Samenvatting van de hoorcolleges van het vak 'Longen 1' gegeven door prof. Oostveen in de 2e Bachelor Geneeskunde aan de UA. Volledige samenvatting gebaseerd op college slides, eigen lesnotities én handboek.
Handboeken:
- West's Respiratory Physiology
- West's Respiratory Pathophysiology
lnhoudstafel
Structuur & functie van het ademhalingssysteem......................................................................................3
Ademhalingssysteem................................................................................................................................. 3
Veelgebruikte afkortingen.....................................................................................................................3
Normale (ideale) long........................................................................................................................... 3
Partiële druk................................................................................................................................... 4
De samenstelling van “lucht” (zeeniveau)...................................................................................... 4
Ademhalingsproces....................................................................................................................................4
Anatomie.................................................................................................................................................... 5
Anatomie volgens Weibel..................................................................................................................... 6
Doorgankelijkheid per luchtweggeneratie.......................................................................................7
Doorsnede door een long.....................................................................................................................7
Verdedigingsmechanismen.................................................................................................................. 8
Ventilatie......................................................................................................................................................... 9
De ideale long............................................................................................................................................ 9
Ventilatie...............................................................................................................................................9
Totale ventilatie (VE’) vs. alveolaire ventilatie (VA’)........................................................................ 9
Relatie tussen ventilatie en PCO2................................................................................................10
Ventilatie/perfusie ratio ...................................................................................................................... 10
Longvolumes............................................................................................................................................ 11
Meting van longvolumes..................................................................................................................... 11
Elastische eigenschappen van long & borstkas................................................................................. 12
Ademhalingsspieren.................................................................................................................................13
Statische longvolumes bepalen............................................................................................................... 13
Helium-verdunning............................................................................................................................. 13
ATP - BTPS condities................................................................................................................... 14
Bodyplethysmograaf...........................................................................................................................14
He-verdunning vs. bodyplethysmograaf.............................................................................................16
, Wet van Fick.............................................................................................................................................28
Pathologie.......................................................................................................................................... 28
Gaswisseling door middel van diffusie............................................................................................... 28
Diffusiemeting...........................................................................................................................................29
Single breath diffusie-meting (DL,CO-SB)......................................................................................... 29
Gastransport.................................................................................................................................................34
Overzicht.................................................................................................................................................. 34
O2-transport............................................................................................................................................. 34
Bloedgassen (O2).............................................................................................................................. 34
Hypoxie.............................................................................................................................................. 35
CO2-transport...........................................................................................................................................36
CO2 uitwisseling naar het bloed.........................................................................................................36
Zuurgraad...........................................................................................................................................37
Longcirculatie...............................................................................................................................................39
Anatomie.................................................................................................................................................. 39
Drukken in kleine en grote circulatie.................................................................................................. 39
Systemische vs. pulmonale circulatie.......................................................................................................40
Systeemcirculatie............................................................................................................................... 40
Pulmonale circulatie........................................................................................................................... 40
Pulmonale vaatweerstand........................................................................................................................ 40
Invloed van arteriële en veneuze bloeddruk op de pulmonale vaatweerstand...................................41
Invloed van longvolume op pulmonale vaatweerstand.......................................................................41
Vaatvernauwende en vaatverwijdende stoffen................................................................................... 41
Verdeling van ventilatie en perfusie over de long...............................................................................42
Pulmonale hypertensie.......................................................................................................................42
Vochtbalans in de long............................................................................................................................. 43
Andere functies van longcirculatie........................................................................................................... 44
Ademmechanica...........................................................................................................................................55
Ademmechanica.......................................................................................................................................55
Drukontwikkeling tijdens de ademhaling............................................................................................ 55
Luchtwegweerstand................................................................................................................................. 55
Stromingsprofielen............................................................................................................................. 56
Weerstandsverdeling over de luchtwegen......................................................................................... 56
Pathologisch verhoogde luchtwegweerstand..................................................................................... 56
Luchtwegweerstand meten................................................................................................................ 56
Druk/flow-relatie................................................................................................................................. 57
Invloed van het longvolume op Raw.................................................................................................. 57
Interrupter weerstand......................................................................................................................... 58
Elasticiteit & compliantie...........................................................................................................................58
Oppervlaktespanning......................................................................................................................... 58
Elasticiteit van het ademhalingssysteem............................................................................................59
Hysteresis: P/V-curve......................................................................................................................... 59
Ademarbeid.................................................................................................................................. 60
Adempatronen.............................................................................................................................. 60
Statische & dynamische hyperinflatie...........................................................................................61
Ergometrie.................................................................................................................................................... 63
Longfunctietesten..................................................................................................................................... 63
Ergometrie................................................................................................................................................63
Keuze van de inspanningstest........................................................................................................... 63
Organisatie inspanningstest............................................................................................................... 64
Incremental inspanningstest.................................................................................................................... 65
Metingen.............................................................................................................................................65
Inspanningsrespons bij gezonden......................................................................................................66
Normaalwaarden.......................................................................................................................... 67
Ventilatoire respons bij COPD............................................................................................................68
Casussen (zie ppt 15.17)......................................................................................................................... 69
Longfunctietesten........................................................................................................................................ 70
Luchtwegcompressie tijdens de geforceerde expiratie............................................................................ 70
Longfunctiekenmerken............................................................................................................................. 71
Diagnose astma....................................................................................................................................... 71
Bronchiale hyperreactiviteitstest.........................................................................................................71
Inspanningsastma.............................................................................................................................. 71
2
, Structuur & functie van het ademhalingssysteem
Ademhalingssysteem
functie: in stand houden van adequate gaswisseling (producten van metabolisme: O2 en CO2)
● niveau van de ademhaling wordt gereguleerd door CO2
structuur van de long
● ademhalingspomp met statistische volumes & ademminuutvolume (AMV)
○ AMV = VE’ = af · Vt = ademfrequentie · teugvolume = 12-15/min · 0.5 liter = +/- 7.5 liter/min
● gaswisselingsorgaan: > 500 miljoen longblaasjes
○ groot oppervlak: 75 m²
○ dunne alveolo-capillaire wand: 0.5 µm
○ diffusie = passief transport via de partiële drukgradiënt
⇒ diffusiesnelheid is afhankelijk van de oppervlakte en afstand (dikte)
Veelgebruikte afkortingen
● A = alveolair (longblaasje)
● B = barometer
● a = arterieel (slagaderlijk)
● c = capillair
● 𝑣 = gemengd veneus
● I (i) = inspiratoir (inademing)
● E (e) = expiratoir (uitademing)
● P = pressure = druk (Pascal, mmHg) = partieeldruk wanneer het een specifiek gas betreft
○ PB = barometerdruk (op zeeniveau) = 1 bar = 1013 hPa = 101.3 kPa = 760 mmHg
● V = volume (liter)
● V’ = flow (l/sec) of ventilatie (l/min) = volume per tijdseenheid
Normale (ideale) long ❗💥❗
pulmonale arterie
● bevat gemengd veneus bloed (𝑣) uit de rechter harthelft: mengsel van het bloed uit alle organen
● lagere PO2 dan de alveoli om zuurstof op te nemen
● hogere PCO2 dan de alveoli om koolstofdioxide af te geven
3
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