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Ventilation Perfusion Mismatch
Ventilation perfusion mismatch or V/Q defects are defects in the total lung ventilation/perfusion ratio (V/Q ratio). It is a condition in which one or more areas of the lung receive oxygen but no blood flow, or they receive blood flow but no oxygen. In a healthy lung, the rate of alveolar ventilation to the rate of pulmonary blood flow is roughly equal; more precisely, because normal lungs are not perfectly matched, the V/Q ratio of a healthy lung is approximately 0.8. Pathogenesis Consider some scenarios where there is a defect in ventilation and/ or perfusion of the lungs. In a condition such as pulmonary embolism, the pulmonary blood flow is affected, thus the ventilation of the lung is adequate, however there is a perfusion defect. Gas exchange thus becomes highly inefficient leading to hypoxemia, as measured by arterial oxygenation. A ventilation perfusion scan or lung scintigraphy shows some areas of lungs being ventilated but not adequately perfused. This results in ...
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Ventilation/perfusion Ratio
In respiratory physiology, the ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching of two variables: * V – ventilation – the air that reaches the alveoli * Q – perfusion – the blood that reaches the alveoli via the capillaries The V/Q ratio can therefore be defined as the ratio of the amount of air reaching the alveoli per minute to the amount of blood reaching the alveoli per minute—a ratio of volumetric flow rates. These two variables, V and Q, constitute the main determinants of the blood oxygen (O2) and carbon dioxide (CO2) concentration. The V/Q ratio can be measured with a ventilation/perfusion scan. A V/Q mismatch can cause Type 1 respiratory failure. Physiology Ideally, the oxygen provided via ventilation would be just enough to saturate the blood fully. In the typical adult, 1 litre of blood can hold about 200 mL of oxygen; 1 litre of dry air has about 210 mL of oxygen. Therefore, under these cond ...
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Lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of the heart. Their function in the respiratory system is to extract oxygen from the air and transfer it into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere, in a process of gas exchange. Respiration is driven by different muscular systems in different species. Mammals, reptiles and birds use their different muscles to support and foster breathing. In earlier tetrapods, air was driven into the lungs by the pharyngeal muscles via buccal pumping, a mechanism still seen in amphibians. In humans, the main muscle of respiration that drives breathing is the diaphragm. The lungs also provide airflow that makes vocal sounds including human speech possible. Humans have two lungs, one on the left an ...
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Pulmonary Embolism
Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream ( embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, obstructive shock, and sudden death. PE usually results from a blood clot in the leg that travels to the lung. The risk of blood clots is increased by advanced age, cancer, prolonged bed rest and immobilization, smoking, stroke, long-haul travel over 4 hours, certain genetic conditions, estrogen-based medication, pregnancy, obesity, trauma or bone fracture, and after some types of surgery. A small proportion of cases are ...
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Ventilation Perfusion Scan
A ventilation/perfusion lung scan, also called a V/Q lung scan, or ventilation/perfusion scintigraphy, is a type of medical imaging using scintigraphy and medical isotopes to evaluate the circulation of air and blood within a patient's lungs, in order to determine the ventilation/perfusion ratio. The ventilation part of the test looks at the ability of air to reach all parts of the lungs, while the perfusion part evaluates how well blood circulates within the lungs. As Q in physiology is the letter used to describe bloodflow the term V/Q scan emerged. Uses This test is most commonly done in order to check for the presence of a blood clot or abnormal blood flow inside the lungs (such as a pulmonary embolism (PE) although computed tomography with radiocontrast is now more commonly used for this purpose. The V/Q scan may be used in some circumstances where radiocontrast would be inappropriate, as in Allergy to contrast agent or kidney failure. A V/Q lung scan may be performed in ...
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Scintigraphy
Scintigraphy (from Latin ''scintilla'', "spark"), also known as a gamma scan, is a diagnostic test in nuclear medicine, where radioisotopes attached to drugs that travel to a specific organ or tissue (radiopharmaceuticals) are taken internally and the emitted gamma radiation is captured by external detectors ( gamma cameras) to form two-dimensional images in a similar process to the capture of x-ray images. In contrast, SPECT and '' positron emission tomography'' (PET) form 3-dimensional images and are therefore classified as separate techniques from scintigraphy, although they also use gamma cameras to detect internal radiation. Scintigraphy is unlike a diagnostic X-ray where external radiation is passed through the body to form an image. Process Scintillography is an imaging method of nuclear events provoked by collisions or charged current interactions among nuclear particles or ionizing radiation and atoms which result in a brief, localised pulse of electromagnetic radi ...
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Alveolar–arterial Gradient
The Alveolar–arterial gradient (A-, or A–a gradient), is a measure of the difference between the alveolar concentration (A) of oxygen and the arterial (a) concentration of oxygen. It is a useful parameter for narrowing the differential diagnosis of hypoxemia. The A–a gradient helps to assess the integrity of the alveolar capillary unit. For example, in high altitude, the arterial oxygen is low but only because the alveolar oxygen () is also low. However, in states of ventilation perfusion mismatch, such as pulmonary embolism or right-to-left shunt, oxygen is not effectively transferred from the alveoli to the blood which results in an elevated A-a gradient. In a perfect system, no A-a gradient would exist: oxygen would diffuse and equalize across the capillary membrane, and the pressures in the arterial system and alveoli would be effectively equal (resulting in an A-a gradient of zero). However even though the partial pressure of oxygen is about equilibrated between th ...
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Parenchymal Lung Diseases
Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word παρέγχυμα ''parenchyma'' meaning 'visceral flesh', and from παρεγχεῖν ''parenchyma'' meaning 'to pour in' from παρα- ''para-'' 'beside' + ἐν ''en-'' 'in' + χεῖν ''chyma'' 'to pour'. Originally, Erasistratus and other anatomists used it to refer to certain human tissues. Later, it was also applied to plant tissues by Nehemiah Grew. Structure The parenchyma is the ''functional'' parts of an organ, or of a structure such as a tumour in the body. This is in contrast to the stroma, which refers to the ''structural'' tissue of organs or of structures, namely, the connective tissues. Brain The brain parenchyma refers to the functional tissue in the brain that is made up of the two types of brain cell, neurons a ...
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Tracer Gas
A tracer-gas leak testing method is a nondestructive testing method that detects gas leaks. A variety of methods with different sensitivities exist. Tracer-gas leak testing is used in the petrochemical industry, the automotive industry, and in the manufacture of semiconductors, among other uses. Types Several tracer-gas leak testing methods exist, including: * Detection of leaks using helium mass spectrometer, which provides high sensitivity * Hydrogen leak testing, which provides the best mobility * Refrigerant gas leak detection, for refrigeration applications Method selection Typical leakage rates The nature of the product or the process and the process gases will set the leak rate requirement: Sensitivity of methods Based on the target leak rate, the table below will help to choose the most suitable method. Applications Typical applications of tracer-gas leak testing include: * In petrochemical plants, hydrocracking, vapocracking, catalytic reforming, and steam re ...
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COPD
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce mucus. COPD progressively worsens, with everyday activities such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common conditions of COPD are emphysema and chronic bronchitis and they have been the two classic COPD phenotypes. Emphysema is defined as enlarged airspaces (alveoli) whose walls have broken down resulting in permanent damage to the lung tissue. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema is just one of the structural abnormalities that can limit airflow and can exist without air ...
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Asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise. Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens. Other potential triggers include medications such as aspirin and beta blockers. Diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry lung function testing. Asthma is classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. It may also be classified as atopic or non-atop ...
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Tidal Volume
Tidal volume (symbol VT or TV) is the volume of air moved into or out of the lungs during a normal breath. In a healthy, young human adult, tidal volume is approximately 500 ml per inspiration or 7 ml/kg of body mass. Mechanical ventilation Tidal volume plays a significant role during mechanical ventilation to ensure adequate ventilation without causing trauma to the lungs. Tidal volume is measured in milliliters and ventilation volumes are estimated based on a patient's ideal body mass. Measurement of tidal volume can be affected (usually overestimated) by leaks in the breathing circuit or the introduction of additional gas, for example during the introduction of nebulized drugs. Ventilator-induced lung injury such as Acute lung injury (ALI) /Acute Respiratory Distress Syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dy ...
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Lung Disorders
Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease. The study of respiratory disease is known as pulmonology. A physician who specializes in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory me ...
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