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res-hcpmini01 - Coggle Diagram
res-hcpmini01
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gas exchange histology
respiratory unit
respiratory bronchiole, alveolar ducts, atria, and alveoli
respiratory membrane
gas exchange between the alveolar air and the pulmonary blood
1.surfactant
2.alveolar epithelium
3.epithelial BM
4.interstitial space (fibroblast, macrophage
5.capillary BM (fused with 3)
6.capillary epithelium
0.6 micrometer 70m2
type 1 pneumocyte
1.95%表面積, 扁平
2.構成air-blood barrier
type 2 pneumocyte
1.5%
2.lamellar body, microvilli
3.cube
4.可分裂，分化成type1
dust cell
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diffusion
決定速度
1.膜厚度 (edema, fibrosis)
2.膜表面積 (emphysema
3.gas的diffusion coefficient (sol/開根號MW，CO2爲O2 20倍)
4.分壓差 (a measure of the total number of molecules of a particular gas striking a unit area of the alveolar surface of the membrane in unit time)趨勢
diffusion capacity
1mmHg的分壓壓力差之下，每分鐘擴散通過膜的氣體體積
O2 21 ml/min/mmHg
運動變成65，原因
1.開啟關閉的微血管，或更擴張，增加表面積
2.v/q ratio better match
CO2 400，擴散太快無法測量
CO測量法
effect of vq ratio
=0
PO2=40
PCO2=46
=無限
PO2=149
PCO2=0
shunt flow vq ratio不足，未經氧合
dead space vq ratio大
肺上葉vq ratio大→死腔 (運動血流量大改善
肺下葉vq ratio小→分流
Intrinsic Correcting Mechanisms
肺上面vq ratio高
下面vq ratio低
vq高→肺泡死腔→bronchoconstriction
vq低→shunt flow→vasoconstriction
respiratory unit可以氣體交換 respiratory bronchiole一下 單層連續性大
respiratory membrane 6層
加快擴散速率
1.分佈廣
2.不需經plasma
影響擴散速度
idiopathic pulmonary fibrosis
excess collagen in connective tissue or interstitial tissue usually after tissue damage
1.chronic
2.loss of lung tissue
type1 damage
→transforming growth factor beta 1 to type 2
→type 2 刺激fibroblast→myofibroblast
→myofibroblast分泌reticular fiber (結構強度) elastic fiber (彈性
→apoptosis
type2過度增生
過多collagen
myofibroblast不進行apoptosis
fluid堆積、cyst
wound healing不完美我
在interstitial發生
type2→fibroblast→訊息傳遞路徑pi3k/akt pathway→不正常增生
gerd ipf互相影響
microaspiration
負壓
risk factor
1.old
2.smoke
3.man
4.病毒感染
5.GERD
6.gene
1.environmental
抽菸、粉塵、毒素epithelial cell damage、viral、gerd
2.genetic
tert terc loss of function telomerase defect 防止老化、muc5b mucin fibrosis更容易增加
3.年齡
50以後
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症狀
咳嗽（第一個症狀）、呼吸困難、fatigue、lung volume、pulmonary hypertension、右心衰竭、hypoxemia、cyanosis、clubbing finger, crackles, 體重減輕
diagnosis
1.ct (honeycomb蜂窩狀, interstitial layer變厚)
microcystic、macrocystic
2.DLCO (lung diffusion rate)
連CO難以通過air-blood-barrier
3.blood test O
PaO2 SaO2下降
diffusion capacity CO2遠大於氧
or 身體compensate
4.Xray fibrosis
shaggy heart border
lung volume下降→diaphragm (9~10,5)
肺功能測試
TLC\FVC\FEV1
fev1/fvc上升 (recoiling power up)
DLCO
ABG
X-ray
walking assessment
treatment
1.supplement oxygen
2.antifibrotic (只能減緩
supportive care (肺復建、疫苗、止痛
medical therapy (不會生成fibrosis) nintedanib、pirfenidone tyrosine kinase
肺移植
Restrictive lung disorders
1.chronic interstitial and infiltrative diseases
inflammation and fibrosis of the pulmonary interstitium
dyspnea, tachypnea, end-inspiratory crackles, and eventual cyanosis
reductions in diffusion capacity, lung volume, and lung compliance
2.chest wall disorders
restrictive lung disease
1.chronic intersitial lung disease
fibrosing
IPF
granulomatous
2.chest wall
alkalosis
narrowing of airway
hyperventilation
CO2分壓少
影響分壓不影響飽和度
bohr effect→
acidosis
obtruction→花較多時間到達
吸氣短→到肺泡volume少→hypoventilation
呼吸肌→lactic acid