4. Respiratory Pathologies Flashcards
Rhinitis
Rhinitis is inflammation of the nasal mucosa. • The inflammation leads to mucosal swelling and an increase in the volume and viscosity of nasal secretions (mucous).
Rhinitis: Causes
CAUSES: • Immune compromise (leading to viral, bacterial or fungal infections). I.e. related to emotional stress, medications, diet etc. • ‘Allergic rhinitis’ (e.g. due to pollen, spores, mites) –IgEstimulates mast cells to release histamine. • ‘Non-allergic rhinitis’ (associated with environmental & lifestyle changes e.g. pollution, diet, drugs such as NSAIDs, stress etc).
Rhinits: Signs and Symptoms
• Itchy runny nose, sneezing, stuffy nose, ↓ smell.
Rhinitis: Complications
Nasal polyps, ear infections, loss of smell
Rhinitis: Treatment
TREATMENT: •Allopathic: Anti-histamines, decongestants, steroid nasal sprays.
Common Cold
Infection of the upper respiratory tract. • Those with lower immunity become infected with virus. SIGNS & SYMPTOMS: gradual onset, lasting 2-7 days: • ‘Rhinorrhoea’ (runny nose), sneezing, sore throat & mild fever. ALLOPATHIC DRUG TREATMENT: • Symptomatic: Painkillers, decongestants.
Influenza
Influenza is an acute respiratory disease, associated with various strains of the flu virus. • Incubation period: 1-4 days(time between microbial exposure and first symptoms). • Symptomstend to besystemic, more severe andlast longer. • Flu vaccinations often don’t provide effective immunity as the virus mutates (the vaccine also produces significant side effects).
Influenza: Signs and Symptoms
• Sudden onset: Fever and shivering, malaise, muscle & joint pain, rhinitis, sore throat.
Influenza: Treatment
ALLOPATHIC TREATMENT: • Antiviral drugs –reduces viral shedding. Has to be taken within 48 hrs, but very poor effectiveness & side effects! • Antibioticsto prevent secondary bacterial infection. (side effects: lowered immunity, diarrhoea, poor digestion & thrush). • Flu vaccinein vulnerable populations:
Influenza: Complications
• Secondary infections while the immune system is depleted due to primary flu infection. • Post viral syndrome (chronic fatigue syndrome) following compromised immune system. • Morbidity / mortality - influenza pandemics such as the pandemic of 1918 which wiped out a third of the European population & killed more than twice that in the war (consider that this pandemic followed WWI after huge loss and distress!). • Pigs are known as “mixing reservoirs” as they can host both human and non-human viruses, potentially allowing the mixing of viral genes creating a new virus.
Cold vs Flu
Sinusitis
- Inflammation of membranous lining of one or more of the sinuses (‘rhinosinusitis’).
- Sinusitis can be acute or chronic (>3 months).
- Often associated with immunocompromise. Frequently follows a respiratory infection. An infected tooth can sometimes cause the sinuses to become infected too.
Sinusitis: Signs and Symptoms
- Pain over affected sinus & congestion.
- ‘Sinus’ headaches.
- Fever, nasal drip, change in tone of voice, reduced sense of smell.
Sinusitis: Treatment
• Painkillers, decongestants.
Nasal Polyps
Nasal polyps are soft, non-cancerous (‘benign’) masses of oedematous nasal mucosa.
CAUSES/RISKS:
• The end product of chronic inflammation,due to:
• Viral, bacterial or fungus.
• Allergies: chronic rhinitis.
PATHOPHYSIOLOGY:
• Chronic inflammation causes the blood vessels in the lining of the nose and sinuses to become more permeable, allowing water to accumulate in the cells.
• Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.
Nasal Polyps: Signs and Symptoms
• Difficulty breathing, runny nose, persistent
stuffiness.
• Chronic sinus infections, reduced sense of smell.
• Dull headaches, snoring, mouth breathing.
• Can cause sleep apnoea.
Nasal Polyps: Treatment
- Intranasal steroids (side effects!).
- Anti-histamines, anti-fungal, surgery.
Tonsilitis
- Tonsillitis describes inflammation of the tonsils.
- Common type of infection in children 5-10 years & 15-25 years.
- Viral (common cold or flu virus) or bacterial (streptococci).
- Short incubation period.
Tonsilitis: Signs and Symptoms
- Sore throat that becomes worse when swallowing.
- Fever over 38oC.
- Coughing, headache & red/inflamed tonsils
Tonsilitis: Complications and Treatment
• Middle ear infection, Quinsy (abscess).
ALLOPATHIC TREATMENT:
• Painkillers, antibiotics ( side effects: lowered immunity, disturbed gut function (diarrhoea, bloody stools, poor digestion & absorption, candida).
• Surgery (tonsillectomy) – loss of immune tissue!
Quinsy
- An abscess that has formed around the tonsils, occurring as a result of tonsillitis.
- Mostly affecting adolescents & young adults.
Quinsy - Signs and Symptoms
Severe unilateral throat pain, dysphagia, unilateral earache, trismus (limited mouth opening), fever, swollen lymph nodes.
Quinsy: Treatment
• Allopathic: Antibiotics, pus drainage, surgery.
Pharyangitis
- An acute inflammation of the mucous membrane of the pharynx.
- Usually accompanies colds and tonsillitis and is often accompanied by swollen lymph nodes
ALLOPATHIC TREATMENT:
• Painkillers for virus (side effects!)
• Antibiotics -side effects!
Laryngitis
• Laryngitis describes inflammation of the larynx.
• Can be acute or chronic:
• Acute:viral, bacterial.
• Chronic:overuse -repeated strain, irritants (smoke, fumes), acid reflux.
SIGNS & SYMPTOMS:
• Hoarseness, weak voice or voice loss.
• Sore / dry / tickly throat.
• Dry cough.
• Difficulty breathing (in children).
ALLOPATHIC TREATMENT:
• Antibiotics (consider side effects).
• Avoid smoking and smoke, maintain oral hygiene.
Asthma
- Asthma is a chronic airway disease with reversible narrowing of the bronchi & bronchioles.
- Aninflammatory condition combined with bronchial hyper-responsiveness with varying degrees of immune cell infiltration.
- Airflow obstruction due to oedema, mucous build-up & smooth muscle proliferation (= problems exhaling).
- Asthma can develop at any age, but most commonly affects children under 10 years of age, with another peak in the elderly.
- ‘Leukotrienes’ are key chemical inflammatory mediators in asthma. They are bronchoconstrictors
Increased prevalence of Asthma
- Earlier weaning.
- Inadequate exposure to pathogens in childhood.
- Inherited dysbiosis (imbalance of gut flora) and antibiotic use in children.
- Food additives.
- Leaky gut syndrome.
- Nutritional deficiencies i.e. C, D, E, magnesium.
Extrinic Asthma
- Extrinsic (or ‘atopic’) asthma:
- Affecting children typically, immunologically mediatedwith an increase in IgEantibodies. Brought on by exposure to allergens e.g. pollen, dust, animal dander
Intrinsic Asthma
- A bronchial reaction that is not due to antigen-antibody stimulation. Adult onset typically.
- Common triggers include anxiety, chemicals, exercise, cold air, drugs (NSAIDs, beta blockers), stress, dustetc.
Asthma: Signs and Symptoms
- Recurrent episodes of breathlessness & chest tightness.
- Wheezing when exhaling.
- Nocturnal coughing, occasionally with thick clear or yellow sputum.
- Accessory muscles of ventilation are overused and can cause aching in the neck and upper back.
Asthma: Diagnosis
- Based on signs/symptoms and history.
- Spirometry.
Asthma: Treatment
- Bronchodilators (blue inhaler)
- Corticosteroids(brown inhaler) –many side effects.
Asthma Attack
- An asthma attack can be life-threatening.
- Do not hesitate to call for help! It is severe if the patient can not speak in sentences and has more than 25 breaths per minute (tachypnoea).
- Encourage the patient to sit down (do not lie down) and take slow, steady breaths. Try to keep the patient calm.
- Use Inhaler (usually blue bronchodilator) every 30-60 seconds, up to a maximum of 10 puffs.
- CALL AN AMBULANCE IF YOU CAN NOT GET THE PATIENTS SYMPTOMS UNDER CONTROL.
Bronchitis
- Bronchitis describes inflammation of the bronchial tubes. Inflammation can be acute or chronic.
- Viral or bacterial infections can result from compromised immunity (considered a lower respiratory tract infection). Can be associated with environmental irritants.
- When an irritant enters the airways, goblet cells secrete mucous to flush it out. If mucous is overproduced, the respiratory system attempts but struggles to clear it.
- This can increase airway resistance and hence breathing difficulties.
Bronchitis: Signs and Symptoms
- Hacking unproductive cough, becoming productive within days (thick yellowy mucous).
- Fever, sore throat, shortness of breath headache, runny or blocked nose, muscle pain.
- Signs: Crackles on auscultation, tachypnoea, tachycardia, cyanosis.
Bronchitis: Treatment
• Allopathic: Antibiotics (side effects).
Chronic Obstructive Pulmonary Disease (COPD)
• COPD causes airflow limitation that is not fully reversible and is progressive.The airflow limitation is due to airway and functional lung tissue damage.
• Associated with a chronic inflammatory response of the lungs (usually, to inhaled toxins).
• COPD refers to a combination of two main pathologies (of varying proportions):
Emphysema -> walls of the alveoli damaged & destroyed, leading to reduced gas exchange.
Chronic bronchitisthe bronchial lining is constantly irritated & inflamed -> thick mucous.
COPD: Signs and Symptoms
- Chronic cough with sputum, dyspnoea.
- Prolonged expiration & wheeze.
- Frequent infections.
- Signs: Tachypnoea, breathlessness on exertion, pursed lips breathing, patients may lean forward and rest arms on the table, flapping tremor, cyanosis, hyperinflation of chest (“barrel chest”), clubbed nails.
COPD: Complications
- Chronic hypoxaemia pulmonary hypertension.
- Recurrent respiratory infections.
- Respiratory failure.
COPD: Treatment
- Smoking cessation.
- Bronchodilators, corticosteroids, oxygen therapy.
Chronic Bronchitis
Pathology:
•Inflammation & thickening of bronchial lining withmucous hyper-secretion.
Key symptoms:
•Cough & wheezing
Appearance:
•Blue bloater.
Emphysema
Pathology:
•Dilation of alveolar sacs by destruction of alveolar wall, leading to collapse of alveoli during expiration
Key symptoms:
•Breathlessness
Appearance:
•Pink puffer
Pneumonia
- Pneumonia is an infection of the alveoli and terminal bronchioles, mostly bacterial.
- Associated with an infiltration of neutrophils with inflammation and oedema.
- Most common in infants, children and the elderly. Higher risk if the patient is immune suppressed.
Pneumonia: Signs and Symptoms
- Cough andpurulent sputum which may be blood-stained.
- Breathlessness, fever, malaise.
- Signs:tachypnoea, crepitations on auscultation (crackling. rattling)
Pulmonary Fibrosis
• Gradual replacement of the one layer thick epithelial cell lining in alveoli with fibrotic tissue.
• Fibrotic (scar) tissues are less able to exchange oxygen and CO2.
CAUSES:
• Idiopathic: Unknown, may be genetic, presents around 70 years.
• Smoking, asbestos, some drugs, radiation therapy, accompanies some diseases (autoimmune e.g. RA).
SIGNS & SYMPTOMS:
• Progressive dyspnoea, chronic cough, fatigue, discomfort in the chest, loss of appetite, weight loss
TREATMENT:
Currently no allopathic treatment
Obstructive Sleep Apnoea
- Intermittent and repeated upper airway collapse during sleep leading to interrupted breathing.
- Causes / risks include: Obesity, male gender, middle aged, smokers, alcohol, sedatives, nasal obstruction (rhinitis, polyps).
- Treatment with Nasal Continuous Positive Airway Pressure (CPAP), lifestyle modification. It is essential to treat the cause.
Obstructive Sleep Apnoea: Signs and Symptoms
• Loud snoring, daytime sleepiness, morning headache, morning drowsiness, nocturnal choking, reduced libido.
Diagnosis by polysomnography.
Pneumothorax
- A pneumothorax describes air accumulation within the pleural cavity, causing part or all of a lung to collapse.
- Air enters via defect in visceral or parietal pleura(e.g. rib fracture).
- Can be “simple”(i.e. heart remains central) or “tension”(unstable -progressive build up of air shifting the heart away).
Pneumothorax: Causes
- Spontaneous-rupture of cyst/pocket of air, tuberculosis, cystic fibrosis, emphysema.
- Traumatic(damage to pleura) -fracture, surgical complication.
Pneumothorax: Signs and Symptoms
- Dyspnoea and pleuritic (sharp) chest pain.
- Cyanosis.
- Loss of consciousness, coma.
- Signs: Reduced breath sounds, decreased cardiac output.
Pneumothorax: Treatment
• A pneumothorax is a medical emergency and typically requires a chest drain (via the lateral ribcage) where accumulated air can be expelled. The patient is often given oxygen and the pleura will require repair.
Pleurisy
- Pleurisy describes pleural inflammation.
- The pleural surfaces become coated with inflammatory materials and are hence roughened, (producing the friction rub on auscultation).
- Causes include a tumour or infection (e.g. pneumonia).
Pleurisy: Signs and Symptoms
- Dyspnoea.
- Sharp chest pain –aggravated by inspiration & coughing.
- Dry cough, shallow breathing.
- Dullness with percussion, friction rub on auscultation.
Pulmonary Embolism
- A pulmonary embolism results from obstruction within the pulmonary arterial tree.
- The embolus (mobile clot) often occurs as a result of a thrombosis, travelling up from one of the deep veins in the legs (i.e. a DVT).
- Fat embolisms can occur following bone fractures.
Pulmonary Embolism: Signs and Symptoms
- Symptoms: Dyspnoea, pleuritic chest pain, cough, coughing blood, calf pain (if following a DVT).
- Signs: Tachypnoea, tachycardia, crackles on chest auscultation.
Pulmonary Embolism: Treatment
• A medical emergency –poor prognosis if untreated. Potentially life threateningas it can lead to cardiac arrest & heart failure.
TREATMENT:
• Emergency: anti-coagulation therapy and oxygen.
• Prevention: regular exercise, hydration & an anti-inflammatory diet.
Cystic Fibrosis
- A multi-organ genetic disease of exocrine glands.
- Recessive disease of chromosome 7 that affects chloride channels. This alters the amount of Cl-and Na+secreted.
- Excessive Cl-, Na+and water are absorbed from the airways (& pancreas, gallbladder).
- Mucous or secretions arethick and clog up the lungs and some digestive organs.
- Causes chronic respiratory infections & pancreatic enzyme insufficiency.
- Lung disease is the principal cause of death
Cystic Fibrosis: Signs and Symptoms
- Respiratory symptoms: Persistent cough, sputum production, recurring lung infections, wheezing, chest pain.
- GIT symptoms: Bloating, obstruction, bleeding, dyspepsia, malnutrition.
Cystic Fibrosis: Treatment
Antibiotics, physiotherapy, bronchodilators, mucolytics.
