SLP 542 - Exam 1

what structure separates the upper/lower respiratory systems?

vocal folds

lamina propria

mucosal lining on top of the VF

rales

abnormal noise at the base of lungs

trachea

- semi-circular, U-shaped, cartilaginous rings

- calcify with age

- lined with ciliated epithelial columnar cells and goblet cells

- bifurcates into mainstem bronchi

ciliated epithelial columnar cells

vertically lined hairs to grab/hold mucous so it doesn't go down trachea

goblet cells

secrete mucous to protect hair cells against bacteria, virus, smoke, etc.

aspiration pneumonia is ~more likely to occur on...

the R side (wider opening, straighter tube)

bronchi

- cartilaginous rings like trachea

- L/R mainstem bronchi enter the lungs and split into secondary (lobar) bronchi

mainstem bronchi path

mainstem bronchi -> secondary (lobar) bronchi -> tertiary (segmental) bronchi -> terminal bronchioles -> alveolar sacs -> alveolus

one singular alveolus has...

O2 and CO2 capillaries

R lung has ___ lobes

3

L lung has ___ lobes

2

lungs

- made up of spongy material

- elastic fibers

- surface tension from sufactant

surfactant

lines alveoli and keeps their tension intact for gas exchange

what happens without surfactant?

alveoli collapse and cannot be used for gas exchange

visceral pleura

covers lung surface and house the lungs

pleural cavity

fluid filled space between visceral and parietal pleura

negative pressure of the pleural cavity

holds the lung tissue against ribs to form the chest well

pleural linkage

chest wall and lungs move together as one during breathing

parietal pleura

lines the thorax or inner chest well

chest wall to lungs from superficial to deep

chest wall -> parietal pleura -> pleural cavity -> visceral pleura -> lungs

pneumothorax

collapsed lung (or lobe) when external air leaks into the pleural cavity

causes of pneumothorax

- injury

- lung disease

- ruptured air blisters (blebs)

- mechanical ventilation

- iatrogenic (punctured during surgery)

risk factors for pneumothorax

- male

- smoking

- genetics

- age (for blebs)

- previous pneumothorax

pleural effusion

- excess fluid accumulating in the pleural cavity

- limits lung expansion (b/c fluid is taking up space)

causes of pleural effusion

- leakage from other organs (congestive heart disease)

- cancer

- infection

- autoimmune conditions

- pulmonary embolism

pulmonary embolism

blood clot from anywhere to the pulmonary artery

risk factors for pleural effusion

- male

- smoking

- genetics

- age (for blebs)

- previous pneumothorax

pneumonitis

- general term for inflammation of some type

- not infectious

opacities, infiltrates, consoldiations

- something abnormal in the lungs

- infection, blood, exudate (pus)

pneumonia

- infection and inflammation

- impairs gas exchange

thorax

- formed by rib cage, sternum, spine, and clavicles

- houses lungs, heart, diaphragm, and thoracic portion of esophagus

- expands with inspiration

diaphragm

- primary muscle of inspiration

- separates thorax and abdomen

- unpaired, but functionally divided into L/R

- surrounded by diaphragmatic pleura

during inspiration, the diaphragm...

- contracts and flattens

- increases thoracic volume

- compresses abdominal volume

during inspiration, the intercostal muscles...

contract

accessory respiration muscles (pectoralis)

sometimes involved in inspiration, but only when the shoulder girdle and arms are in a fixed position

abdominal muscles

- relaxed during inspiration and passive exhalation

- engaged during speech and forced expiration

forced expiration

compress the abdominal contents with push against the diaphragm, assisting in maximum exhalation

neurology of phonation

- CN X: intrinsic laryngeal muscles

- CN V and VII: suprahyoid muscles

- CN XII: tongue

- C1-C3: omohyoid

neurophysiology of breathing

- brainstem central pattern generator

- phrenic nerve (diaphragm)

- cervical, thoracic, and lumbar spinal nerves

goal of quiet breathing

gas exchange (CO2 for O2)

baseline of quiet breathing

alveolar pressure (inside lungs) = atmospheric pressure

inspiration during quiet breathing

- diaphragm contracts and flattens

- intercostals elevate and twist ribs

- thorax, lungs, alveoli expands

- abdomen compresses

- air continues to enter until return to baseline pressures

alveoli expansion is...

passive

decreased alveoli pressure

lung pressure is now less than atmospheric pressure, and air enters the system

expiration

- passive expiratory forces = relaxation pressures

- gravity, torque, elastic recoil

- work together to reverse actions of inspiration

gas exchange process

CO2 for O2 via alveolar capillaries

O2 carried in blood via...

hemoglobin (Hb)

respiration

process of gas exchange at alveoli (moving O2/CO2 in and out of blood)

ventilation

process of moving air in/out of lungs

normal adult respiratory rate

12-20 bpm

oxygen saturation

- amount of oxygen in the blood

- SpO2: measured peripherally with a sensory

- SaO2: measured internally in the lab

perfusion

amount of blood (and therefore O2) reaching the tissue

hypoxemia

not enough O2 in the blood

hypoxia

not enough O2 in the tissue (skin, heart, etc.)

hypercapnia

excessive CO2 in the blood

veins

- CO2

- pumps to lungs

- into heart

arteries

- O2

- pumps to the body

- away from heart

pulonary artery

- only artery that carries CO2

- away from heart

pulmonary vein

- only vein that carries O2

- into heart

top of the heart

atrium

bottom of the heart

ventricles

capillary

gas exchange in and around body

total lung capacity

total volume of air in the lungs and total after exhalation

vital capacity

how much you can breathe in and out

inspiratory capacity

newly exhaled lung to maximum inhalation

functional reserve capacity

a normal exhale and what is left over

inspiratory reserve volume

how much more you can expand beyond TV

tidal volume

normal/quiet breathing

expiratory reserve volue

how much more you can exhale beyond TV

residual volume

it's impossible to exhale 100%

what happens if someone is always using their max inhale/exhale?

- too much exercise

- fatigue

- muscle failure

- need mechanical ventilation

maximum lung volume

deepest possible breath

forced breathing

body has increased demand for air (ex: during physical exertion in a healthy person)

forced inhalation

uses primary and accessory muscles of respiration

forced exhalation

passive expiration and active contraction of intercostals and abdominal muscles

during forced breathing, tidal volume...

increases

during forced breathing, respiratory rate...

stays the same or slows down

speech breathing

- active inspiration and active expiration through resistance (VF)

- continuously modulating due to VF and articulator valving acting

inspiration during speech breathing

cycle is shorter relative to expiration

expiration during speech breathing

when phonation occurs

typically, if adequate breath support for quiet breathing exists then...

adequate breath support for speech exists

louder voice requires increased...

inspiratory volume above tidal volume

longer phrases require increased...

inspiratory volume above tidal volume

what's longer in speech breathing? (ex/in?)

exhale

tidal volume is usually...

~ 35-40% of vital capacity

conversation is initiated with a large increase in air up to...

~ 55-60% of vital capacity

speech breathing uses some amount of...

- inspiratory reserve volume or "extra air"

- ~ 20% more than tidal volume

to maintain adequate alveolar pressures for speech, balance is needed between...

- active inhalation

- active exhalation

- passive exhalation/recoil

breathing that affects speech is technically...

dysarthria

brainstem central pattern generator (CPG)

maintains balanced O2 and CO2

primary driver of ventilation regulation

CO2 levels

chemoreceptors

- blood-borne, sensory system

- react to the amount of a chemical in the system

central CO2 chemoreceptors

- in medulla

- react to chemistry changes in CSF

- constantly monitoring levels and adjusting as needed

- keep acid (H+) and base (HCO3-) balanced

peripheral CO2 receptors

- in aortic body and carotid bodies

- constantly monitoring and adjusting to keep homeostasis

- sends info to the medulla

peripheral O2 receptors

- in aortic body and carotid bodies

- constantly monitoring

- only reacts when levels are critically low

stretch receptors

- afferent and efferent neural

- react to the amount of muscle stretch in a muscle system

- react to expansion/deflation of lungs and bronchi

% of blood gases in normal room air at sea level

- oxygen: 21%

- nitrogen: 80%

- carbon dioxide: .03%

acid-base balance

homeostasis

acid-base level

pH level