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Pathology Applied To Nursing > 10 Respiratory pathology Non-neoplastic > Flashcards

10 Respiratory pathology Non-neoplastic Flashcards

1
Q

Respiratory pathology Non-neoplastic”

Overview

A 
Anatomy and physiology
Infection
Obstructive/restrictive disorders
Vascular
Expansion
Respiratory failure
Summary
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2
Q

The respiratory system

A

Upper airways: nose, accessory air sinuses, nasopharynx, larynx
Lower airways: trachea, bronchi, bronchioles, terminal bronchioles, alveoli
Pleura

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3
Q

General overview

A

Infections:
Uri/sinusitis
Flu
Pneumonia

Obstructive disorders:
COPD – bronchitis/emphysema
Asthma
Bronchiectasis

Miscellaneous:
Respiratory failure

Restrictive:
Chest wall abnormalities
Connective tissue disorders
pneumoconioses

Vascular disorders:
Pulmonary oedema
Pulmonary embolism

Expansion disorders:
Atelectasis
pneumothorax

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4
Q

Infection upper airways

A

Definition: acute inflammatory process that affects mucous membranes of the respiratory tract
Includes: rhinitis, laryngitis, tonsilitis sinusitis

Symptoms: malaise, headache, sore throat, discharge
Aetiology
Commonly viral
Can get secondary bacterial infection

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5
Q

Lower airways: infectionPNEUMONIA

A

Definition: Inflammation of the lung parenchyma

  • Consolidation of the affected part
  • Exudate with inflammatory cells and fibrin in the alveolar air spaces
Causes:  infectious agents
	 inhalation of chemicals
	 chest wall trauma
Categories 
 Setting:  
 Community acquired
Hospital acquired
Aspiration pneumonia
 Chronic pneumonia
 Necrotizing pneumonia and lung abscesses
Pneumonia in the immunocompromised host
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6
Q

Pneumonia

A

Clinical features/course
Fever, rigours, SOB, pleuritic chest pain, purulent sputum, cough

Morphology:
Lobar
Multifocal/lobular (bronchopneumonia)
Interstitial (focal diffuse)

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7
Q

Community acquired pneumonia

A

Relatively common, especially in elderly population

Strep. pnuemoniae most common organism
Haemophilus influenzae
Staph aureus- complicates viral infection and in IVDU
Lobar or bronchopneumonia

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8
Q

Hospital acquired pneumonia

A

Aka nosocomial pneumonia
Any pneumonia contracted by patient at least 48-72hrs after admission
Usually bacterial- gram negative bacilli and Staph aureus
Severe and can be fatal- most common cause of death in ITU
Fever
Increased white cell count
Cough with purulent sputum
Chest X-ray changes

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9
Q

Aspiration pneumonia

A

Develops after inhalation of foreign material.
Elderly, Strokes, Dementia, Anaesthetic
Usually right middle and right lower lobe
Oral flora +/- other bacteria

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10
Q

Obstructive vs restrictive

A

Diffuse pulmonary disease divided into:

Obstructive disease
Characterised by partial or complete obstruction at any level from the trachea to respiratory bronchioles
PFT: limitation of maximal airflow rate during forced expiration FEV1

Restrictive disease
Characterised by reduced expansion with decreased total lung capacity,
FVC is reduced: amount of air that can be blown out after maximal inspiration

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11
Q

Obstructive

A 
Asthma
	Reversible airways obstruction
	common
COPD
	Emphysema
	Chronic bronchitis
Bronchiectasis
	 chronic infection leading to destruction and dilatation of the airways
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12
Q

COPD - Emphysema

A

Irreversible enlargement of the airspaces distal to the terminal bronchiole - destruction of their walls without obvious fibrosis
Types: centriacinar / panacinar / paraseptal / irregular
Pathogenesis:
mild chronic inflammation throughout the airways
protease – antiprotease imbalance hypothesis
+ imbalance of oxidants and antioxidants
role of smoking and genetics

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13
Q

Emphysema

A

Morphology: voluminous lungs
large alveoli, large apical bullae or blebs

Clinical course - symptoms:
dyspnoea, cough, wheezing, weight loss
expiratory airflow limitation – “pink pufferrs”
death due to cor pulmonale,
congestive heart failure, pneumothorax

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14
Q

COPD – chronic bronchitis

A

persistent cough with sputum production
for at least 3 months in at least 2 consecutive years
without any other identifiable cause

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15
Q

Chronic bronchitis cont..

A

long-standing irritation by inhaled substances (e.g tobacco smoke, dust from grain, cotton, silica)

hypertrophy of submucosal glands in trachea and bronchi, increase in goblet cells

mucus hypersecretion + alterations in the small airways  chronic airway obstruction

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16
Q

Chronic bronchitis cont…

A

Morphology
mucous membrane hyperaemia, swelling, oedema
excessive mucous/mucopurulent excretions,
narrowing of the bronchioles caused by mucus plugging, inflammation and fibrosis,
may cause obliteration in severe cases

Clinical course
persistent cough productive of sputum
dyspnea on exertion
hypercapnia, hypoxemia, mild cyanosis (“blue bloaters”)
Leads to cor pulmonale, cardiac failure, may cause atypical metaplasia/dysplasia

17
Q

Asthma

A

Chronic inflammatory disorder of the airways
recurrent episodes of wheezing, breathlessness, chest tightness and cough, particularly at night and/or in the early morning.
widespread but variable bronchoconstriction and airflow limitation
At least partly reversible (spontaneously/with treatment).

Hallmarks: increased airway responsiveness  episodic bronchoconstriction, inflammation of bronchial walls, increased mucus secretion

Types: extrinsic (response to inhaled antigen – atopic, occupational) intrinsic (non-immune mechanisms – cold, exercise,aspirin). Atopic best understood – IgE mediated hypersensitivity……

18
Q

Asthma

A

genetic predisposition + exposure to environmental triggers

early phase reaction: bronchoconstriction, increased mucus production, vasodilation + increased vascular permeability

late phase reaction: inflammation, epithelial damage, more bronchoconstriction

19
Q

Asthma

A

Morphology
lung overinflation + small areas of atelectasis,
thick mucus plugs in bronchi and bronchioles,
airway remodelling

Clinical course
chest tightness, wheezing, dyspnea, cough +/- sputum
status asthmaticus
increase in airflow obstruction, difficulty with exhalation

20
Q

Bronchiectasis

A

Permanent destruction and dilatation of the airways associated with severe infections or obstructions:
Aetiology: CF, kartageners, post infectious: TB, measles, bronchial obstruction eg TB/FB
Morphology: dilated, inflamed airways.
Clinical course: persistent cough, purulent sputum +++, haemoptysis,

21
Q

Restrictive:

A

Heterogenous group of diseases

Characterised by inflammation and fibrosis of the pulmonary connective tissue (eg interstitium of the alveolar walls)

22
Q

Restrictive lung disease

A

Morphology
Xray: bilateral infiltrative lesions - small nodules, irregular lines, ground-glass shadows

Scarring and gross destruction of the lung - end-stage/honeycomb lung

Clinical features
dyspnea, tachypnea, end-inspiratory crackles,
eventual cyanosis, without wheezing
reductions in gas diffusing capacity, lung volume, and compliance
May lead to secondary pulmonary hypertension and right-sided heart failure with cor pulmonale

23
Q

Pulmonary Embolism

A

Blockage of a main or branch pulmonary artery by an embolus –

Usual source of emboli are deep venous thrombi of the leg (95% of cases)

Pathophysiology: respiratory compromise and haemodynamic compromise

24
Q

Pulmonary embolism

A

Morphology
central/peripheral emboli
pulmonary haemorrhage
pulmonary infarction

Clinical course
abrupt onset pleuritic chest pain, 
shortness of breath
hypoxia
increased pulmonary vascular resistance – 
 right ventricular failure
25
Q

Pulmonary oedema

A

Accumulation of fluid in the air spaces and parenchyma of the lungs

Haemodynamic oedema
Increased venous pressure
Eg left ventricular failure
Decreased oncotic pressure
Eg nephrotic syndrome
Liver failure

Oedema due to alveolar injury
infections
Shock/trauma

Oedema of undetermined origin
Eg neurogenic/high altitude

26
Q

Pulmonary oedema

A

Morphology
initial fluid accumulation in basal regions – dependent oedema
engorged alveolar capillaries, intra-alveolar granular pink precipitate
alveolar microhaemorrhages, hemosiderin-laden macrophages
heavy, wet lungs

Clinical features
SOB, pink frothy sputum, characteristic CXR findings

27
Q

Expansion

A

Pneumothorax
Air in the pleural cavity
Assd with ephysema, asthma, TB, trauma, idiopathic
Atelectasis
Incomplete expansion of lungs
Reduces oxygenation and predisposes to infection
reversible

28
Q

Respiratory failure

A 
Type I -Hypoxia with a normal or low PCO2
Pneumonia
Pulmonary oedema
Asthma
PE
Pulmonary fibrosis
ARDS			
Type II -Hypoxia with high PCO2
Asthma, COPD, OSA
Reduced respiratory drive
Neuromuscular disease
Thoracic wall disease eg kyphoscoliosis
29
Q

Summary

A 
Infections
	URTI
	Pneumonia	
	Infection and inflammation
	Viral, bacterial
	Fungal

Obstructive
COPD
Asthma
Bronchiectasis

Airway obstruction +/- destruction

Restrictive
Heterogenous
Inflammation and fibrosis of connective tissue of lung

Vascular
PE – VQ mismatch
Pulmonary oedema – different mechanisms

Expansion
Pneumothorax air in the pleural cavity
atelectasis

Respiratory failure
Type I vs II
Caution with oxygen in II

Pathology Applied To Nursing (23 decks)

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