Baker/Parks: Smoking and Pleura Flashcards
Congenital anomaly
Caused by anything that impedes normal lung expansion in utero
Agenesis or hypoplasia of the lungs - one lung or single lobes
Congenital anomaly
Abnormal detachment of primitive foregut
Foregut cyst
Congenital anomaly
Lung tissue without connection to the airway system
Can be internal to lung or external to lung
Pulmonary sequestration
Collapse of the lung
Loss of lunge volume caused by inadequate expansion of air spaces
Results in shunting of inadequately oxygenated blood from pulmonary arteries into veins
atelectasis
**three forms: resorption, compression, contraction
This form of atelectasis occurs when an obstruction prevents air from reaching the distal airways. The air already present becomes absorbed and alveolar collapse follows.
resorption atelactasis
What is the most common cause of resorption collapse of the lung?
obstruction of a bronchus by mucous or mucopurulent plug
**frequently occurs post operatively
Pleural effusion can cause this type of atelectasis - build up of fluid, blood or air in the pleural cavity mechanically collapses the adjacent lung
Compression atelactasis
Airless pulmonary parencyma
Can occur at birth, from incomplete expansion
Can be acquired
Atelectasis “collapsed lung”
3 ways in which you can get “acquired” atelectasis?
- resorption: airway obstruction leads to resorption of O2 within the alveoli (obstruction can be a mucous plug, a foreign body, or a neoplasm)
- compression of pleural cavity with fluid, blood, or air
- contraction from pulmonary fibrosis
5 “W’s” that cause post-op fever
wind (pneumonia) water (UTI) wound (surgical site infection) walking (DVT/PE) wonder drugs (drug or other iatrogenic cause)
Pleural space is a potential space with approximately (blank)mL of lubricating serous fluid
15
Most pleural disease is secondary to some other condition
Biggest exception to this is (blank)
mesothelioma
Any excess accumulation of pleural fluid Can be symptomatic or asymptomatic Variety of causes Transudative vs. Exudative Non-inflammatory vs. Inflammatory
pleural effusions
What usually causes the transudative, non-inflammatory pleural effusions?
What usually causes the exudative, inflammatory pleural effusions?
hydrostatic mechanism: heart failure, renal failure, liver failure
infections, malignancies, immune responses, trauma
What are these values/ratios, and what do they tell you about a patient’s pleural effusion?
ProteinF/ProteinS > 0.5
LDHF/LDHS > 0.6
Serum LDH > 2/3 of the upper limit of normal for serum
These values are called Light’s criteria. If you have any of these three criteria, you have an exudative effusion
Protein F = fluid protein
Protein S = serum protein
LDHF = pleural fluid LDH
LDHS = serum LDH
Two types of inflammatory effusions
pleuritis: inflammation of the pleura
empyema
Purulent pleural exudate
Typically loculated
Etiology
Usually contiguous spread (pneumonia), but can come from a distant source
Purulence can resolve completely, but also can organize and cause permanent respiratory restriction.
empyema
If there is a clear/straw-colored effusion, often from cardiac failure or pulmonary edema, we call it a (blank).
If there is frank blood in the pleural space, typically from trauma or vascular rupture, we call it a (blank).
If there is a milky, lymphatic fluid in the pleural space, often from thoracic duct trauma or obstruction, we call it a (blank).
hydrothorax
hemothorax
chylothorax
What things and disease processes can cause a pneumothorax?
most commonly - emphysema, asthma, TB
truama - perforating injury to the chest wall
spontaneous idiopathic pneumothorax in young people due to rupture of small peripheral blebs
Progressive worsening of the pneumothorax
Often associated with mechanical ventilation - positive pressure
Tension pneumothorax
How do you diagnose a tension pneumothorax?
clinically, NOT via radiograph
look for absence of breath sounds, hyper-resonance to percussion, contralateral deviation of the trachea/mediastinum
**if reduced cardiac output –> medical emergency
This is used to decompress the chest when a patient is deteriorating because of a tension pneumothorax. Place in the 2nd intercostal space at the mid clavicular line.
needle thoracostomy
Which type of pleural tumors are the most common?
mets!
usu from the lung and breast
**pleural effusion with positive cytology
Uncommon
Asbestos-related in 90% of cases
7-10% lifetime risk in heavily exposed people
Risk is not worsened by smoking
Long (25-45 yrs) latent period
Metastatic spread to liver and other distant organs
50% death rate in 12 months, rare survival after 2 years
Not exclusive to pulmonary pleura
Peritoneum, pericardium
Peritoneal mesothelioma is particularly related to heavy exposure
50% have asbestosis coexisting asbestosis
Malignant mesothelioma
How will malignant mesothelioma present?
chest pain
dyspnea
recurrent pleural effusions
20% have asbestosis
Is the risk of malignant mesothelioma increased by smoking?
no!
Disorder of ion transport in epithelial cells that affects fluid secretion in exocrine glands and the epithelial lining of the respiratory, GI and reproductive tracts.
Mutation in the CFTR gene
1 in 2500 live births
cystic fibrosis
This is used to test for cystic fibrosis
chloride sweat test
**elevated sweat chloride in CF
What are the most serious complications of cystic fibrosis?
viscous mucous leads to chronic infections and bronchiectasis
patients are often colonized by resistant organisms
What organisms most commonly cause infection in CF patients?
Pseudomonas
Staph aureus
Describe the trends in smoking over time
smoking gradually increased until like the 1970’s and then began to decline
What was happening to rates of lung and bronchus cancer from 1930 - 2009?
steadily increasing!
T/F: 90% of lung cancer in men is caused by smoking
78% of lung cancer in females is caused by smoking
True
What happens over time after the cessation of smoking?
after 2-3 yrs, your risk for cardiac events approaches that of never-smokers
after 5 yrs, your risk for bladder, cervical, oral, and esophageal cancer decreases towards that of never-smokers
after 10 yrs, pancreatic cancer risk drops
after 15 yrs, risk of stroke drops
What happens to your chronic cough when you quit smoking?
What happens to your SOB?
cough resolves or markedly improves in 94-100% of patients
SOB improves w/i 1-9 months
T/F: Should begin before the doctor even enters the room
When office staff asks about and documents smoking status…
3x more likely that a physician will intervene.
2x more likely that the patient will quit.
True
What are the five A’s for encouraging patients to quit smoking?
Ask about tobacco use Advise to quit Assess willingness to quit Assist in quit attempt Arrange a follow up
What are the five R’s when encouraging a patient to quit smoking?
relevance of quitting risks of smoking rewards of quitting roadblocks repeat at every visit
Physicians advice alone increases rates of smoking cessation by (blank)%
30
