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Case Study: A patient is experiencing breathing difficulty & has a…

- - - - Inspiration & expiration depends on vol. changes
        
        Boyle's law describes this relationship
        
        Def: Vol. changes -> Pressure changes -> Flow of gases to equalize the pressure
        
        At constant temp, the pressure varies INVERSELY w/its vol.
        
        P1V1 = P2V2
        
        Ex in respiratory sys.
        
        For every 10m of depth a scuba diver descends in water, they experience an additional 1 atm of pressure
        
        Due to the weight of the water above them
        
        The pressure regulator used in scuba diving delivers air at a pressure that matches the external pressure
        
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      - Factors influencing pulmonary ventilation
        
        Alveolar surface tension
        
        Whats going on w/the alvoli them selves
        
        Has to do w/amount of surfactant the body is making
        
        Produced by type II alveolar cells
        
        Lung compliance
        
        How stretchy the lung tissue is
        
        Effected by smoking
        
        Factors that reduce it
        
        Infection
        
        Scar tissue
        
        Inflammation
        
        Fibrosis
        
        Airway resistance
        
        Def: How well air moves through the tubes
        
        Caused by constriction in tubes that air is going through
        
        Most of this resistance occurs in the bronchi
        
        Thoracic cage compliance
        
        Deals w/ coastal cartilage ostefying or weakness that occurs in the muscles that allows the chest to open
        
        Can be reduced if exercise is not incorporated as one ages
      - Gases exchanged by diffusion
        
        Dalton's law
        
        Def: Amount of pressure of a gas in a mixture = the % of that gas
        
        Total pressure of a gas mixture is the sum of the partial pressures of its components
        
        How to calculate
        
        % of the gas in a mixture x 760mmHg
        
        Ex in respiratory sys.
        
        Increased partial pressure of a gas is higher on one side of a membrane than the partial pressure of that gas on the other side of the membrane
        
        At high altitudes
        
        Partial pressures DECLINE in DIRECT proportion to the decreased atm pressure
        
        For ex.
        
        At 10,000 feet above sea level where atm pressure is 523mmHg, Po2 is110 mmHg
        
        Going towards sea level, atm pressure increases by 1 atm for each 33 feet of descent in water
        
        Henry's law
        
        Def: When a gas is in contact w/a liquid, the gas will dissolve in the liquid proportional to its partial pressure
        
        The partial pressure of a gas in a gas state = partial pressure of that same gas in liquid
        
        The greater the [of a gas], the more & faster that gas will go into solution in the liquid
        
        Amount of gas that will dissolve depends on
        
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        Shows the solubility of a gas in a liquid is directly proportional to the pressure of the gas above the liquid
        
        Eq: Sgas (solubility of gas) = KH (henry's law constant) x Pgas (partial pressure gas)
        
        Ex in respiratory sys.
        
        O2 in air -> blood
        
        Gas in air can directly be carried in a liquid
        
        If a scuba diver rises rapidly from the ocean, dissolved N2 forms bubbles in their blood #
        
        Composition of alveolar gas
        
        Gas in atm is ~ 21 % O2 & 78.6% N2
        
        Whereas alveolar gas contains more CO2, H2O vapor, & much less O2
        
        External respiration
        
        Has to do w/getting O2 -> blood
        
        3 Factors influence this process
        
        Thickness & surface area of respiratory membrane
        
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        Ventilation-profusion coupling (matching alveolar ventilation w/pulmonary blood perfusion)
        
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        Partial pressure gradients & gas solubilities
        
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    - - This could cause swelling in respiratory structures
        
        Thereby increasing airway resistance
        
        This causes constriction of tubes that air flows through above the terminal bronchioles
        
        For example
        
        It could affect the conducting zones
        
        Such as the left & right primary bronchi thereby, preventing air from leaving & entering in order to perform diffusion
      - Effects on alveoli
        
        The inflammation could cause alveoli to fill w/fluid
        
        Causing pneumonia or left heart failure
        
        As a result of pneumonia
        
        Pleurisy could occur
        
        Def: Inflammation of the pleurae
        
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      - This could lead to fibrosis
        
        Due to fibrosis being the the cause of chronic inflammation
        
        This can cause nonelastic scar tissue to replace normal tissue
    - - Haldane effect
        
        The lower Po2 & the lower Hb saturation w/O2, the more CO2 can be carried in the blood
        
        As CO2 enters the systemic bloodstream, more O2 dissociates from Hb called the bohr effect #
        
        The dissociation of O2 allows more CO2 to combine w/ Hb (haldane effect)
        
        The haldane effect encourages CO2 exchange in BOTH the tissues & lungs
        
        Ex: The higher you go up a mountain, the more CO2 can be carried in the blood
        
        If acidosis is occurring, that weakens the Hb-O2 bond to better deliver O2
      - Blood transports CO2 from cells -> lungs in 3 forms
        
        1) Dissolved in plasma (7-10%)
        
        2) Chemically bound to hemoglobin (20%)
        
        Dissolved CO2 is carried in the RBCs (red blood cells) as carbaminohemoglobin (carba.)
        
        Eq: CO2 + Hb <--> HbCO2 (carba.)
        
        CO2 binds directly to the aminos of globin (NOT TO THE HEME)
        
        3) As bicarbonate ions in plasma (70%)
        
        When dissolved CO2 diffuses into RBCs, it combines w/ H2O, forming H2CO3 (carbonic acid). H2CO3 is UNSTABLE & DISSOCIATES into H+ & HCO3- (bicarbonate ions)
        
        Eq: CO2 + H2O <-> H2CO3 <-> H+ + HCO3-
        
        Although this occurs in plasma, it is 1000s of times faster in RBCs b/c they contain carbonic anhydrase
        
        This enzyme catalyzes the conversion of CO2 & H2O -> HH2CO3-
        
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    - - O2 is carried in blood in 2 ways
        
        Bound to Hb within blood cells
        
        98.5% of this occurs
        
        Dissolved in plasma
      - Hb is composed of 4 polys each bound to an iron-containing heme group
        
        Iron atoms bind O2
        
        Loading & unloading of O2: HHb + O2 <--> HbO2 + H+
        
        Factors that control how well O2 binds to hemoglobin
        
        Temp
        
        Amount of CO2
        
        pH
        
        [BPG]
        
        Red blood cells produce BPG as they metabolize C6H12O6
        
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        An increase in ANY of these lowers Hb's affinity (binding strength) for O2
        
        This enhances O2 unloading from the blood as shown by the O2-Hb dissociation curve
        
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  - - - Consists of
        
        Nose
        
        Respiratory mucosa lines most of cavity
        
        It is a pseudostratified cilliated columnar epithelium
        
        Containing goblet cells
        
        Function
        
        Produces mucus
        
        Filters, warms, & moistens air coming in
        
        Resonance chamber for speech
        
        Bone structures & cartilage pieces
        
        Collectively called turbinates
        
        Def: Moves air
        
        Term for
        
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        Nasal cavity
        
        Cavity is divided by the nasal septum
        
        Part of cavity superior to the nares
        
        Nasal vestibule
        
        Line w/ skin containing
        
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        Paranasal sinuses
        
        The nasal cavity is surrounded by a ring of these
        
        Include
        
        Sphenoid
        
        Ethmoid
        
        Frontal
        
        Maxillary
        
        Function
        
        They help to warm & moisten air
        
        Lined w/mucosa
        
        Hollow spaces in bones
        
        NOT the nasal cavity
        
        Sinuses are IN bones
        
        Pharynx (AKA throat)
        
        Divided into
        
        Nasopharynx
        
        Oropharynx
        
        Laryngopharynx
        
        Composed of skeletal muscle
        
        Passageway for air
      - Warms, humidifies, & filters
    - - Consists of 2 zones
        
        Conducting zone
        
        Consists of
        
        All respiratory passageways from nose -> respiratory bronchioles
        
        Lungs
        
        Larynx
        
        Bronchi
        
        Trachea
        
        Just moving air
        
        Not doing any gas exchange
        
        Respiratory zone
        
        Actual site of gas exchange
        
        Composed of
        
        Alveolar ducts
        
        Alveoli
        
        Respiratory bronchioles
        
        Tips of bronchioles that help in gas exchange
        
        All microscopic structures
        
        Zone begins as the terminal bronchioles feed into respiratory bronchioles
        
        Contains
        
        A respiratory membrane
        
        Type I alveolar cells
        
        Walls of alveoli composed of simple squamous epithelial cells
        
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        Type II alveolar cells
        
        They are cuboidal epithelial cells
        
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        Alveolar macrophages
        
        Cells that consume bacteria & other debris
    - - Consists of
        
        Each is surrounded by pleurae
        
        Connected -> mediastium by vascular & bronchial attachments
        
        Together coined the lung root
        
        Costal surface
        
        Anterior, lateral, & posterior lung surfaces form this
        
        Apex
        
        Deep to the clavicle
        
        Base
        
        Concave inferior surface of lung that rests on diaphragm
        
        Hilum
        
        Mediastinal surface of each lung is an indentation
        
        Pulmonary & systemic vessels, bronchi, lymphatic vessels, & nerves enter & leave lungs
        
        Left lung
        
        Is smaller than the right due to heart's apex leaning to left
        
        Contains
        
        Left superior lobe
        
        Left inferior lobe
        
        Right lung
        
        Contains
        
        Right superior lobe
        
        Right meddle lobe
        
        Right inferior lobe
        
        Lobules
        
        Smallest subdivisions of lung
        
        Look like hexagons
        
        Stroma
        
        Consists of elastic connective tissue
        
        This is the reason lungs are soft & spongy
        
        Blood supply
        
        Pulmonary circulation
        
        Pulmonary arteries (Blue)
        
        Carries depxygenated blood from right ventricle -> lungs
        
        Pulmonary veins (Red)
        
        Carries oxygenated blood from lungs back -> left atrium
        
        Bronchial circulation
        
        Provide OXYGENATED SYSTEMIC blood -> bronchi
        
        These provide HIGH pressure, low-vol supply of oxygenated blood to lung tissues excepts alveoli
        
        Part of systemic, NOT pulmonary
        
        Innervation of lungs
        
        Fibers enter each lung through pulmonary plexus
        
        Contains
        
        Parasympathetic motor fibers
        
        Cause air tubes to constrict
        
        Sympathetic motor fibers
        
        Cause air tubes to dilate
- - - - Viral infection, high altitude, & age
        
        Symptoms
        
        Wet wheezy cough
        
        Wheezing usually indicates theres an obstruction of intrathoracic airways
        
        & The wet aspect seems to be due to fluid build up in alveoli
        
        Due most likely to pneumonia
        
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        https://www.youtube.com/watch?v=q9dKz8UwEcY
  - - - Interactions between the respiratory sys. & other systems
        
        Immune sys.
        
        The virus may multiply to the point that the alveolar macrophages are not enough to inhibit the rapid multiplication of the virus
        
        Normally, the immune sys. can attack these viruses
        
        However, if the immune sys. is weakened, due to age
        
        Pneumonia causing virus can overwhelm immune cells & multiply
        
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        Cardiovascular sys.
        
        Being that pulmonary arteries & veins connect to the heart, the virus could leak into the blood -> heart
        
        Causing septic shock
        
        This could cause reduced blood flow to the heart
        
        Thereby reducing blood flow to the organs
        
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      - Pneumonia can lead to
        
        Pleurisy
        
        Inflammation of the pleurae
        
        Inflamed pleurae become rough
        
        Resulting in friction w/each breath
        
        As it progresses, pleurae produce excessive fluid
        
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      - Fibrosis
        
        Can cause nonelastic scar tissue to replace normal tissue
        
        If the pneumonia is left untreated long enough
        
        The chronic inflammation can lead to this disease
      - Respiratory failure can occur by
        
        O2 deprivation to the point that the lungs do not get enough O2 to perform cellular respiration
        
        This same event can occur in other organs
      - Atelectasis (Lung collapse)
        
        If a bronchiole becomes plugged w/fluid
        
        The alveoli cannot hold all the pressure & therefore the lung collapses
- - - - Symptoms
        
        Fast shallow breathing
        
        Wet, wheezy cough
        
        Due to pneumonia
  - - - Presents of viral infection
        
        This could have immune suppressing effects
        
        This increases the risk of acquiring pneumonia
        
        This decreases the ability to get rid of bacteria, viruses, ect
        
        Therefore a buildup can occur easily
      - Age
        
        70 yrs old
        
        Ordinarily healthy lungs will be able to fight off bacteria, viruses, ect before inflammation settles in too long to cause pneumonia
        
        However, as one ages, their immune system becomes less efficient
        
        The elderly & infants are at risk for developing pneumonia due to having a weaker immune system
        
        This also puts them at risk for aspiration which increases the risk for acquiring pneumonia
      - location
        
        Moved from Fort Worth -> Denver, CO
        
        Fort Worth
        
        Is closer to sea level
        
        There is much more O2 in the air
        
        Therefore, Hb is at 100% dissociation
        
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        Colorado
        
        Is at a much higher altitude
        
        There is much less O2 in the air
        
        Therefore, Hb is closer to 95% dissociation
        
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      - Other possible factors unknown
        
        The patient could have been a smoker at some point in their life
        
        This increases the risk for pneumonia
        
        Due to the reason that smoking destroys the cilla & surfactant levels in lungs
        
        If cillia is destroyed, it cannot effectively eradicate bacteria & debris