lungs volume and capacities
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on Jul 21, 2012 Says :
superb presentation on lung volumes and capacities.
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Lung volume and capacities Dr sourav
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The total volume contained in the lung at the end of a maximal inspiration is subdivided into volumes and subdivided into capacities There are four volume subdivisions which do not overlap. Can not be further divided. When added together equal total lung capacity. Lung capacities are subdivisions of total volume that include two or more of the 4 basic lung volumes. Lung volume
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Methode of study: Spirometry Apparatus used : Spiromter(spirograph) Record obtained : Spirogram
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The amount of gas inspired or expired with each normal breath. Normal value: About 500 ml Tidal Volume (TV)
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Extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force Normal value: 3000 milliliters Inspiratory Reserve Volume (IRV)
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Maximum extra volume of air that can be expired by forceful expiration after the end of a normal tidal expiration. Normal value: 1100 milliliters Expiratory Reserve Volume: ERV
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The volume of air remaining in the lung after a maximal expiration. Normal value: 1200 milliliters Residual Volume: RV
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Capacities : Consists of more than one volume. Obtained by addition of different volumes. Inspiratory capacity Functional residual capacity Vital capacity Total lung capacity Lung Capacities
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The amount of air a person can breathe in, beginning at the normal expiratory level and distending the lungs to the maximum amount. IC = TV + IRV Normal value: 3500 milliliters This capacity is of less clinical significance than the other three Inspiratory capacity (IC)
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Amount of air that remains in the lungs at the end of normal expiration. (At this volume, the inward elastic recoil of the lung approximates the outward elastic recoil of the chest (including resting diaphragmatic tone). FRC = ERV + RV Normal value: 2300 milliliters . Functional Residual Capacity (FRC)
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FRC and can be measured by any one of 3 techniques: Nitrogen washout, helium wash-in technique and total body plethysmography
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FRC is the resting expiratory volume of the lung and is the primary determinant of oxygen reserve in humans when apnea occurs. It greatly influences ventilation–perfusion relationships within the lung. When FRC is reduced, venous admixture increases and results in arterial hypoxemia
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FRC may be used to quantify the degree of pulmonary restriction. Disease processes that reduce FRC include acute lung injury, pulmonary edema, pulmonary fibrotic processes, and atelectasis. Mechanical factors also reduce FRC: Pregnancy(up to 20% at term & returns to normal within 48 h of delivery), obesity, pleural effusion, and posture. The FRC decreases 10% when a healthy subject lies down. Ventilatory muscle weakness or paralysis will also decrease FRC.
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Sleep : The reduction in FRC occurs almost immediately after the onset of sleep, with the most marked fall taking place in REM sleep, during which time it amounts to approximately 0.3 L, or 10% of the awake value Postoperatively there is proportional decreases in all lung volumes. Nonlaparoscopic upper abdominal operations cause 40-50% decrease in FRC compared with preoperative levels, when conventional postoperative analgesia is employed. Lower abdominal and thoracic operations causes decreases in FRC to 30% of preoperative levels. Most other operative sites—intracranial, peripheral vascular, otolaryngologic—have approximately the same effect on FRC, with reductions to 15 to 20% of preoperative levels.
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The maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent. VC = TV + IRV + ERV Normal value: 4600 milliliters Vital Capacity (VC)
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VC does not remain constant even in healthy adults and altered by age,physical traning,changes in wt and hight. VC can be reduced in disease process Alteration of muscle power : lessions in the brain such as brain tumors.raised icp,lessions affecting nerves(poliomyelitis,polyneuritis,myesthenia gravis ) leads to reduced vital capacity PULMONARY DISEASE: chronic bronchitis, pulmonary fibrosis ed vc lobar colapse pneumonia,asthma
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Space occupying lessions in the chest: Neurofibroma,kyphoscoliosis,pericardial and pleural effusion,pneumothorax,consolidation VC Abdominal tumors which impede the descent of the diaphragm: VC (but not in pregnancy) Abdominal pain: 70-75% in upper abdominal procedure, 50% in lower abdominal procedure. Alteration of posture
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The volume of air contained in the lungs at the end of a maximal inspiration. Called a capacity because it is the sum of the 4 basic lung volumes TLC= RV+IRV+TV+ERV Normal value: 5800 milliliters Total Lung Capacity (TLC)
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As small airways lacking cartilaginous support Patency of these airways depend on radial traction caused by the elastic recoil of surrounding tissue to keep them open( particularly in basal areas of the lung) Which is highly dependent on lung volume. The volume at which these airways begin to close in dependent parts of the lung is called the closing capacity Closing Capacity
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Closing capacity is usually measured using a tracer gas (single breath N2 wash out ,helium,argon,xenon-133) which is inhaled near residual volume and then exhaled from total lung capacity Graph has 4 phase. Phase I-dead space gas Phase II-mixed space gas Phase III-mixed alveolar Gas from all alveoli Phase IV-sudden rising of Nitrogen concentration
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CC=CV+RV. This is expressed as a percentage of TLC. Smoking, obesity, aging and supine posture all increase the CC. Early chronic bronchitis and left ventricular failure following myocardial infarction It is also increased after surgery(post operative hypoxaemia) Closing volume exceeds FRC in up to 50% of all pregnant women when they are supine at term
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RELATION BETWEEN FRC AND CC
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Restrictive Disease: Makes it more difficult to get air in to the lungs. They “restrict” inspiration. Decreased VC; Decreased TLC, RV, FRC Includes: Fibrosis Sarcoidosis Muscular diseases Chest wall deformities Respiratory Diseases
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Make it more difficult to get air out of the lungs. Decrease VC; Increased TLC, RV, and FRC Includes: Emphysema Chronic bronchitis Asthma Obstructive Disease
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