Need help with a Chest Wall/Compliance graph question

anybody familiar with this stuff?

I don't think you'll find help in so specific a field on d2jsp
What's your problem though, I rock at pubmed lol

You are working with a patient with interstitial pulmonary fibrosis who also has considerable
subcutaneous fat on his chest. The average additional pressure on his chest is 15 cm H2O

1) The curves above show data for the lung and chest wall compliance of a healthy individual. Use them to
determine the FRC for the normal individual and also the patient. Please draw your answer on the graph
provided and explain your answer briefly in the space below. PLEASE LABEL YOUR DIAGRAM

5)) If airway diameter changes in the same direction as lung volume, describe a possible effect of
obesity?

6)) The patient has no sign of obstruction on a pulmonary function test but you notice that he has a wheeze
especially while he is walking. What might be the cause of this wheeze?


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fg for anyone that can help!!

This post was edited by Acceptance on Jan 22 2018 05:43pm

5)

In normal breathing, the diaphragm contracts, pushing the abdominal content downward and forward, and at the same time, contraction of the external intercostal muscles tractions the ribs upwards and forward.(17) In obese individuals, this mechanism is hindered, since the excess adiposity that covers the thorax and the abdomen encumbers the breathing muscles. Such a mechanism also explains the findings by Steele et al.(14) that demonstrate a stronger relation of the FVC and FEV1 alterations in men when compared to women. This is because the male gender has a greater frequency of android fat deposit pattern, while gynoid fat is more common in the female gender.(22) In other words, a greater deposit of fat in the abdominal region generates a greater resistance to diaphragmatic contraction, hindering ventilatory mechanics.

There isn't an ongoing consensus on the physiological mechanism in the way that fat induces lung performance deterioration. I would say, for 5, that mechanical obstruction induced by the adipose in the thoracic region shortens your airway diameter and with it, lung capacity, therefore not making use of the capacity of the lungs, though early on it should still be present. Wolff's law will induce degenerate changes, I suppose. Perfusion will also drop which may have its effect on the heart, and so on.

Melo, L. C., da Silva, M. A. M., & Calles, A. C. do N. (2014). Obesity and lung function: a systematic review. Einstein, 12(1), 120–125. http://doi.org/10.1590/S1679-45082014RW2691

1)
For 1, you're graphic capacity against compliance. I'm not a 100% on this but I feel like that's just a summation of the two compliances to get the total compliance, which in turn should be your FRC.
Add in the X-direction, by the way.

6)
Sounds like exercise-induced airway pathology like an improper bronchoconstriction. This wouldn't show on tests taken at rest because it's the reactiveness of the respiratory system that causes the problem, there is no general obstruction or mechanic change. This need not be related to obesity, but it is possible. After all, obesity changes a whole lot of mechanics which in turn may influence the physiological response to exercise.


/e Just for your reference, I am a graduated (but with near zero experience) physiotherapist studying a second bachelor, being in my first semester of medicine. That means I have no full comprehension on these subjects but I can fully well interpret the things I find on pubmed and stuff. This took me about an hour but I'm glad, I learned a little bit too.

This post was edited by Forg0tten on Jan 25 2018 04:56am

That's also why I am not very big on statins.. They work wonders for what they are meant for, but with the induced changes in perfusion you're basically killing anybody's chance to move without pain, which in turn leads to seditary lifestyles.