Pulmonary Emphysema

Pulmonary Emphysema - David G Morris and Dean Sheppard...

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21:396-403, 2006. doi:10.1152/physiol.00027.2006 Physiology David G. Morris and Dean Sheppard You might find this additional information useful. .. 54 articles, 33 of which you can access free at: This article cites http://physiologyonline.physiology.org/cgi/content/full/21/6/396#BIBL on the following topics: http://highwire.stanford.edu/lists/artbytopic.dtl can be found at Medline items on this article's topics Physiology . . Mice Medicine . . Pulmonary Emphysema Medicine . . Emphysema Physiology . . Lungs Physiology . . Pulmonary Circulation Physiology . . Capillary Bed including high-resolution figures, can be found at: Updated information and services http://physiologyonline.physiology.org/cgi/content/full/21/6/396 can be found at: Physiology about Additional material and information http://www.the-aps.org/publications/physiol This information is current as of August 23, 2010 . http://www.the-aps.org/. ESSN: 1548-9221. Visit our website at Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2006 by the American Physiological Society. ISSN: 1548-9213, developments. It is published bimonthly in February, April, June, August, October, and December by the American Physiological ) publishes brief review articles on major physiological News in Physiological Science (formerly published as Physiology on August 23, 2010 physiologyonline.physiology.org Downloaded from
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the capacity of the chest wall to expand during inspira- tion and collapse during exhalation, thus limiting ven- tilation. Eventually, the loss of functional alveolar units leads to chronic respiratory failure, evidenced by low blood oxygen levels (hypoxemia), elevated levels of carbon dioxide (hypercapnia, hypercarbia, chronic res- piratory acidosis), and eventually death ( FIGURE 1 ). Abnormalities of the pulmonary circulation are also important in the pathogenesis and clinical physiology of patients with emphysema. The loss of alveolar cap- illary units and the compensatory vasospasm that occurs in the lung in response to chronic hypoxia cause increased resistance to blood flow from the right ventricle through the lungs to the left atrium. Interestingly, autopsy studies suggest that vascular remodeling, which results in increased resistance to pulmonary blood flow, precedes the development of hypoxia and appears be an integral part of the early disease process (35, 36). The molecular mechanisms of this process remain elusive, although recent animal studies, outlined below, are beginning to offer some glimpses into possible etiologies. In any case, chroni- cally elevated resistance to blood flow from the right ventricle causes pulmonary hypertension. Over time, if pulmonary arterial pressure rises beyond the capac- ity of the right ventricle to compensate, patients with emphysema may develop cor pulmonale or chronic right heart failure. Patients with cor pulmonale develop severe swelling, or edema, of the legs and an accumu- lation of fluid in the abdominal space, known as ascites. The pathophysiology of this syndrome is com-
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Pulmonary Emphysema - David G Morris and Dean Sheppard...

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