Lecture 26 Ventilation and Gas Exchange Disorders

A decrease in tissue oxygenation is called ____.

A reduction in the partial pressure of oxygen (PaO2) of the arterial blood is called ____.

An increase in the carbon dioxide (PaCO2) content of the arterial blood is called _____

hypoxia; hypoxemia; hypercapnia

The normal value for PO₂ should be greater than ____ mmHg.

Oxygen is present in two forms:

1. 98-99% are bound to hemoglobin called ______. A normal saturation value is from ___ to 97%.

2. Unbound to hemoglobin called ____ O2.

80; oxyhemoglobin; 95; dissolved

The normal value for PCO₂ ranges from ___ to 45 mmHg. 

It exists in three forms:

1. 20% bound to hemoglobin called _______. 

2. 70% in the form of _____ ____ which disassociates into bicarb and H+

3. 10% unbound to hemoglobin called ____ CO₂

When you exhale, you remove CO2 which ____ carbonic acid and ____ the pH. 

35; carbaminohemoglobin; carbonic acid; dissolved; decreases; increases

A _____ occurs when there is perfusion but no ventilation. An example would be _____which is an obstruction of airflow due to a collapsed lung. 

A dead air space occurs when there is ____ but not _____. This occurs with a pulmonary _____ leading to blocked blood flow. 

shunt; atelectasis; ventilation; perfusion; embolism

When PO2 < 60, this is called ____. Causes include:

1. _____ in which you are not taking in enough O2.

2. Impaired ____ of gases so O2 cannot cross alveolar wall.

3. Inadequate circulation of ___ through pulmonary capillaries

4. The ___ of ventilation/perfusion.

It can manifest as:

1. ____ RR and HR.

2. Metabolic ____ due to production of lactic acid

3. Cyanosis

4. Impaired sensory and ____ functions.

5. Activation of compensatory mechanisms in chronic hypoxemia like increased ventilation, pulmonary ____ to push blood to better alveoli, and increase in _____ (acronym) production leading to polycythemia.

hypoxemia; hypoventilation; diffusion; blood; mismatching; increased; acidosis; neurologic; vasoconstriction; RBC

When PCO2 > 50 mmHg, this is called _____. Causes include:

1. ____ which decreases CO2 expiration. 

2. A ____ of ventilation/perfusion which is accompanied by decrease in PO2 levels. 

Manifestations include:

1. _____ respiratory effort

2. ____ acidosis due to increas in carbonic acid formation. 

3. ______ of blood vessels leading to headaches, conjuctival _____, and warm, flushed skin. 

4. Depression of the ___ nervous sytem. This leads to decreased nerve ___, CO2 narcosis, disorientation, coma, and decreased muscle _____. 

hypercapnia; hypoventilation; mismatch; increased; respiratory; vasodilation; hyperemia; central; firing; contraction

____ chemoreceptors measure the PCO2 and pH in the cerebrospinal fluid. They ___ respiration when PCO2 increases or pH ____. It does not respond to _____ levels. 

Peripheral chemoreceptors measure the ___ levels in the arterial ____. They increase respirations when PO2 is ___ than 60 mmHg. They can also respond to PCO2 and levels of ____ (shorthand). 

central; increase; decreases; PO2; PO2; blood; less; H

Obstructive airway disorders are caused by conditions thatl limit ____ airflow.

A ____ can be used to measure the amount of CO2 in exhaled air over time. It reflects how well a person is ____.

expiratory; capnography; ventilating

Bronchial asthma is an _____ airway disorder. Features include:

1. A _____ recurring inflammation

2. Hyper-____ airways to stimuli

3. Episodic/reversible broncho______.

4. Persistent changes like ____ hypersecretion, injury to ____ cells, smooth muscle ___, and blood vessel proliferation. 

It is classified by ___ or intrinsic.

The bronchial smooth muscle are innervated by the ANS. Parasympathetic innveration via the ___ nerve and cholinergic receptors causes broncho ____. Sympathetic stimulation via the beta ___ receptors cause broncho ____. 

obstructive; chronic; reactive; constriction; mucus; epithelial; hypertrophy; extrinsic; vagus; constriction; 2; dilation

Extrinsic or ___ asthma is a type ___ hypersensitivity response due to an extrinsic _____ like pollen or dust. The early or acute phase response that develops within ___ to 20 minutes.

During this phase, the antigen attaches to the ____ layer of bronchial which opens/loosens the intercellular _____ which allows the antigen to get through and come into contact with the ____ layer which contains the IgE coated ____ cells. Once the antigen binds to the IgE, the mast cells degranulate and release chemical ____. 

These chemical mediators stimualte the parasympthatic receptors causing broncho ___ and increased ____ secretions. 

atopic; 1; antigen; 10; mucus; junctions; submucosal; mast; mediators; spasm; mucus

During the late-phase response of extrinsic asthma, it developes 4-8 ____ after and can last for 12-24 hours.

The release of the inflammatory mediators ____ other immune cells like basophils, eosinphils, and neutrophils. These ____ the inflammation and damages the _____ lining and decrease ____ function which leads to the accumulation of mucus. 

The chemical mediators also increase vascular ____ leading to mucosal edema due to the fluid. 

This also increases airway _____ and can cause bronchospasm.

hours; recruit; amplifies; epithelial; mucociliary; permeability; responsiveness

____ bronchial asthma or non-atopic consists of non-____ mechanisms.

Characteristics include:

1. ____ IgE levels

2. Not linked to a specific ____

3. No family history

4. Onset is usually in _____.

5. There is ____ of the tracheobronchial tree

Triggers could include:

1. A ____ or respiratory tract infection

2. Exercise, cold, and emotional ____

3. Drugs, inhaled irritants, foods, sleep, and premenstrual asthma. 

intrinsic; immune; normal; antigen; adulthood; hyperirritability; virus; stress

Bronchodilators include ____ for the beta ___ receptors. These ____ the smooth muscle cells to improve breathing. These should be given for the ___ phase of asthma.

Glucocorticoids are anti ______medications. They inhibit ___ cells, eosinophils, basophils, lymphocytes, macrophages, neutrophils. They should be given for the ____ phase of asthma. 

agonists; 2; relax; acute; inflammatory; mast; late

COPD is a group of respiratory disorders that are characterized by chronic/recurrent _____ of airflow. 

This includes _____ which is the enlargement of air spaces and destruction of lung tissue. 

This also includes chronic obstructive ______ which is increased mucus production, obstruction of small airways, and and a chronic productive ____. 

The most common cause of COPD is ____. 

The different mechanisms of COPD include:

1. Inflammation and ___ of bronchial wall. 

2. The ____ of mucous glands causing excess mucous which obstructs airfloew. 

3. Loss of elastic lung fibers causing the airway to ____ leading to obstructed air exhalation and air trapping. 

obstruction; emphysema; bronchitis; cough; smoking; fibrosis; hypertrophy; collapse

Emphysema is the loss of lung ____ and abnormal ____ of the air spaces distal to the terminal bronchioles with destruction of the alveolar ____ and capillary beds which decreases SA for gas exchange. 

Causes include smoking and an inherited deficiency in alpha1 - ____ which is an antiprotease enzyme that protects the lung from injury. 

It clinically manifests as _____ of the lungs and increased in total lung _____. The chest wall will adapt to this leading to the appearance of a ____ chest on a xray with a ___ diaphragm. 

Emphysema patients are often referred to as pink ____. This is because they:

1. Increase ____ to maintain O2 levels which prevents them from having _____. 

2. They experience _____ due to air trapping and increase in ventilatory effort. 

3. They use accessory muscles and ____ lip breathing. 

elasticity; enlargement; wall; antitrypsin; hyperinflation; capacity; barrel; flattened; puffers; respiration; cyanosis; dyspnea; pursed

Chronic bronchitis is airway obstruction of the major and ____ airways. 

This is when there is a marked increased in ____ cells and ___ production which plugs the airway lumen. This causes the ____ cells to infiltrate the airways leading to swelling nad narrowing of the airways. There is also ___ of the bronchiolar wall causing a fixed airway obstruction. 

It is caused by chronic ____ from smoking and recurrent infections. 

It manifests as a chronic productive ____. Patients with this disease are described as blue _____. This is because they ____ inc respiration enough to maintain PO2. and thus they experience ____ and polycythemia. There is also fluid ____ due to right heart failure.

small; goblet; mucus; inflammatory; fibrosis; irritation; cough; bloaters; cannot; cyanosis; retention

______ is destruction of the smooth muscle and elastic supporting tissue of the bronchi and bronchioles which leads to permanent ____ of these structures. 

This is a ____ disease meaning that it occurs due to obstruction and chronic persistent ____ and inflammation. 

It clinically manifests as:

1. A _____ bronchopulmonary infection due to the bacteria thriving in the mucus. 

2. A productive cough with a large amount of ____ sputum and hemoptysis. 

3. Marked dyspnea and ____ due to poor oxygenation (color). 

4. The ____ of fingers due to inc tissue growth from hypoxemia. 

5. Weight ___ and anemia due to inc metabolic demands and dec appetite.

bronchiectasis; dilation; secondary; infection; recurrent; purulent; cyanosis; clubbing; loss

Cystic fibrosis is an autosomal ____ genetic disorder that affects the ____ transport system, specifically the CFTR. This leads to ____ Na and water in the mucus and pancreatic secreations leading to the accumulation of _____ mucus in the bronchi creating an airway ____. It also obstructs the _____ and biliary ducts. Because the glands are unable to reabsob NaCl, this leads to salty ____. 

It can manifest as:

1. Chronic bronchiolitis and _____

2. Bronchiectasis

3. Chronic _____

recessive; chloride; less; thick; obstruction; pancreatic; sweat; bronchitis; infection

Disorders of lung function are caused by conditions that ____ the airways, cause lung compression or produce lung _____. 

This includes disorders of the ____ and atelectasis. 

obstruct; collapse; pleura

Inflammation of the pleura is called ____. This is usually secondary to viral ____ or pneumonia which irritates the pleura. 

Pleura pain usually results from the somatic pain fibers that innervate the ____ pleura as the visceral pleura does not contain pain _____. 

Pleura pain is usually _____ due to only the inflamed region hurting and has an abrupt onset. It is made worse by chest _____ and a patient will have rapid and  ____ breathing to avoid the pain. 

pleuritis; infection; parietal; receptors; unilateral; movements; shallow 

An abnormal collection of fluid in the pleural cavity is called pleural ____. This is due to excess fluid formation and decreased removal by the ____ system.

There are different types:

1. _____ effusion includes clear fluid. 

2. _____ effusion contains inflammatory cells

3. Empyema has _____ fluid

4. _______ is the effusion of lymph in the thoracic cavity

5. ______ has bloody fluid. 

This manifests as decrease in lung _____ on the affected side, flatness or ____ to percussion and diminished breath _____. A person may also experience dyspnea, hypoxemia, and ______ pain. 

effusion; lymphatic; transudative; exudative; purulent; chylothorax; hemothorax; expansion; dullness; sounds; pleuritic

The presence of air in the pleural cavity is called a ______. This results in partial/complete ____ of the affected lung. 

There are different types:

1. In a _____ or tension pneumothorax, air enters the space but cannot escape. This can occur when an air-filled ____ on the lung ruptures. This can be primary in that occurs in ____ persons or it can be ____ in that it occurs in person with an underlying lung disease. 

2. In a _____ or open pneumothorax, air can move in and out of the pleural cavity. This occur due to a chest ____ or trauma.

pneumothorax; collapse; spontaneous; bleb; healthy; secondary; traumatic; injury

An incomplete expansion of a lung or portion of the lung is called ______. 

Primary atelactasis most occurs in ___ due to failure of lungs to inflate at birth. 

Secondary atelectasis occurs in ____ in which they initially opened but collapsed again commonly due to respiratory ____ syndrome and airway obstruction due to _____ of amniotic fluid or blood. 

Acquired atelectasis occurs mainly in _____ and are commonly caused by airway obstruction and lung ____ from a mucous plug, pneumothorax, or pleural effusion. 

It manifests as decreased chest ____ and breath sounds on the affected side, intercostal _____ during inspiration, and signs of respiratory distress including:

1. Tachypnea, dyspnea, and ____ (HR)

2. ____ (color)

3. ____ (blood oxygenation)

atelectasis; newborns; infants; distress; aspiration; adults; compression; expansion; retraction; tachycardia; cyanosis; hypoxemia

Inflammatory and fibrotic changes in the interstitium or the interalveolar septa of the lung is called ____ lung disease.

It can be caused by occupation/environmental ____, drugs, granulomatous, Immunologic disorders, and some are ____ or of unknown cause.

This is a ____ disease rather than an obstructive disease.

It clinically manifests as:

1. A _____ VC and TLC due to inability to expand well and dec lung volumes.

2. A _____ expiratory flow rate due to no obstructions.

3. Small but ____ breaths with a nonproductive cough.

4. The ____ of fingers and toes

5. Hypoxemia, cyanosis, hypercapnia, and respiratory _____. 

6. Respiratory failure associated with pulmonary ____ (acronym) and cor pulmonale

interstitial; inhalants; idiopathic; restrictive; reduced; normal; frequent; clubbing; acidosis; HTN

The FVC or forced vital capacity is the amount of air you can forcefully ____ from your lungs after taking the deepest breath possible.

The FEV_1,0 is the amount of air you can pust out in the first ___ of exhaling.

The FEV_1.0/FVC is the _____ of total air that leaves the lungs within the first sec. 

In obstructive lung disease, this is a ____ ratio due to inability to get air out. 

In restrictive lung disease this is a ____ or normal ratio due to smaller and stiffer lungs.

exhale; second; percentage; low; high

The majority of pulmonary embolisms are caused by a ______ but it can also be caused due to air, fat, and amniotic fluid.

It manifests as:

1. Rapid and ___ breathing

2. Pleuritic pain with a productive cough and ____-streaked sputum.

3. Tachycardia

4. Pulmonary _____ (acronym) and right HF

Massive pulmonary emboli are often ____.

thrombus; shallow; blood; HTN; fatal

Pulmonary HTN is defined by a mean pulmonary ____ pressure ≥25 mm Hg at rest, measured during ____ heart catheterization.

It can be a primary disease due to abnormal ____ and contraction of vascular SM or marked intimal ____ which increases resistance. 

The majority are of secondary disease in which pulmonary HTN can occur due to:

1. An elevation of pulmonary ___ pressure meaning blood is not able to leave the lungs which causes the arteries to constrict. This can be due to ____ valve disorder or LV diastolic dysfunction. 

2. Increased pulmonary blood ____ which can occur due to left to right shunts, and septal defects.

3. A pulmonary vascular _____ like pulmonary embolism

4. _____ from advanced COPD or interstitial lung diseases which causes vasoconstriction.

artery; right; proliferation; fibrosis; venous; mitral; flow; obstruction; hypoxemia

Right heart failure secondary to primary lung disease or pulmonary hypertension is called ____ _____.

Clinical manifestations of the primary lung disease lead are ____ and hypercapnia which causes vasoconstriction of the pulmonary vessels which increases the ____ that the RV has to pump against. 

This increases the workload of RV and which leads to RV ______ and eventual failure of the RV bc its not supposed to be pumping that hard. 

The blood is then backed up into the venous system causing venous ____, peripheral edema, SOB, and a productive ____. 

It also leads to ______ as hypoxemia causes the release of erythropoeitin from the kidney to make more RBC

cor pulmonale; hypoxemia; pressure; hypertrophy; congestion; cough; polycythemia

ARDS is a ____ threatening reaction to injuries or an acure infection. It has a 90% death rate in untreated patients and a 50% in treated patients who are usually on _____ ventilation in the ICU. 

This is a clinical syndrome characterized by severe rapid onset of ____, hypoxemia, and bilateral pulmonary ____. 

The injury/infection damages the alveolar-capillary ____ which increases the permeability of the membrane which allows:

1. Exudate to enter the alveoli which ___ gas exchange and makes ____ more difficult

2. Neutrophils to enter the alveoli which release inflammatory mediators and _____ enzymes which destroy lung tissue and surfactant.

life; mechanical; dyspnea; infiltrates; membrane; blocks; inhalation; proteolytic

A condition in which the respiratory system fails in one or both of its gas exchange functions (O2 to blood or CO2 elimination) is called _____ _____. 

In hypercapnic/hypoxemic RF, this is a ____ failre meaning the the person cannot get air in/out of the lungs. 

In hypoxemic RF, there is failure of gas _____. This can be due to a ____ of ventilation/perfusion or impaired fusion. The air gets in/out okay which is why the person experiences hypoxemia and ____ hypercapnia. 

respiratory failure; ventilatory; exhange; mismatching; not