70. Pulmonary Physiology

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70. Pulmonary Physiology

70. Pulmonary Physiology

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 70

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Syllabus

Preface ix
Chapter 1 Function & Structure of the Respiratory System 1
Objectives / 1
Functions of the Respiratory System / 2
Structure of the Respiratory System / 4
Key Concepts / 10
Suggested Readings / 10
Chapter 2 Mechanics of Breathing 11
Objectives / 11
Generation of a Pressure Gradient Between Atmosphere & Alveoli / 12
Pressure-Volume Relationships in the Respiratory System / 20
Interaction of Lung & Chest Wall: The Static Pressure-Volume Curve / 29
Airways Resistance / 32
The Work of Breathing / 49
Key Concepts / 50
Clinical Problems / 51
Suggested Readings / 52
Chapter 3 Alveolar Ventilation 54
Objectives / 54
The Lung Volumes / 54
Measurement of the Lung Volumes / 57
Anatomic Dead Space & Alveolar Ventilation / 65
Measurement of Alveolar Ventilation / 67
Alveolar Ventilation & Alveolar Oxygen & Carbon Dioxide Levels / 71
Regional Distribution of Alveolar Ventilation / 75
The Closing Volume / 79
The Effects of Aging / 81
Key Concepts / 82
Clinical Problems / 83
Suggested Readings / 84
Chapter 4 Blood Flow to the Lung 86
Objectives / 86
The Bronchial Circulation / 87
The Functional Anatomy of the Pulmonary Circulation / 89
Pulmonary Vascular Resistance / 92
The Regional Distribution of Pulmonary Blood Flow: The Zones
of the Lung / 99
Hypoxic Pulmonary Vasoconstriction / 105
iii

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iv / CONTENTS
Pulmonary Edema / 108
Key Concepts / 111
Clinical Problems / 111
Suggested Readings / 112
Chapter 5 Ventilation-Perfusion Relationships 113
Objectives / 113
The Concept of Matching Ventilation & Perfusion / 113
Consequences of High & Low V/Q ̇ ̇
/ 114

Testing for Nonuniform Distribution of Inspired Gas & Pulmonary Blood
Flow / 116
Regional V/Q ̇ ̇ Differences & Their Consequences in the Lung / 125
Key Concepts / 128
Clinical Problems / 128
Suggested Readings / 129
Chapter 6 Diffusion of Gases 130
Objectives / 130
Fick’s Law for Diffusion / 130
Limitations of Gas Transfer / 133
Diffusion of Oxygen / 135
Diffusion of Carbon Dioxide / 137
Measurement of Diffusing Capacity / 137
Key Concepts / 140
Clinical Problems / 140
Suggested Readings / 141
Chapter 7 The Transport of Oxygen & Carbon Dioxide
in the Blood 142
Objectives / 142
Transport of Oxygen by the Blood / 142
Hemoglobin & the Physiologic Implications of the Oxyhemoglobin
Dissociation Curve / 145
Influences on the Oxyhemoglobin Dissociation Curve / 148
Transport of Carbon Dioxide by the Blood / 156
The Carbon Dioxide Dissociation Curve / 158
The Bohr & Haldane Effects Explained / 159
Key Concepts / 161
Clinical Problems / 161
Suggested Readings / 162
Chapter 8 The Regulation of Acid-Base Status 163
Objectives / 163
The Chemistry of Acids, Bases, & Buffers / 163

Buffer Systems of the Human Body / 166
Acidosis & Alkalosis / 171
Respiratory & Renal Compensatory Mechanisms / 176
Clinical Interpretation of Blood Gases & Acid-Base Status / 178
The Causes of Hypoxia / 181
Key Concepts / 184
Clinical Problems / 185
Suggested Readings / 188
Chapter 9 The Control of Breathing 189
Objectives / 189
The Generation of Spontaneous Rhythmicity / 191
The Medullary Respiratory Center / 192
The Pontine Respiratory Group / 194
Spinal Pathways / 195
Reflex Mechanisms of Respiratory Control / 195
Influences of Higher Centers / 201
The Response to Carbon Dioxide / 202
The Response to Hydrogen Ions / 209
The Response to Hypoxia / 210
The Response to Exercise / 211
Key Concepts / 213
Clinical Problems / 214
Suggested Readings / 215
Chapter 10 Nonrespiratory Functions of the Lung 216
Objectives / 216
Pulmonary Defense Mechanisms / 216
Nonrespiratory Functions of the Pulmonary Circulation / 222
Metabolic Functions of the Lung / 224
Key Concepts / 227
Suggested Readings / 227
Chapter 11 The Respiratory System Under Stress 228
Objectives / 228
Exercise & the Respiratory System / 228
Altitude & Acclimatization / 234
Diving & the Respiratory System / 240
Key Concepts / 247
Clinical Problems / 247
Suggested Readings / 248
Clinical Problem Answers 250

Appendix 263
I. Symbols Used in Respiratory Physiology / 263
II. The Laws Governing the Behavior of Gases / 263
III. Frequently Used Equations / 264
IV. Pulmonary Function Test Decision Tree / 265
V. Table of Normal Respiratory and Circulatory Values / 266
VI. General Suggested Readings / 266
Index 267

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