercostal muscles assist
![Page 25: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/25.jpg)
Ventilation MechanicsHow air gets to the alveoli.
Forces acting on the lung
Elastic Tissue
Elastic tissue of lungs is stretched under normal conditions. Resulting tension acts as a force pulling inwards on visceral pleura
As chest wall and diaphragm pull on outwards on parietal pleura causing a negative pressure in interpleural space. This keeps the lungs inflated
![Page 26: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/26.jpg)
Ventilation MechanicsHow air gets to the alveoli.
Airway Resistance
If radius halved then resistance increases 16 fold
Chief site of airway resistance is the medium sized bronchi.Peripheral airways contribute little resistance
Considerable small airway disease can be present before being detected in pressure changes.
Lung Compliance
Factors determiningLung volume
Bronchi supported by surrounding tissueTheir calibre is increased as the lung expandsSo as lung volume is reduced resistance is increased
Contraction of bronchial smooth muscle
the slope of the pressure-volume curve at a particular lung volume => i.e. volume change per unit of pressure change (mL/cmH2O) normal value = 200mLs/cmH2O Lower compliance = more effort of breathing
Posture affects lung volume, therefore complianceDisease states
Asthma leads to hyper-inflationFibrosis, collapse and consolidation all decrease distensibilityEmphysema increases compliance
![Page 27: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/27.jpg)
Ventilation MechanicsHow air gets to the alveoli.
FRC- volume of gas remaining in lungs at end of normal expiration
Volume of lung at which elastic forces causing recoil = thoracic chest wall forces causing expansion
FRC = 30mls/kg = 2200 mls in supine 70kg adult
Functional Residual Capacity
FRC increases withHeightChanging from supine to erectEmphysema- gas trapping
FRC decreases withObesityMuscle paralysis and GAChanging from supine to erectRestrictive lung diseasePregnancyRaise intra-abdominal pressure
![Page 28: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/28.jpg)
Gas ExchangeHow gas crosses the blood gas interface.
Rate of diffusion is: Directly proportional to cross sectional area across which diffusion occursInversely proportional to the thickness of the membraneDirectly proportional to the partial pressure of the gas across both sides
![Page 29: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/29.jpg)
Gas ExchangeHow gas crosses the blood gas interface.
The amount of time that blood is in contact with the alveolus also influences gas exchange.The speed of blood flow past the alveolus is:
0.75 seconds under normal conditions0.25 seconds with heavy exercise
![Page 30: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/30.jpg)
Ventilation-Pleural pressure are higher at the bases of the lungs.So they receive 4 times more ventilation than apices.Circulation-Low pressures in pulmonary circulation are affected by gravityBases of upright lungs receive 20 times more blood flow than apices.
Gas ExchangeHow gas crosses the blood gas interface.
![Page 31: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/31.jpg)
Gas TransportHow they are carried
around the body.
![Page 32: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/32.jpg)
Respiratory Examination
• Common Problems- Asthma.– Baseline control
• Usual exercise tolerance• Frequency of attacks• Best Peak expiratory flow rate• Usual precipitating factors• Medication• Usual response to therapy• Previous hospital/ITU admissions• Symptoms suggestive of poor baseline control
Jonathan Downham 2010
![Page 33: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/33.jpg)
Respiratory Examination
• Common Problems – Asthma– Drug History
• Do they have a nebuliser at home?• Do they use a bronchodilator?• Do they take theophylline or aminophylline?
(bronchodilators).• Do they take steroids?• Are they on medication which aggravates the
symptoms... Beta blockers, aspirin.• Demonstrate inhaler technique.
Jonathan Downham 2010
![Page 34: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/34.jpg)
Respiratory Examination
• Common Problems – Chronic Obstructive Pulmonary Disease (COPD)– Detailed history
• Time course• Treatment given and effects• Any hospital admissions in the last year• Baseline function• Chronically deteriorating exercise tolerance.• Quantify normal amounts of sputum
Jonathan Downham 2010
![Page 35: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/35.jpg)
Respiratory Examination
• Common Problems – Chronic Obstructive Pulmonary Disease (COPD)– Past Medical History– Drug History– Social History– Review of systems.
Jonathan Downham 2010
![Page 36: Respiratory anatomy and physiology faculty version](https://reader035.fdocuments.in/reader035/viewer/2022062616/5494a59cac7959292e8b4c1e/html5/thumbnails/36.jpg)
Respiratory Examination
• Common Problems – Chest Infection– History
• Cough• Sputum Production• Dyspnoea• Wheeze• Pleuritic chest pain• Fever.
– Drug History.
Jonathan Downham 2010