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Respiratory basic science, Physiology, Embryology, anatomy - Coggle Diagram
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Physiology
lung volume
residual volume; RV(残気量)
air in lung after maximal expiration, cannot be measured by spirometory
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tidal volume; TV(一回換気量)
air that moves into lung with each quiet inspiration, typically 500mL
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hemoglobin
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CL, H, CO₂, 2,3-BPG and temperature favor deoxygenated form
deoxygenated form has low affinity for O₂, promoting release of O₂
myoglobin is composed of a single polypeptide chain associated with one heme moiety, higher affinity
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pulmonary circulation
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perfusion limited: O₂, CO₂, N₂O; diffusion can be ↑only if blood flow ↑
a low-resistance, high compliance system
diffusion limited: O₂(emphysema, fibrosis, exercise), CO; gas does not equilibrate by the time blood reaches the end of the capillary
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ventilation
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RR=12-20/min, Vt=500mL/breath, Vd=150mL/breath
cyanide poisoning
findings: almond breath odor, pink skin, cyanosis
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inhibit aerobic metabolism via complex 4 inhibition→hypoxia unresponsive to supplemental O₂ and ↑aerobic metabolism
oxygen content of blood
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1gHb=1.34ml O₂, normal Hb=15g/dL
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alveolar gas equation
PIo₂: Po₂ in inspired air, R: respiratory quotient(呼吸商)
A-a gradient=PAo₂-Pao₂, normal=10-15mm Hg; ↑by shunting, V/Q mismatch(換気血流不均等), fibrosis
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oxygen deprivation
hypoxemia: normal A-a gradient= high altitude, hypoventilation; ↑A-a gradient= V/Q mismatch, diffusion limitation, right-to-left shunt
ischemia: impeded arterial flow, ↓venous drainage
hypoxia: ↓cardiac output, hypoxemia, anemia, CO poisoning
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lung and chest wall
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compliance
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high=lung easier to fill, low=harder to fill
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hemoglobin modifications
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methemoglobin
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does not bind O₂ as readily as Fe²⁺, but has affinity for cyanide
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Embryology
lung development
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alveolar (week36-8years)
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at birth, ↓ pulmonary vascular resistance
at birth, 20-70 million aveoli; by 8 years, 300-400million alveoli
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alveolar cell type
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type 2
secret surfactant from lamellar bodies→↓alveolar surface tension, prevent alveolar collapse, ↓lung recoil, ↑compliance
surfactant synthesis begin around week 20 of gestation, mature levels are not achieved until around week35
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club cell: nonciliated, low columnar, cuboidal with secretory granules, located in bronchioles; degrade toxins; secrete component of surfactant; act as reserve cell
anatomy
lung anatomy
right lung has 3 lobes, left has 2 lobes and lingula(舌区)
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right lung is a more common site for inhaled foreign bodies (right main stem is wider, more vertical, and shorter)
if you aspirate a peanut,,,
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horizontal fissure, oblique fissure
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respiratory tree
conducting zone
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pseudostratified ciliated columnar cell extend to beginning of terminal bronchioles, then transition to cuboidal cell
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nose, pharynx, larynx, trachea, bronchi, bronchioles that further devide into terminal bronchioles
respiratory zone
respiratory bronchioles, alveolar ducts, alveoli
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cuboidal cell (respiratory bronchioles), simple squamous cell (alveoli)
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diaphragm structures
perforating diaphragm
at T10: esophagus, vagus nerve
at T12: aorta, thoracic duct, azygos vein(奇静脈)
at T8: IVC, right phrenic nerve
innervated by phrenic nerve (C3, C4, C5)