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Respiratory Part 6

Name properties that lung elasticity is due to 50% due to tissue which includes collagen, elastin and smooth muscle. 50% due to surfactant film lining inside of alveolar
Compliance Change in lung volume/change in IPP which equals 0.2 L/cmH2O. The slope of the curve in a lung volume vs. IPP diagram
Emphysema and relation to compliance Emphesyma has increased compliance and decreased elasticity
Fibrosis and relation to compliance Fibrosis has decreased compliance and increased elasticity.
Surfactant Produced by Type II alveolar cells, main component is dipalmitoylphosphatidyl choline, reduces surface tension and increases lung compliance
What happens if surfactant is absent? Surface tension of the film lining the alveolus would be constant and a small alveolus would generate a greater pressure than a large alveolus and would empty more rapidly (prone to collapse) Progressive Atelectasis
What does the surfactant do to keep the pressure of a large and small alveolus equal? Reduces the surface tension more in small alvoli and adjusts the 2S.T./r ratio so that there are no inter-alveolar pressure gradients.
Respiratory Distress Syndrome of newborns High surface tension. Premature birth and maternal diabetes are risk factors. Elasticity is 6-8 x normal. Progressive atelectasis
How do you treat RDS? Pre-treat mother with glucocorticoids to activate secretory machinery. Give surfactant to newborn through trachea.
Restrictive Lung Disease Increase in elasticity and a decrease in all lung volumes
Name restrictive lung diseases RDS, Fibrotic lung disease, Pulmonary vascular congestion, and pulmonary edema (ARDS, pneumonia)
What is decreased in restrictive lung disease? FVC, FEV1sec, FRC, RV and TLC
What is increased in restrictive lung disease? FEV1sec/FVC and FEF25-75%
Flow-volume loop of obstructive diseases Begins and ends at abnormally high lung volumes and the expiratory flow rate is lower than normal. Inspiratory flow rate remains relatively normal
Flow-volume loop of restrictive diseases Flow-volume loop begins and ends at unusually small lung volumes. Expiratory flow rates are somewhat greater than normal.
Gas Exchange Uptake of O2 from alveoli to pulmonary and removal of CO2 from capillary
Partial Pressure gradient The gradient responsible for gas movement is the partial pressure gradient. Diffuse from high partial pressure to low partial pressure
What is the partial pressure? Part of the total barometric pressure for which that gas is responsible. Concentration of the gas * TBP
Inspired air Air that has been inhaled, warmed to 37C and completely saturated with water vapor but has not yet engaged in gas exchange (gas in anatomical dead space)
What is the partial pressure of H2O dependent on? The temperature. At 37C it is 47mmHg.
Partial pressure of inspired air Concentration of gas (TBP-PH2O)
What does the partial pressure of alveolar gas depend on? The ratio of alveolar ventilation (Va) to pulmonary capillary blood flow (Qc). Ideal is Va/Qc is 0.8 O2 leaves alveolus in response to pressure gradient.
What happens with low Va/Qc? High Va/Qc? Low-decreased PO2=below 100. High-increased PO2=above 100



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