Pathophysiology Denver School of Nursing – ADN & BSN Programs

Pathophysiology Denver School of Nursing – ADN & BSN Programs
No Laboratory component for this class Pathophysiology BIO 206 & 308 – Ch 25 & 26 – Pulmonary Phys / Path

The Respiratory System
What are the three most important structures of the Respiratory System???

What are the three most important structures of the Respiratory System??? 1. Lungs – WHY? 2. Muscles of Respiration – WHY? 3. Brain – WHY?

Primary = Secondary = Tertiary= Muy Importante!=

The Respiratory System is divided into two general parts: The Upper Respiratory Tract The Lower Respiratory Tract Where do you think the division starts?

The Respiratory Mucosa
What is the respiratory mucosa?

Proper Definition: From A&P Thibodeau: “Mucous membranes are epithelial membranes that line body surfaces opening directly to the exterior (latin name, mucosa)... Their name is derived from the fact that they produce a film of mucus that coats and protects the underlying cells.” In addition to protection, the mucus has other purposes, can you tell me what they are??

Function of Mucosa: Protection – for underlying tissue Immune Support! Mechanically capture debris Presence of “mucins” (proteoglycans) Bacterial interface Lubricant – to allow food to move in digestive tract, and if aspiration occurs in respiratory tract the mucosa will also allow for the pleasantry of “regurg” / emesis.

Primary Features of the RS
Nose Pharynx Larynx Trachea Bronchi Bronchioles Alveoli Lungs Pleura What is the purpose and function of each of these structures???

The NOSE

Pharynx

Larynx – aka the “Voice box”

Larynx

Trachea

Brochi Remember what these are REALLY called?

Brochi Bronchioles 

Alveoli

LUNGS (3 lobes on 3, 2 Lobes on Left)

Serous Membranes What are the serious membranes in the body?

Serous Membranes Image from

Serous Membranes Where are the 3 primary serous membranes found in the human body? Image from

Digestive System Serous membranes: Heart, lungs, GI
Image from

How Does Breathing Work??
Illustration of the mechanism of respiration

Mechanics of Breathing
Major and accessory muscles Major muscles of inspiration Diaphragm External intercostals Accessory muscles of inspiration Sternocleidomastoid and scalene muscles Accessory muscles of expiration Abdominal and internal intercostal muscles

Muscles O’ Ventilation

Mechanics of Breathing
Alveolar surface tension and ventilation Function of surfactant Elastic properties of the lung and chest wall Elastic recoil Compliance Airway resistance Work of breathing

Gas Transport Four steps Diffusion of CO2 occurs in reverse order
Ventilation of the lungs Diffusion of oxygen from the alveoli into the capillary blood Perfusion of systemic capillaries with oxygenated blood Diffusion of oxygen from systemic capillaries into the cells Diffusion of CO2 occurs in reverse order

How does it really work? IN the PONS (of the Brain Stem)
1) Apneustic Center Stimulates neurons to promote Inspiration via External intercostals and the diaphragm 2) Pneumotaxic Center Stimulated neurons to promote Expiration via the Internal intercostals and rectus abdominis

Ventilation Neurochemical control Respiratory center
Dorsal respiratory group Ventral respiratory group Pneumotaxic center Apneustic center

How does it really work? Chemoreceptors 1) Central Chemoreceptors
~ located in the medulla 2) Peripheral Chemoreceptors ~ located in the Aorta & the carotid bodies Both detect increased levels in Carbon Dioxide, and then stimulate Increase in RR

Function of the Pulmonary Sys
Ventilate the alveoli Diffuse gases into and out of the blood Perfuse the lungs so the body receives oxygen

Function of the Pulmonary Sys
Ventilation Mechanical movement of gas or air into and out of the lungs Minute volume Ventilatory rate multiplied by the volume of air per breath Alveolar ventilation

White Board Sesh… Lung Volume chart

White Board Sess… Image Source:

Tests of Pulmonary Function
Spirometry Diffusion capacity Residual volume Functional reserve capacity (FRC) Total lung capacity Arterial blood gas analysis Chest radiographs

Pulmonary System Conducting airways Upper airways Larynx Lower airways
Nasopharynx Oropharynx Larynx Connects upper and lower airways Lower airways Trachea Bronchi Terminal bronchioles

Bronchioles-”respiratory tree”

Pulmonary Physiology Gas-exchange airways Respiratory bronchioles
Alveolar ducts Alveoli Epithelial cells Type I alveolar cells Alveolar structure Where diffusion of Respiratory gasses occurs Type II alveolar cells Surfactant production

CO2 & O2 – alveolar exchange

Structures of the Pulmonary System

Pulmonary & Bronchial Circ.
Pulmonary circulation has a lower pressure than the systemic circulation One third of pulmonary vessels are filled with blood at any given time Pulmonary artery divides and enters the lung at the hilus Each bronchus and bronchiole has an accompanying artery or arteriole

Alveolocapillary membrane Formed by the shared alveolar and capillary walls Gas exchange occurs across this membrane Membrane formed by what cells?

Measurement of Gas Pressure
Barometric pressure Partial pressure Partial pressure of water vapor

Barometric pressure Partial pressure Speaking of partial pressure… Have you ever wondered what the partial pressure of O2 is at sea level is?

Gas Transport Distribution of ventilation and perfusion
Gravity and alveolar pressure Ventilation-perfusion ratio(0.8)

Gas Transport Oxygen transport
Diffusion across the alveolocapillary membrane Determinants of arterial oxygenation Hemoglobin binding, oxygen saturation Oxyhemoglobin association and dissociation Oxyhemoglobin dissociation curve Bohr effect

Gas Transport Carbon dioxide transport Dissolved in plasma
Bicarbonate(HCO3) Carbamino compounds (hemaglobin) Haldane effect

Carbon Dioxide Transport
Dissolved in plasma-Pco2 Arterial -5% Venous-10% Bicarbonate-HCO3 Arterial-90% Venous-60% Carbamino compounds-Hb Arterial-5% Venous-30%

Control of Pulmonary Circ.
Hypoxic pulmonary vasoconstriction Caused by low alveolar PO2 Blood is shunted to other, well-ventilated portions of the lungs Provides better ventilation and perfusion matching If hypoxia affects all segments of the lungs, the vasoconstriction can result in pulmonary hypertension

Control of Pulmonary Circ.
Acidemia also causes pulmonary artery constriction

Break Time!! Image Source:

Chapter 26 – Pulm Path

Signs and Symptoms of Pulmonary Disease
Dyspnea Subjective sensation of uncomfortable breathing Orthopnea Dyspnea when a person is lying down Paroxysmal nocturnal dyspnea (PND)

Dyspnea Subjective sensation of uncomfortable breathing Orthopnea Dyspnea when a person is lying down Paroxysmal nocturnal dyspnea (PND)  Generally w LV Failure

Abnormal breathing patterns Kussmaul respirations (hyperpnea) Cheyne-Stokes respirations

Hypoventilation Hypercapnia Hyperventilation Hypocapnia Cough Acute cough Chronic cough Hemoptysis

Cyanosis Pain Clubbing Abnormal sputum

Clubbing

Conditions Caused by Pulmonary Disease or Injury
Hypercapnia Hypoxemia Hypoxemia versus hypoxia Ventilation-perfusion abnormalities Shunting Acute respiratory failure Pulmonary edema Excess water in the lungs

Ventilation-Perfusion

Pulmonary Edema

What is missing from this cartoon?

Aspiration Passage of fluid and solid particles into the lungs Atelectasis Compression atelectasis Absorption atelectasis Bronchiectasis Persistent abnormal dilation of the bronchi

Compression Atelectasis
Squeeze

Absorption Atelectasis

Bronchiolitis Inflammatory obstruction of the small airways Most common in children Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases (50% of the time due to what virus??)

Bronchiolitis obliterans Late-stage fibrotic disease of the airways Can occur with all causes of bronchiolitis

Pleural Abnormalities
Pneumothorax Open pneumothorax Tension pneumothorax Spontaneous pneumothorax Secondary pneumothorax

Pneumothorax

Tension Pneumothorax One way valve

Pleural Abnormalities
Pleural effusion Transudative effusion Exudative effusion Hemothorax Empyema Infected pleural effusion Chylothorax

Pleural Effusion Pleural space

Hemothorax Blood

Abscess formation and cavitation Abscess Consolidation Cavitation Pulmonary fibrosis Excessive amount of fibrous or connective tissue in the lung

Chest wall restriction Compromised chest wall Deformation, immobilization, and/or obesity Flail chest Instability of a portion of the chest wall

Flail Chest

Inhalation disorders Exposure to toxic gases Pneumoconiosis Silica Asbestos Coal Allergic alveolitis Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Pulmonary Disorders Acute respiratory distress syndrome (ARDS)
Fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury Injury to the pulmonary capillary endothelium Inflammation and platelet activation Surfactant inactivation Atelectasis

Manifestations Hyperventilation Respiratory alkalosis Dyspnea and hypoxemia Metabolic acidosis Hypoventilation Respiratory acidosis Further hypoxemia Hypotension, decreased cardiac output, death

Evaluation and treatment Physical examination, blood gases, and radiologic examination Supportive therapy with oxygenation and ventilation and prevention of infection Surfactant to improve compliance

Acute Respiratory Distress Syndrome (ARDS)

Pulmonary Disorders Postoperative respiratory failure Atelectasis
Pneumonia Pulmonary edema Pulmonary emboli Prevention Frequent turning, deep breathing, early ambulation, air humidification, and incentive spirometry

Obstructive Pulmonary Disease
Airway obstruction that is worse with expiration Common signs and symptoms Dyspnea and wheezing Common obstructive disorders Asthma Emphysema Chronic bronchitis

Asthma “Chronic inflammatory disorder of the airways”
Inflammation results from hyperresponsiveness of the airways Can lead to obstruction and status asthmaticus

Asthma

Asthma Symptoms include expiratory wheezing, dyspnea, and tachypnea
Peak flow meters, oral corticosteroids, inhaled beta-agonists, and anti-inflammatories used to treat

Chronic Obstructive Pulmonary Disease
Chronic bronchitis Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years Inspired irritants increase mucus production and the size and number of mucous glands

Chronic bronchitis The mucus is thicker than normal Bronchodilators, expectorants, and chest physical therapy used to treat

Bronchitis

Emphysema Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis Loss of elastic recoil Centriacinar emphysema Panacinar emphysema

Emphysema

Emphysema ULL

Respiratory Tract Infections
Pneumonia Community-acquired pneumonia Streptococcus pneumoniae Hospital-acquired (nosocomial) pneumonia Pneumococcal pneumonia Viral pneumonia

Pneumococcal Pneumonia
Lobar

Tuberculosis Mycobacterium tuberculosis Acid-fast bacillus Airborne transmission Tubercle formation Caseous necrosis Positive tuberculin skin test (PPD)

Tuberculosis Cavitary

Acute bronchitis Acute infection or inflammation of the airways or bronchi Commonly follows a viral illness Acute bronchitis causes similar symptoms to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

Pulmonary Vascular Disease
Pulmonary embolism Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble Pulmonary emboli commonly arise from the deep veins in the thigh Virchow triad Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels

Pulmonary Embolism

Pulmonary hypertension Mean pulmonary artery pressure 5 to 10 mm Hg above normal or above 20 mm Hg

Pulmonary hypertension Classifications Pulmonary arterial hypertension Pulmonary venous hypertension-CHF Pulmonary hypertension due to a respiratory disease or hypoxemia-COPD Pulmonary hypertension due to thrombotic or embolic disease-PE Pulmonary hypertension due to diseases of the pulmonary vasculature

Primary pulmonary hypertension Idiopathic Diseases of the respiratory system and hypoxemia are more common causes of pulmonary hypertension

Pulmonary Hypertension

Cor Pulmonale Pulmonary heart disease Right ventricular enlargement
Secondary to pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle

Cancer Lip cancer Most common form Laryngeal cancer Exophytic Stages
Forms Carcinoma of the true vocal cords (most common) Supraglottic Subglottic

Lip Cancer

Laryngeal Cancer

Lung Cancer Bronchogenic carcinomas
Most common cause is cigarette smoking Heavy smokers have a 20 times’ greater chance of developing lung cancer than nonsmokers Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder

Lung Cancer

Lung Cancer Environmental or occupational risk factors are also associated with lung cancer

You have completed Week 4 …
of Pathopysiology!! Remember to… KEEP UP WITH YOUR: 1) Text READING 2) Powerpoint Review 3) Study Guide Prep

Pathophysiology Denver School of Nursing – ADN & BSN Programs

Similar presentations

Presentation on theme: "Pathophysiology Denver School of Nursing – ADN & BSN Programs"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Pathophysiology Denver School of Nursing – ADN & BSN Programs

Similar presentations

Presentation on theme: "Pathophysiology Denver School of Nursing – ADN & BSN Programs"— Presentation transcript:

Similar presentations

About project

Feedback