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An elderly female moved from Texas to Colorado where elevation is much…

- - - - Apex: super tip, deep to clavicle
        
        Base: inferior surface that rests on diaphragm
        
        Helium; indentation found on mediastinal surface, it is the site for entry and exit of blood vessels, bronchi and lymphatic vessels and nerves
        
        Left Lung: separated into superior an inferior lobes by the oblique fissure
        
        Smaller than right side because of position of heart
        
        Cardiac Notch: concavity for heart to fit into it
        
        Right Lung: separated into superior, middle and inferior lobes
        
        superior and middle lobes separated by horizontal fissure
        
        Each lobe divided into bronchopulmonary segments: 10 on the right 8-10 on left each separated by connective tissue
        
        Middle and inferior lobes separated by oblique fissure
  - - - Pulmonary veins carry oxygenated blood from respiratory zones back to heart
        
        Profusely feed into pulmonary capillary network and is a low pressure/ high volume system
    - - Part of systemic so high pressure/ low volume system
        
        Bronchial veins anastomose with pulmonary veins which carry most venous blood back to heart
    - - Visceral Pleura: membrane on external surface
      - Parietal Pleura: membrane of thoracic wall, superior face of diaphragm around heart and in between lungs
      - Pleural fluid: fills slitlike pleural cavity between two pleurae
        
        Provides lubrication and surface tension that helps lungs expand and recoil
  - - - Trachea divides to form right and left (primary) bronchi. Right main bronchus is wider, shorter and more vertical.
        
        Each main bronchus enters medial depression (hilum) of one lung.
        
        Then they branch into lobar (secondary) bronchi. Three on right two on left with each supplying one lobe.
        
        Each lobar bronchus branches into segmental (tertiary) bronchi. These divide repeatedly with branches becoming smaller and smaller .
    - - These zones begin with bronchioles feed into respiratory bronchiole.
        
        These lead into alveolar ducts and finally into alveolar sacs.
        
        Alveolar sacs contain alveoli which is the actual site of gas exchange.
- - - - Oxygen makes up 20.9% of air so partial pressure=.209x 760 mmHG= 159 mmHG
  - - - Amount of each gas dissolved at any given partial pressure depends on two things:
        
        Solubility: carbon dioxide is twenty times more soluble in water than oxygen, which is two times more than N2
        
        At a given partial pressure much more carbon dioxide than oxygen is dissolves in water and practically no N2 gets into solution
        
        Temperature: as temperature of liquid rises, gas solubility decreases
- - - - With altitude the partial pressure (molecules of oxygen molecules in given volume of air) changes because atmospheric pressure are lower.
        
        At high altitudes oxygen molecules are further apart because there is less pressure to push them together
        
        When exposed to high altitudes for several days or weeks the body acclimates to low oxygen levels.
        
        Hemoglobin levels increase
        
        Increase in ratio of blood vessels to muscle mass
        
        Increase in breathing rate
        
        There are fewer oxygen molecules in the same volume of air we inhale often referred to as hypoxia
        
        Less oxygen throughout circulatory system so less oxygen reaches muscles.
        
        Within few hours water loss increases causing dehydration and your metabolism also increases.
        
        Ventilation is increased as body responds to less oxygen in each breath. This is an attempt to increase oxygen uptake.
  - - - Partial pressure gradient for carbon dioxide is less steep but still diffuses in equal amounts with oxygen.
        
        This happens because carbon dioxide is twenty times more soluble in plasma and alveolar fluid than oxygen.
- - - - Can spread to ear ducts and paranasal sinus, causing blockage of sinus passageways.
        
        This leads to inflamed sinuses and results in sinus headache.
  - - - Often caused by viral infections but also due to overuse of voice, bacterial infections, tumors or inhalation of irrupting chemicals
  - - - Pleural Effusion: fluid accumulation in pleural cavity
  - - - Results in obstructed airways that impair lung ventilation and gas exchange.
  - - - Airway is inflamed because of immune response and airway thickens with extra mucus
  - - - Trapped air causes hyperinflation which causes barrel chest
      - Damaged pulmonary capillaries lead to enlarged right ventricle
      - Accessory muscles need more energy to perform breathing
- - - - Scattered cuboidal (type 2 alveolar cells) that secrete surfactant and antimicrobial proteins
        
        Alveoli is surrounded by fine elastic fibers and pulmonary capillaries and macrophages keep surface sterile.
  - - - Water has a very high surface tension that coats alveolar walls. This causes alveoli to shrink to smallest size.
        
        Surfactant: body's detergent like lipid and protein complex that helps reduce surface tension of alveolar fluid
        
        Produced by type 2 alveolar cells and prevents collapse
  - - - humidification of air by conducting passages
      - Mixing of alveolar gas with each breath
        
        Inspired air mixes with air that was left in passageways between breathes
      - Gas exchange in lungs: oxygen diffuses out and carbon dioxide diffuses in
  - - - Perfusion: blood flow in pulmonary capillaries
        
        Partial pressure of oxygen controls profusion by changing arteriolar diameter
        
        Where alveolar oxygen is high arterioles dilate.
        
        Directs blood to alveoli where oxygen is high so blood can pick up more oxygen.
        
        Where alveolar oxygen is low they constrict.
      - Ventilation: amount of gas reaching alveoli
        
        Partial pressure of carbon dioxide controls ventilation by changing bronchiolar diameter.
        
        Where alveolar carbon dioxide is high bronchioles dilate
        
        Where alveolar carbon dioxide is low bronchioles constrict
    - - External respiartion occurs as a function of partial pressure differences in oxygen and carbon dioxide between alveoli and the blood in pulmonary capillaries.
        
        There is a drastic difference in partial pressure of oxygen in alveoli versus in the pulmonary capillaries .
        
        This large difference creates a strong pressure gradient that causes oxygen to rapidly cross the respiratory membrane from alveoli to blood
        
        Partial pressure of carbon dioxide is also different between alveolar air and blood of capillaries but the difference is less.
        
        The solubility of carbon dioxide is much greater than oxygen making concentrations diffuse equally.
  - - - AVR takes into account amount of dead space, TV and rate of breathing.
        
        Dead space is normally constant so AVR is affected by TV and frequency. Rapid swallow breathing can actually decrease AVR.
      - Important in gas exchange as ventilation must be sufficient to create a high partial pressure of oxygen in the alveoli.
        
        If ventilation is insufficient and partial pressure of oxygen drops in the alveolar air, capillary is constructed and blood flow is redirected to alveoli with sufficient ventilation.