Cardiovasculair stelsel ademhaling nier en urinewegen
Summary
samenvatting fysiologie van het ademhalingstelsel, Blok cardiovasculair stelsel, ademhalingsstelsel en urinewegen
49 views 1 purchase
Course
Cardiovasculair stelsel ademhaling nier en urinewegen
Institution
Universiteit Gent (UGent)
Dit is een volledige samenvatting van het partim fysiologie: het ademhalingstelsel. Zowel de lessen als de cursus zit in deze samenvatting verwerkt. Mocht er iets mis zijn met de samenvatting mag je me altijd een berichtje sturen!! Veel succes :))
Cardiovasculair stelsel ademhaling nier en urinewegen
All documents for this subject (14)
Seller
Follow
mgrtgeneeskunde
Reviews received
Content preview
2023-2024 Fysiologie van het
ademhalingsstelsel
Cardiovasculair stelsel, ademhaling, nier
en urinewegen
Emma Degroote
2DE BACH GENEESKUNDE
,Inhoudsopgave
Algemene inleidende begrippen ..................................................................................................................... 5
De inwendige en uitwendige ademhaling .......................................................................................................... 5
Geleidingszone en uitwisselingszone .................................................................................................................. 6
Geleidingszone............................................................................................................................................... 6
Uitwisselingszone .......................................................................................................................................... 6
Func8onele aspecten van de luchtwegenstructuur ............................................................................................ 6
LuchtstroomkarakterisCeken ......................................................................................................................... 6
Klaring van luchtwegen .................................................................................................................................. 7
Aerodynamische filtraCe ........................................................................................................................... 7
Mucociliair transport ................................................................................................................................ 7
Chronische ontstekingen ...................................................................................................................... 8
Belangrijke fysische aspecten van gassen ...................................................................................................... 8
Het begrip parCële druk of spanning ........................................................................................................ 8
BevochCgde lucht...................................................................................................................................... 8
ParCële druk van een gas in een vloeistof................................................................................................. 8
Gasvolumes en correcCefactoren ............................................................................................................. 8
OmzeQng tussen types voorwaarden.................................................................................................. 9
Longven2la2e ............................................................................................................................................... 10
De adembeweging ............................................................................................................................................ 10
Longen in rust en de funcConele residuele capaciteit (FRC)........................................................................ 10
Subatmosferische of negaCeve druk ....................................................................................................... 10
Pathologie ............................................................................................................................................... 10
De inademing ............................................................................................................................................... 11
De uitademing ............................................................................................................................................. 11
Opmerking: ............................................................................................................................................. 11
Drukveranderingen in de thorax als gevolg van de adembewegingen ........................................................ 11
Intrapulmonale of alveolaire druk .......................................................................................................... 12
Intrapleurale druk ................................................................................................................................... 12
Transmurale druk .................................................................................................................................... 12
Regionale verschillen in venClaCe (ongelijkmaCge venClaCe) ..................................................................... 13
Liggende houding .................................................................................................................................... 13
Staande houding ..................................................................................................................................... 13
Pathologie ............................................................................................................................................... 13
Longvolumes, longcapaciteiten en spirometrie ................................................................................................ 13
De vier klassieke longvolumes ..................................................................................................................... 13
Meten van residueel volume .................................................................................................................. 13
Verdunningsmethode ......................................................................................................................... 13
Totale lichaamsplethysmograaf .......................................................................................................... 14
De longcapaciteiten ..................................................................................................................................... 14
Longvolumes zijn verschillend ................................................................................................................ 14
Dynamische parameters .............................................................................................................................. 14
De 1-secondewaarde en Tiffeneau index ................................................................................................ 14
De piekstroom ......................................................................................................................................... 15
Maximale voluntary venClaCon (MVV) ................................................................................................... 15
Dode ruimte en alveolaire venClaCe ........................................................................................................... 15
Anatomische en fysiologische dode ruimte ............................................................................................ 15
Bepalen fysiologische dode ruimte .................................................................................................... 15
Alveolaire venClaCe (VA) ......................................................................................................................... 16
Ademhalingsweerstanden en ademarbeid ....................................................................................................... 16
Dynamische of wrijvingsweerstand ............................................................................................................. 16
1
, Algemeen ................................................................................................................................................ 16
Het transmuraal drukgradiënt – dynamische luchtwegencompressie .................................................... 17
Invloed van transmuraal drukgradiënt ............................................................................................... 17
Gevolgen van dynamische luchtwegencompressie ............................................................................ 17
Veranderingen in tonus van de bronchomotoren ................................................................................... 18
EvaluaCe van luchtwegenweerstand ....................................................................................................... 18
StaCsche (of elasCsche) weerstand (complianCe) ....................................................................................... 19
ComplianCe van de long ......................................................................................................................... 19
Voordelen van surfactans ................................................................................................................... 19
Surfactans en prematuur.................................................................................................................... 20
ComplianCe van de thorax ...................................................................................................................... 20
Gasuitwisseling in de longen ......................................................................................................................... 21
Alveolaire lucht ................................................................................................................................................. 21
Bepalen van PAO2 en PACO2 uit alveolaire venClaCevergelijkingen: ............................................................. 21
Gasuitwisseling doorheen het alveolo-capillaire membraan............................................................................ 22
Zuurstof........................................................................................................................................................ 22
Koolstofdioxide ............................................................................................................................................ 22
Transport gassen doorheen alveolo-capillaire membraan ............................................................................... 22
Debiet- of diffusie-gelimiteerde opname..................................................................................................... 22
Opname van een gas ................................................................................................................................... 23
Drukgradiënt ................................................................................................................................................ 23
Klinische toepassing: ............................................................................................................................... 23
Longdiffusiecapaciteit .................................................................................................................................. 23
Determinanten van de longdiffusiecapaciteit van een gas ..................................................................... 23
Totaal oppervlak van de alveolo-capillaire membraan ....................................................................... 23
Eigenschappen van het gas ................................................................................................................ 24
Dikte van het membraan .................................................................................................................... 24
Bepalen van de longdiffusiecapaciteit .................................................................................................... 24
Het respiratoir quo8ënt .................................................................................................................................... 24
Longdoorbloeding – kleine bloedsomloop..................................................................................................... 25
Druk, volume en debiet in de longcircula8e ..................................................................................................... 25
Invloed van de zwaartekracht .......................................................................................................................... 25
Regula8e van de longcircula8e ........................................................................................................................ 26
Rechts-links shunt = veneuze bijmenging ......................................................................................................... 26
Opmerking: .................................................................................................................................................. 26
Transport ademhalingsgassen in het bloed.................................................................................................... 27
ZuurstoPransport ............................................................................................................................................. 27
Rol van hemoglobine in het transport van zuurstof .................................................................................... 27
Hemoglobine en oxyhemoglobine .......................................................................................................... 27
De O2-hemoglobine dissociaCecurve/ hemoglobine-desaturaCecurve .................................................. 27
Oxyhemoglobine-dissociaCecurve ..................................................................................................... 28
Verschuivingen in de dissociaCecurve .................................................................................................... 28
Methemoglobine .................................................................................................................................... 29
De zuurstofcascade in het organisme ..................................................................................................... 29
Transport van CO2 ............................................................................................................................................. 29
3 manieren van CO2 transport ..................................................................................................................... 29
Ven2la2e/perfusie verhouding ..................................................................................................................... 30
Invloed van houding op ven8la8e/perfusie verhouding ................................................................................... 30
2
, Invloed van V/Q op samenstelling van de alveolaire lucht ............................................................................... 30
Stoornissen van de V/Q verhouding.................................................................................................................. 30
V/Q stoornis door relaCef verminderde doorbloeding ................................................................................ 31
V/Q stoornis door relaCef verminderde (ongelijkmaCge) venClaCe ............................................................ 31
Oorzaken van verminderde venClaCe: .................................................................................................... 31
Gecompenseerde V/Q stoornis .................................................................................................................... 31
Fasen van compensaCe van de 𝑉𝐴𝑄 stoornissen ................................................................................... 31
IniCële theoreCsche fase .................................................................................................................... 31
Tweede fase: gecompenseerde V/Q stoornis ..................................................................................... 31
Derde fase: laaQjdige, niet-compenseerde 𝑉𝐴𝑄 stoornis ................................................................. 32
Evalueren van een ven8la8e/perfusie stoornis ................................................................................................. 32
Regula2e van de ademhaling ........................................................................................................................ 33
Algemeen.......................................................................................................................................................... 33
Ademhalingscentra in de hersenstam en ritmogenese..................................................................................... 34
Verschillende hersendelen en hun funcCe bij ademhaling .......................................................................... 34
Medulla ................................................................................................................................................... 34
Pons......................................................................................................................................................... 34
Cortex ...................................................................................................................................................... 34
SecCe op verschillende niveaus en hun effecten ......................................................................................... 34
Chemische regula8e van de ademhaling .......................................................................................................... 34
Chemoreceptoren ........................................................................................................................................ 35
Perifere chemoreceptoren ...................................................................................................................... 35
Centrale chemoreceptoren ..................................................................................................................... 35
Verband longvenClaCe en zuur-base evenwicht .......................................................................................... 35
VenClaCe stoornissen en respiratoire zuur-base stoornissen ................................................................. 35
Metabole stoornissen en venClaCeverandering ..................................................................................... 36
Invloed van CO2 en O2 op de venClaCe ........................................................................................................ 36
Invloed van CO2 ....................................................................................................................................... 36
Acuut effect ........................................................................................................................................ 36
Chronisch effect.................................................................................................................................. 36
Invloed van O2-tekort .............................................................................................................................. 36
Acuut effect ........................................................................................................................................ 36
Chronisch effect.................................................................................................................................. 36
Invloed van wijzigingen in PCO2 en PO2 .................................................................................................. 37
Neurogene regula8e van de ademhaling ......................................................................................................... 37
Invloed vanuit andere centra in het centraal zenuwstelsel ......................................................................... 37
Reflexen vanuit longen en luchtwegen en de intrapulmonale receptoren .................................................. 37
Stretchreceptoren en reflex van Hering en Breuer ................................................................................. 37
Irritant receptoren .................................................................................................................................. 38
J-receptoren ............................................................................................................................................ 38
Hoesten en niezen................................................................................................................................... 38
Andere ademhalingsreflexen ....................................................................................................................... 39
De ademhaling in speciale omstandigheden.................................................................................................. 40
Inspanning ........................................................................................................................................................ 40
Inspanning en venClaCe............................................................................................................................... 40
Verband ademhaling en hypoxie ...................................................................................................................... 41
Hypox(em)ische hypoxie ................................................................................................................................... 41
Aanpassing aan de hoogte ........................................................................................................................... 41
HypervenClaCe (+tachycardie) ................................................................................................................ 41
AcCvaCe hypoxie-induceerbare factor 1 HIF-1........................................................................................ 42
3
, Hypox(em)ische hypoxie door ademhalingsproblemen (PaO2 < 60 mm Hg) ............................................... 42
HypovenClaCe (‘pompvalen’).................................................................................................................. 42
Diffusiestoornis (‘alveolo-capillair blok’) ................................................................................................. 42
Rechts-links shunt ................................................................................................................................... 42
Alveolaire hypovenClaCe ........................................................................................................................ 43
Opmerking .............................................................................................................................................. 43
Ademefficiën8e bij rokers ................................................................................................................................. 44
Effecten van hypox(em)ie en hypercapnie ........................................................................................................ 44
Hypox(em)ie ................................................................................................................................................ 44
Hypercapnie ................................................................................................................................................. 44
Behandeling van ademproblemen-toediening van zuurstof ............................................................................. 45
Toediening van zuurstof ............................................................................................................................... 45
Risico’s van O2-therapie .......................................................................................................................... 45
Hyperbare O2-therapie (3 atmosfeer) ..................................................................................................... 45
, Algemene inleidende begrippen
De inwendige en uitwendige ademhaling
Ademhaling in fysiologie = alle gasuitwisselingen tussen de cellen van het lichaam en de
buitenwereld:
- Inwendige ademhaling: gasuitwisseling tussen cel en extracellulair milieu
ñ Biochemische intracellulaire processen: aërobe energieproducDe
- Uitwendige ademhaling: uitwisseling O2 en CO2 tussen organisme en omgevingslucht
ñ Uitwisseling aangepast aan cel metabolisme: constante PO2 en PCO2 in
arterieel bloed
ñ 3 processen:
˃ LongvenDlaDe
˃ Gasuitwisseling thv longen
˃ Gastransport in bloed --> weefsel
Gasuitwisseling = passieve diffusie --> gasdrukgradiënt verzekeren door 2 pompen:
- Thoraxwand met ademspieren: O2-rijke/ CO2-arme lucht in longen
- Hart: O2-arme/CO2-rijke lucht in longen
Vereisten voor gezonde ademhaling:
- Goede venDlaDe: pompwerking van thorax en ademhalingsspieren
- Goede bloedstroom naar longen: pompwerking hart
- Goede gasuitwisseling: longziektes gasuitwisseling = verstoord
ñ Compensatoire venDlaDe toename => onvoldoende
˃ Hypoxemie en hypercapnie
FuncDes van longen:
- Verwijderen van giUige verbindingen
- Metabole acDviteit:
ñ InacDeve verbindingen --> acDeve stoffen (AG I --> AG II)
ñ InacDvaDe: serotonine, bradykinine, noradrenaline
- Filteren microtrombi
- Bloedreservoir
5
,Geleidingszone en uitwisselingszone
Luchtwegen onderverdelen in 2 zones:
- Geleidingszone: 25 cm
- Uitwisselingszone: 0,5 cm
Geleidingszone
= bovenste luchtwegen + onderste luchtwegen tot terminale bronchiolen
- Geen gasuitwisseling
- Volume = 150 ml <--> teugvolume = 500 ml
- Einde uitademing: 150 ml aan alveolaire lucht
ñ Alveolaire lucht = lucht dat heeU deelgenomen aan
gasuitwisseling in alveolen (-O2 + CO2)
ñ Inademen: eerste 150 ml alveolaire lucht in longalveolen
˃ 350 ml verste lucht per teug
- FuncDe: lucht geleiden --> uitwisselingszone + lucht
condiDoneren
ñ Lucht condiDoneren = opwarmen, filteren en
bevochDgen ingeademde lucht
ñ Tracheale lucht ≠ atmosferische lucht: parDële spanning
O2, N2, … ↓
Uitwisselingszone
= zone waar alveolo-capillaire membraan gasuitwisseling tussen lucht en bloed mogelijk is
- Alveole-capillaire membraan = 2 cellagen
ñ Epitheel alveool
ñ Endotheel capillair
- Grootste volume longen: 2,5 – 3 l
- Grote oppervlakte: 50 – 100 m2 => capillairen omspoelen
300 miljoen alveolen
ñ 1 alveool + capillaire omspoeling = respiratoire
eenheid
Func5onele aspecten van de luchtwegenstructuur
Luchtstroomkarakteris7eken
Trachea --> alveolaire zakken
- Diameter: kleiner
- Cross-secDonal area: ∅1 < ∅2 +∅3
ñ 2,5 cm2 --> 2,5 x 5000 cm2
6
, Gevolgen ↑ CSA:
- Luchtstroomsnelheid: geleidingszone >> uitwisselingszone
ñ Uitwisselingszone: gassen staan sDl => beweging moleculen door diffusie
ñ ConcentraDeverschillen weg binnen 1 seconde
˃ Snelheid diffusie
˃ Geringe afstanden
- Luchtstroomweerstand: geleidingszone >> uitwisselingszone
ñ Pathologie: verhoogde weerstand in bronchiolen
˃ Kleinere diameter => gemakkelijk verstopt
˃ Veel gladde spiercellen => makkelijker vernauwen
Aerodynamische filtra5e
Aerodynamische filtraDe op basis van inerDe stofdeeltjes en snelheid luchtstroom
- InerDe = traagheid: wat in beweging is wil in beweging blijven in dezelfde zin
ñ Hoe zwaarder voorwerp hoe groter inerDe
- Doel = lucht progressief zuiveren van stofdeeltjes => slijmvlies kleven
ñ Grote diameter/zwaardere stofdeeltjes: vliegen uit de bocht => nasofarynx
ñ Diameter 2-5 𝜇m: bronchiolen
ñ Diameter < 2 𝜇m: respiratoire bronchiolen en alveolen
˃ Opruimen door pulmonale alveolaire macrofagen --> lymfe
Aerosoltherapie afzehng parDkels aiankelijk van: diepste penetreren parDkels
- Grooje parDkels: klein
- Snelheid van luchtstroom: traag
- Diepte van in-en uitademen: diep inademen na maximale uitademing
Mucociliair transport
Muco-ciliair transport => 2 noodzakelijke onderdelen:
- Mucus uit 2 lagen: droge lucht => indikking
ñ Gel: oppervlakkig en kleverig
ñ Sol: dieper en minder viskeus
- Ciliair = trilharen: verplaatsen gellaag + parDkels --> epiglohs => inslikken
ñ Koude: vermindering van ciliaire beweging
ñ Volledige klaring in 24 uur
˃ Alveolen hebben geen trilhaar => parDkels opruimen door macrofagen
7
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through EFT, credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller mgrtgeneeskunde. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for $10.24. You're not tied to anything after your purchase.
