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Respiratory Pathophysiology Essentials

16 décembre 2025

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Respiratory Pathophysiology

1. Overview

  • Focus on mechanisms ensuring oxygen intake and CO2 elimination
  • Location: respiratory centers in the brainstem, lungs, airway structures
  • Role: maintain gas exchange, regulate breathing rhythm, and perform additional lung functions
  • Key ideas: respiratory regulation, external and internal disorders, gas exchange, circulation effects, and acute asphyxia

2. Core Concepts & Key Elements

  • Respiratory regulation: controlled by inspiratory, expiratory, apneustic, and pneumotaxic centers; regulated by blood CO2 levels and nervous pathways
  • Lung functions: filter microemboli, remove volatile substances, synthesize phospholipids, convert angiotensin I to II, inactivate serotonin, bradykinin, prostaglandins
  • Hypoxia: oxygen deficiency, classified as alveolar-capillary (external), transport (blood), tissue (internal)
  • External respiratory disorders:
    • Chest: malformations, trauma, reduced thoracic volume, spine deformities, sclerosis, loss of elasticity
    • Muscles: inflammation, dystrophy, nerve lesions causing paresis/paralysis, hiccups
    • Airways: stenosis, obstruction, inflammation at rhino-pharynx, larynx, trachea, bronchi
  • Airway inflammation:
    • Rhinitis: mucosal hypertrophy, mouth breathing
    • Laryngitis/tracheitis: reduced air intake, possible spasms
    • Bronchitis: exudate, mucus, increased sensitivity, cough, dyspnea
  • Lung diseases:
    • Asthma: bronchospasm, mucosal swelling, hypersecretion; allergic/nonallergic
    • Pulmonary emphysema: alveolar overexpansion, wall destruction, decreased elasticity
    • Pulmonary edema: transudate accumulation impairing gas exchange
    • Atelectasis: lung collapse from obstruction or compression
    • Pulmonary hypertension: increased arterial pressure, right heart hypertrophy
  • Pleural diseases:
    • Pleuritis: exudate, lung restriction
    • Pneumothorax: air in pleural cavity causing lung collapse
    • Hydrothorax: fluid accumulation, possible cardiac compromise
  • Circulatory disorders:
    • Stasis, edema, pulmonary embolism impair gas exchange
    • Blood flow issues affect oxygen transport and lead to hypoxia/hypercapnia
  • Blood gas transport disorders:
    • Hypoxemia: low arterial O2 partial pressure due to ventilation/perfusion mismatch
    • Anemic hypoxia: low hemoglobin or dysfunctional hemoglobin
    • Ischemic hypoxia: reduced blood flow
    • Tissular hypoxia: cellular inability to utilize oxygen
  • Internal respiration disorders:
    • Causes: toxins, nervous, circulatory, metabolic, allergic
    • Hypoxia effects: nervous, respiratory, cardiovascular, metabolic disturbances
  • Compensatory mechanisms:
    • Polycythemia, hyperventilation, increased gas exchange surface
  • Breathing regulation disorders:
    • Tachypnea, bradypnea, dyspnea
    • Respiratory arrhythmias: Cheyne-Stokes, Biot, Kussmaul, agonic
  • Acute asphyxia:
    • Phases: excitation, inhibition, agony
    • Symptoms: hypercapnia, hypoxia, CNS depression, potential death within 4-5 min
    • Resuscitation possible if performed early

3. High-Yield Facts

  • Hypoxia types:
    • Hypoxic: low alveolar O2 partial pressure
    • Anemic: low hemoglobin
    • Ischemic: impaired blood flow
    • Tissular: cellular utilization failure
  • Asthma: bronchospasm + mucosal swelling + hypersecretion
  • Pulmonary emphysema: alveolar wall destruction, decreased elasticity, increased residual volume
  • Pulmonary edema: transudate in alveoli, causes orthopnea, cyanosis
  • Pneumothorax:
    • Total: complete lung collapse
    • Partial: localized collapse
    • Causes: trauma, lung rupture, iatrogenic
  • Cheyne-Stokes: cyclic hyperpnea and apnea, common in heart failure, brain damage
  • Kussmaul breathing: deep, labored, in coma/uremia/diabetes
  • Acute asphyxia: 4-5 min to death, phases of excitation, inhibition, and terminal apnea

4. Summary Table

ConceptKey PointsNotes
Respiratory regulationControlled by brainstem centers; CO2 levels regulate activityInvolves inspiratory, expiratory, apneustic, pneumotaxic centers
Lung functionsFilter microemboli, volatile substances, synthesize phospholipids, convert angiotensin IAdditional roles in metabolism and inactivation of mediators
Hypoxia typesExternal (alveolar-capillary), transport (blood), internal (tissue)Exceeding compensation leads to hypoxia
External chest disordersMalformations, trauma, spine deformities, sclerosisReduce thoracic volume, limit expansion
Respiratory musclesInflammation, dystrophy, nerve lesionsCause paresis, paralysis, hiccups
Airway disordersStenosis, obstruction, inflammationAffect rhino-pharynx, larynx, trachea, bronchi
Inflammatory airway diseasesRhinitis, laryngitis, tracheitis, bronchitisReduce lumen, cause dyspnea, cough
Pulmonary diseasesAsthma, emphysema, edema, atelectasis, hypertensionImpair gas exchange, cause hypoxia/hypercapnia
Pulmonary emphysemaAlveolar overexpansion, wall destructionDecreased elasticity, increased residual volume
Pulmonary edemaFluid in alveoli, impairs diffusionCauses orthopnea, cyanosis
AtelectasisLung collapse from obstruction or compressionDyspnea, cough, cyanosis
Pulmonary hypertensionElevated arterial pressureLeads to right heart hypertrophy, possibly reversible
Pleural diseasesPleuritis, pneumothorax, hydrothoraxDisrupt lung expansion, cause respiratory failure
Circulatory disordersStasis, embolism impair gas exchangeCause hypoxia, hypercapnia
Blood gas transportHypoxemia, anemia, ischemia, tissular hypoxiaAffect tissue oxygenation and metabolism
Internal respirationDisrupted by toxins, nervous, circulatory issuesCauses systemic hypoxia and metabolic disturbances
CompensationPolycythemia, hyperventilation, increased surfaceMaintain oxygenation, fail in severe cases
Breathing disordersTachypnea, bradypnea, dyspneaResult from lung, nervous, or circulatory issues
Respiratory arrhythmiasCheyne-Stokes, Biot, Kussmaul, agonicCNS damage, metabolic acidosis, sleep states
Acute asphyxiaPhases: excitation, inhibition, agonyDeath in 4-5 min if untreated; early resuscitation critical

5. Mini-Schema

Respiratory Pathophysiology
 ├─ Regulation
 │   ├─ Centers: inspiratory, expiratory, apneustic, pneumotaxic
 │   └─ Regulation by CO2 and nervous pathways
 ├─ Lung Functions
 │   ├─ Filter microemboli
 │   ├─ Remove volatile substances
 │  ─ Synthesize phospholipids
 │   └─ Convert angiotensin I to II
 ├─ Hypoxia Types
 │   ├─ External (alveolar-capillary)
 │   ├─ Transport (blood)
 │   └─ Tissue (cellular)
 ├─ External Disorders
 │   ├─ Chest malformations, trauma
 │   ├─ Muscular issues
 │   └─ Airways: stenosis, inflammation
 ├─ Lung Diseases
 │   ├─ Asthma
 │   ├─ Emphysema
 │   ├─ Edema
 │   ├─ Atelectasis
 │   └─ Hypertension
 ├─ Pleural Diseases
 │   ├─ Pleuritis
 │   ├─ Pneumothorax
 │   └─ Hydrothorax
 ├─ Circulatory & Gas Transport
 │   ├─ Stasis, embolism
 │   ├─ Hypoxemia, anemia
 │   └─ Tissular hypoxia
 ├─ Internal Respiration
 │   ├─ Toxins, nervous, circulatory
 │   └─ Metabolic disturbances
 ├─ Compensation
 │   ├─ Polycythemia
 │   ├─ Hyperventilation
 │   └─ Increased surface
 ├─ Breathing Disorders
 │   ├─ Tachypnea, bradypnea
 │   ├─ Dyspnea
 │   └─ Arrhythmias: Cheyne-Stokes, Biot, Kussmaul
 └─ Acute Asphyxia
     ├─ Phases: excitation, inhibition, agony
     └─ Death in 4-5 min, early resuscitation essential

6. Rapid-Review Bullets

  • Breathing regulation involves brainstem centers sensitive to CO2
  • Lung functions include filtering emboli and converting hormones
  • Hypoxia classified as external, transport, or tissue
  • Chest malformations and trauma reduce thoracic volume
  • Respiratory muscle lesions cause paresis or paralysis
  • Airway inflammation causes stenosis and dyspnea
  • Asthma: bronchospasm + mucosal swelling + hypersecretion
  • Emphysema: alveolar wall destruction, decreased elasticity
  • Pulmonary edema: fluid in alveoli, causes orthopnea
  • Atelectasis: lung collapse from obstruction or compression
  • Pulmonary hypertension: increased arterial pressure, right heart hypertrophy
  • Pneumothorax: air in pleural cavity, causes lung collapse
  • Hydrothorax: fluid accumulation, may impair cardiac function
  • Circulatory issues impair gas exchange, cause hypoxia/hypercapnia
  • Hypoxemia from ventilation/perfusion mismatch, shunts
  • Anemic hypoxia: low hemoglobin; ischemic: poor blood flow
  • Tissular hypoxia: cellular oxygen utilization failure
  • Cheyne-Stokes: cyclic hyperpnea and apnea
  • Kussmaul: deep, labored breathing in coma
  • Acute asphyxia: phases of excitation, inhibition, terminal apnea

Respiratory Pathophysiology Essentials

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Respiratory Pathophysiology Revision Sheet

1. 📌 Essentials

  • Gas exchange occurs in alveoli; oxygen enters blood, CO exits.
  • Controlled by brainstem centers: inspiratory, expiratory, apneustic, pneumotaxic.
  • Hyp: deficiency in oxygen supply; types include hypoxic, anemic, ischemic, tissue.
  • Common external disorders: chest malformations, trauma, airway obstructions.
  • Lung diseases: asthma, emphysema, edema, atelectasis, pulmonary hypertension.
  • Pleural diseases: pleuritis, pneumothorax, hydrothorax.
  • Circulatory disorders impair oxygen transport: embolism, stasis.
  • Blood gas abnormalities: hypoxemia, hypercapnia, hypoxia.
  • Breathing disorders: tachypnea, bradypnea, dyspnea, arrhythmias.
  • Acute asphyxia leads to rapid CNS depression and death if untreated.

2. 🧩 Key Structures & Components

  • Brainstem centers — regulate breathing rhythm based on CO2 and O2 levels.
  • Alveoli — primary site of gas exchange.
  • Lungs — contain airways, alveoli, blood vessels, and connective tissue.
  • Airways — nasal cavity, pharynx, larynx, trachea, bronchi.
  • Pleura — visceral and parietal layers surrounding lungs.
  • Pulmonary circulation — carries deoxygenated blood for gas exchange.
  • Respiratory muscles — diaphragm, intercostals, accessory muscles.
  • Blood components — hemoglobin, plasma, cells involved in gas transport.

3. 🔬 Functions, Mechanisms & Relationships

  • Regulation:
    • Brainstem centers monitor CO2; increase ventilation when CO2 rises.
    • Chemoreceptors in carotid bodies respond to O2 and CO2 levels.
  • Gas exchange:
    • Oxygen diffuses from alveoli to blood; CO2 diffuses from blood to alveoli.
    • Driven by partial pressure gradients.
  • Circulatory link:
    • Pulmonary circulation transports deoxygenated blood to alveoli.
    • Systemic circulation delivers oxygen to tissues.
  • Disorders:
    • External factors (malformations, trauma) impair ventilation.
    • Internal factors (circulatory issues, toxins) impair gas transport/utilization.
  • Compensation:
    • Polycythemia increases oxygen-carrying capacity.
    • Hyperventilation reduces CO2 in response to hypoxia.

4. Comparative Table: Types of Hypoxia

Hypoxia TypeCauseKey FeatureClinical Note
HypoxicLow alveolar O2 partial pressureReduced oxygen in bloodDue to high altitude, ventilation issues
AnemicLow hemoglobin or dysfunctional HbReduced oxygen transport capacityAnemia, hemoglobinopathies
IschemicImpaired blood flowReduced oxygen delivery to tissuesCirculatory shock, embolism
TissularCellular utilization failureCells can't use oxygen effectivelyToxins, metabolic disturbances

5. 🗂️ Hierarchical Diagram

Respiratory System
 ├─ Regulation Centers
 │    ├─ Inspiratory Center
 │    ├─ Expiratory Center
 │    ├─ Apneustic Center
 │    └─ Pneumotaxic Center
 ├─ Lung Structures
 │    ├─ Airways (Nasal, Pharynx, Larynx, Trachea, Bronchi)
 │    ├─ Alveoli (gas exchange units)
 │    └─ Pulmonary Vessels
 ├─ Respiratory Muscles
 │    ├─ Diaphragm
 │    └─ Intercostals
 └─ Blood Components
      ├─ Hemoglobin
      └─ Plasma

6. ⚠️ High-Yield Pitfalls & Confusions

  • Confusing hypoxia types; remember cause and site of defect.
  • Mistaking asthma (reversible bronchospasm) for COPD (chronic airflow limitation).
  • Overlooking the phases of acute asphyxia; death occurs rapidly.
  • Misidentifying Kussmaul breathing as purely metabolic; also seen in severe acidosis.
  • Assuming all pulmonary edema is cardiogenic; non-cardiogenic causes exist.
  • Confusing pneumothorax (air in pleural space) with hemothorax (blood in pleural space).
  • Overestimating the role of lung elasticity in emphysema; destruction of alveolar walls is key.
  • Forgetting that hypercapnia results from hypoventilation or impaired gas exchange.

7. ✅ Final Exam Checklist

  • Know the main centers regulating respiration and their stimuli.
  • Understand the structure and function of alveoli and blood-air barrier.
  • Differentiate hypoxia types and their causes.
  • Recognize clinical features of asthma, emphysema, edema, atelectasis.
  • Identify pleural diseases: pleuritis, pneumothorax, hydrothorax.
  • Comprehend circulatory impairments affecting gas exchange.
  • Be able to interpret blood gas values: hypoxemia, hypercapnia.
  • Describe common breathing patterns: tachypnea, bradypnea, Cheyne-Stokes, Kussmaul.
  • Recognize phases and symptoms of acute asphyxia.
  • Understand compensatory mechanisms like polycythemia and hyperventilation.
  • Know the effects of external and internal respiratory disorders on gas exchange.
  • Be aware of common diagnostic and clinical signs associated with each condition.
  • Remember that early resuscitation is critical in asphyxia.

This revision sheet provides a structured, high-yield overview suitable for exam preparation on respiratory pathophysiology.

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Respiratory regulation — centers?

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Controlled by brainstem centers

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Which brainstem centers primarily regulate the process of breathing?

Hypothalamus and thalamus
Medullary and pontine centers only
Cerebral cortex and limbic system
Inspiratory, expiratory, apneustic, and pneumotaxic centers

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