Lecture 22-Introduction to Functional Disturbance of The Respiratory System PDF

Introduction to Functional Disturbance of The Respiratory System IKA TRISNAWATI DIVISION OF PULMONOLOGY, INTERNAL MEDICINE DEPARTEMENT DR. SARDJITO HOSPITAL / GADJAH MADA UNIVERSITY YOGYAKARTA Respiratory Dysfunction Shunting an...

Introduction to Functional Disturbance of The Respiratory System IKA TRISNAWATI DIVISION OF PULMONOLOGY, INTERNAL MEDICINE DEPARTEMENT DR. SARDJITO HOSPITAL / GADJAH MADA UNIVERSITY YOGYAKARTA Respiratory Dysfunction Shunting and dead space Dysfunction of the respiratory neurons Chest pathology Respiratory muscles and diaphragm pathology Injure of pleura Obstructive and Restrictive lung disease  Anatomi Respirasi (Pleural – bronchi) Bronchioles Anatomi Respirasi  Fisiologi Respirasi Pulmonary Ventilation = breathing Mechanism Movement of gases through a pressure gradient - hi to low. When atmospheric pressure (760 mmHg) is greater than lung pressure ---- air flows in = inspiration. When lung pressure is greater than atmospheric pressure ---- air flows out = expiration. Anatomi Respirasi  Distribusi Oksigen VENTILASI D I F U S I Distribusi Oksigen P E R F U S I Sistem Oksigenasi Jaringan Acute Respiratory Distress Syndrome (ARDS)  The pathological factors: impair metabolism, structure and function of nerve cells. Hypoxia, Hypoglycemia, Toxic agents, Inflammatory processes in the brain tissue, Compression of the medulla, Traumas, Circulatory disorders in the brain. Neurochemical Respiratory Control System Investigation of Terminal Breathing in Experiment 1 – normal breathing; 2 – apneustic breathing after cutting both vagal nerves and brain between pneumotaxic and apneustic centers; 3 – gasping after cutting under dorsal respiratory group; 4 – an arrest of breathing after cutting medulla under respiratory neurons.  Terminal Breathing In terminal conditions the apneustic breathing and severe gasping are revealed. Apneustic breathing consist of prolonged spastic inhales, interrupted by brief exhalations (impaired connections of apneustic, pneumotaxic centers and vagal nerve). Severe gasping characterized by gradually decreased rate and depth of inhales because of arrest of respiratory neurons activity above dorsal and ventral respiratory group in medulla (in agony of death, terminal period of asphyxia).  Bradypnea Bradypnea – decreased rate of breathing, cased by lack of impulsation from respiratory neurons, that leads to hypoventilation. Bradypnea:  Hypertension (reflexes from carotid sinus baroreceptors)  Increased ventilatory resistance  Inhibition of respiratory neurons by hypoxia  Effect of narcotic drugs to brain that decrease the sensitivity of the respiratory neurons to pH or CO2 in CSF  Functional impaction of nervous system (neurosis, hysteria)  Hyperpnea Hyperpnea - increased breathing movement. Hyperpnea a result of intensive nerve or humoral stimulation of respiratory neuronal area:  Lack of pO2 in inhaled air  Extra pCO2 in inhaled air  Anemia  Acidosis  Apnea Apnea - an arrest of breathing lasting a few seconds. It is more likely in the presence of:  A metabolic alkalosis because decrease pCO2 in blood (after artificial lung ventilation)  Giving adrenalin in blood  Inhibition of respiratory neurons (as a result of hypoxia, toxic effects, organic pathology of the brain)  Periodic Breathing Cheyne–Stokes breathing is irregular. The depth of breathing periodically becomes gradually deeper and then gradually more shallow. It is caused by a delayed response of respiratory neurons to changes in blood gases resulting in an overshooting reaction. It occurs when there is hypoperfusion of the brain, or when breathing is regulated by a lack of oxygen (hypoxia, uremia, immature infants). Biot breathing consists of a series of normal breaths interrupted by long pauses. It is an expression of damage to respiratory neurons. Gasping also signifies a marked disorder in the regulation of breathing (meningitis, encephalitis).  Chest Pathology Astenic chest: at TBC patient, normal at patient with astenic constitution Barrel-shape: at pulmonum emphysema, bronchial asthma, bronchitis asthmatis and bronchiolitic Pigeon breast-shape or pectus carinatum, a protrusion of anterium sternum and costal cartilage in a boat-like shape. Pectus excavatum, a result of distal sternum depression or suppression, caused by variants of thorax vertebra expansion or accuisita due to collapsed anterior corpus vertebra that undergoes estopeni. Kifosis, most obvious shape is gibus deformity where acute angulations occurs at middle torachalis vertebrae.  Chest Pathology PECTUS CARINATUM/ PECTUS EXCAVATUM PIGEON BREAST Chest Pathology Chest Pathology  Chest Damage The contamination of air in the pleural cavity is called pneumothorax (opened, closed, valvular). If air can enter the pleural cavity and go out by place of trauma, this is opened pneumothorax. In case of shift the damaged tissues the air cannot go out the pleural cavity and closed pneumothorax develops. When mild tissues in the place of trauma permit entering of air and prevent outflow of air from the pleural cavity, the valvular pneumothorax develops.  Damage of The Respiratory Muscles Damage of motoneurons of spinal cord that control respiratory muscles may occur due to inflammatory and degenerative processes (with amyotrophic lateral sclerosis, poliomyelitis, syringomyelia), due to intoxication (strychnine, tetanus toxin). Violation of the conduction impulses in the peripheral nerves that supply respiratory muscles can occur because of inflammation, vitamin deficiency, trauma. Diaphragmatic nerve lesion leads to paralysis of the diaphragm, which manifests its paradoxical movements according to changes in pressure in the chest cavity - at the inhalation diaphragm rises, at the exhale – gets plant. Violation of neuromuscular transmission of impulses occurs in myasthenia, botulism, introduction of muscle relaxants. In all these cases, the ventilation function get disturbed.  Obstructive Respiratory Insufficiency Airway can be broken due to their narrow, leading to increased resistance to air movement (when inhaled forensic particles, thickening of the walls of airways due to inflammation, muscle spasm of the larynx, bronchial compression due to swelling, inflammation, enlarged thyroid gland). Pathophysiology of Obstructive Disease Emphysema  Pathophysiology of Obstructive Disease In emphysema the lungs lose their elasticity and stretch considerably with less transpulmonary pressure, so there is lack of pressure from within bronchioles - their clearance decreases, increases resistance to air movement, difficult breath. Exhalation becomes active due to decreased elasticity of the lungs, the pressure increases and bronchioles collapse, so alveoli are filled with residual air.  Atelectasis Atelectasis caused by airway obstruction and absorption of air from the involved lung area on the left and by compression of lung tissue on the right.