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Pathology SEM 2 > CardioResp Pathologies > Flashcards

CardioResp Pathologies Flashcards

1
Q

What is Cystic Fibrosis?

A
  • Inherited autosomal recessive disease -defect on chromosome 7.
  • Impacting protein CFTR responsible for Ion Transport
  • Affecting several organs
  • duct obstruction with mucus – impairment in the transport of chloride ions + levels of sodium and water in the cell - leading to inflammation and tissue scaring.
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2
Q

What does CFTP Stand for?

A

Cystic Fibrosis Transmembrane Regulating Protein

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3
Q

What happens in CFTR defect related respiratory disease?

A
  • Concentrated fluid in the lungs
  • Viscous secretions in airways
  • Mucus not cleared - predisposes patient to disease and infection
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4
Q

What happens in CFTR defect related Pancreatic insufficiency?

A
  • Abnormal ion transport leads to dehydration of pancreatic secretions
  • Stagnation in pancreatic duct
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5
Q

What are some complications of CFTR Defect?

A
  • High sodium sweat- Prevention of sodium absorption
  • Biliary disease
    reduction in water movement results in concentrated bile which can damage walls of lumen
    -Infertility
    Absence of Vas Deferens
    -Cirrhosis of the Liver
    Abnormality in ion transport
  • Gastrointestinal Disease
    Intraluminal water deficiency
  • all of which related to a lack of Na +, Cl- or water diffusion problem
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6
Q

Give a Brief overview on the Prevalence of CF-

A
  • 1 in 15 Caucasians carries the gene
  • 2 carriers = 1 in 4 of affected baby and 1 in 2 of a carrier
  • Affecting more than 10,400 people
  • 1 in 2,500 babies born with CF
  • Claiming 2 lives a week
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7
Q

Name the 3 ways in which CF is diagnosed

A
  • Genetic testing
  • Heal Prick Test - Babies leading to early diagnosis
  • Sweat test - higher concentrations of chloride in sweat
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8
Q

Give the Symptoms of CF at birth-

A
  • 10% babies = bowel obstruction - Meconium lleus
  • Meconium - thick black substance
  • Surgery often needed to remove this
  • Jaundice
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9
Q

Give the Symptoms of the lungs in CF

A
  • Persistent Cough
  • Coughing fits
  • Inflammation
  • SOB
  • SOB after exercise
  • Chest and Lung infections
  • Cross Infection
  • Impaired diaphragm due to enlarged liver
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10
Q

Give the Symptoms of Digestive System in CF

A
  • Large smelly stools

- Malnutrition/ poor weight/stunted growth

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11
Q

Give the general symptoms of CF

A
  • Diabetes
  • Sinusitis
  • Arthritis
  • Infertility
  • Liver failure
  • Urinary Incontinence
  • Muscle weakness
  • Kyphosis of the Spine
  • Delayed Puberty
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12
Q

State the Medication used in CF treatment

A
  • Bronchodilators
  • Hypertonic saline nebs
  • Antibiotics
  • Steroids
  • Vaccinations
  • Creon
  • DNAse
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13
Q

State the management strategies for CF

A
  • Dietary advice
  • Education
  • Exercise
  • Lung Transplant
  • Psychological support
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14
Q

Give the ways in which Physio is used in the treatment of Cf

A
  • PD- Postural Drainage
  • Percussion,vibs/shakes
  • ACBT-Active cycle of breathing techniques
  • AD- Assisted Drainage
  • Adjuncts
  • Mobilisation /Exercise
  • Suction - ITU
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15
Q

Outline the Prognosis for CF

A
  • No cure or Prevention
  • 1/2 will live past 40 - some to 47
  • Lung complications are normally the cause of death
  • Quality of life depends on specific protein mutation.
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16
Q

What is Bronchiectasis?

A
  • Permanent abnormal dilation in one or more of the lungs Bronchi
  • Extra mucus in airways
  • Prone to infection
  • Similar symptoms to COPD but does not always show as airflow obstruction.
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17
Q

Give a brief overview of the Pathogenesis of Bronchiectasis-

A

1 - Impaired mucocilliary clearance = accumulation of secretions
2- leading to infection by bacteria
3-leading to increased mucus production , impaired cilliary performance and inflammatory response
4-= tissue damage
5-leading to dilated Bronchi , loss of ciliated epithelium and impaired mucocilliary clearance

VISCIOUS CYCLE

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18
Q

What causes Bronchiectasis?

A
  • Idiopathic
  • Infection
  • CF
  • Immunodeficiency
  • Cilliary dysfunction
  • Inflammation
  • Aspiration/obstruction
  • ABPA
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19
Q

Give the Clinical features of Bronchiectasis

A
  • Cough
  • Chronic sputum production
  • 75% dysponea and wheeze
  • 50% chest pain
  • 1/3 = chronic sinusitis and nasal polyps
  • recurrent exacerbations are common
  • 50% = haemoptysis
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20
Q

Give the ways in which Bronchiectasis is diagnosed

A
  • chest xray
  • HRCT
  • Blood and Sputum
  • PFTs
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21
Q

State the 3 types of Bronchiectasis

A
  • Saccular - large bronchi = large and balloon-like
  • Cylindrical- medium sized bronchi - symmetrically dilated
  • Varicose - constrictions and dilations deform the bronchi
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22
Q

State the management strategies for Bronchiectasis

A
  • Physio
  • Antibiotics
  • Bronchodilators
  • Steriods
  • Nasal spray
  • Vaccinations
  • Surgery
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23
Q

What is the definition for pneumonia?

A
  • Inflammatory condition of the lung leading to abnormal alveolar filling with consolidation and exudation
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24
Q

Give a brief overview of the pathology behind Pneumonia

A
  • Infection ,chemical or aspiration irritant.
  • Acute inflammation results in the migration of neutrophils out of capillaries and into airspaces
  • these cells phagocytose and release antimicrobial enzymes and inhibitors
  • leading to more inflammation and subsequently more oedema
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25
Q

What is the first stage of pneumonia?

A
  • Congestion
  • First 24 hrs
  • Vascular engorgement
  • Intra-alveolar fluid
  • Numerous bacteria
  • Lung is heavy, boggy and red
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26
Q

What is the second stage of pneumonia?

A

Red Hepatization

  • 2-3 days
  • Exudation
  • red blood cells , leukocytes and fibrin filling the alveolar spaces
  • affected are is red and firm and airless
  • Liver like consistency
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27
Q

What is Third stage of Pneumonia?

A

Grey hepatization

  • 4-6 days
  • Progressive disintegration of red blood cells and the persistence of fibrin exudate
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28
Q

What is the forth stage of Pneumonia ?

A
  • Resolution
  • > 6 days
  • Exudate = progressive digestion
  • resulting in debris that is later reabsorbed , ingested by macrophages or coughed up
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29
Q

Give the causes of Pneumonia

A
  • Bacteria
  • Fungi
  • Varis
  • Paracites
  • Chemical
  • Aspiration
  • Inhalation
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30
Q

What does CAP Pneumonia stand for?

A

Community Acquired Pneumonia

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31
Q

what does HCAP Pneumonia stand for?

A

Health care acquired Pneumonia

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32
Q

What does HAP Pneumonia stand for?

A

Hospital acquired pneumonia

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33
Q

What does VAP Pneumonia stand for?

A

Ventilator acquired pneumonia

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34
Q

Give the common symptoms of pneumonia

A
  • Fever
  • Malaise
  • Muscle ache/fatigue
  • Coughing
  • Tactile fremitus on palpation
  • Dyspnoea
  • Pleuritic or chest pain
  • Loss of appetite
  • Rapid heartbeat
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35
Q

Give the less common symptoms of Pneumonia

A
  • Coughing up blood
  • Fatigue
  • Nausea/vomiting
  • Diarrhoea
  • Wheezing
  • Confusion
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36
Q

What complications can arise from Pneumonia?

A
  • Lung abscess
  • Pleural effusions
  • Empyema - Infection/pus in between the neural cavity
  • Septic shock
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37
Q

Give the main indicators for a medical diagnosis

A
  • temp above 37.8
  • Hr above 100bpm
  • Crackles
  • Decreased breath sounds of bronchial breath sounds
  • Absence of asthma

These clinical features can be used to create a clinical prediction rule where by percentage of probability decreases with each clinical feature not present

38
Q

Give 3 other diagnostic tests used for Pneumonia

A
  • Sputum culture
  • Pleural fluid culture
  • Bronchoscopy
39
Q

How is Pneumonia managed medically ?

A
  • Antibiotics/fungal
  • oxygen
  • IV fluids
  • Analgesics
  • Cough suppressant
  • fever reduction
40
Q

How is physiotherapy used in treatment of Pneumonia?

A
  • increase o2 consumption and demand
  • treat the clinical signs and symptoms
  • non production , positioning V/Q , mobilising, no intervention
  • Productive , sputum clearing techniques including positioning , breathing techniques and adjuncts
41
Q

What is COPD?

A
  • Airflow obstruction
  • Progressive in severity
  • Not fully reversible
  • Does not change markedly over several months
  • Umbrella term - Chronic Bronchitis , Emphysema, Chronic Asthma
42
Q

What is the result of systemic inflammation?

A
  • Weight loss
  • Skeletal muscle dysfunction
  • Cardiovascular disease
  • Osteoporosis
  • Depression and fatigue
  • Cancer
  • Looking at the patient as a whole
43
Q

What is normal airway clearance?

A
  • Cilia - continually beat - moving mucus along until it reaches the throat - swallowed
  • Cells producing mucus - trapping dust particles and bacteria .
44
Q

What goes wrong with airway clearance in COPD?

A
  • Excess mucus
  • Mucus = thicker and stickier
  • cilia unable to beat
  • Smoking - paralyses the cilia
  • Dust /bacteria - trapped
  • Mucus build up
  • Infection can develop.
45
Q

What is Bronchitis?

A
  • Chronic
  • Bronchi become inflamed
  • Increased sputum and overproduction of mucus- airways become hard to clear
  • Airway narrowing
  • Wheezing
  • Chronic cough - tired, fatigue
  • Bronchospasm
  • Reduces the amount of air into the lungs
46
Q

What is Emphysema?

A
  • Alveoli become inflamed
  • Loose elasticity
  • Lose ability to fill and expand
  • Can result in rupture
  • Reduction of surface area
  • Air becomes trapped
  • Breathing becomes very difficult
47
Q

What is Asthma?

A
  • Approx 5 mil people
  • Episodic increase in airway obstruction
  • Various stimuli - Allergies
  • Reversible
  • Inflammation - Bronchoconstriction
  • Breathless , wheeze , tightness
  • Results in sensitive airways , irritated ,m inflamed and narrowed. Reduction in airflow
  • Can become chronic with fixed airways damage - then under COPD umbrella.
48
Q

Causes of COPD?

A
  • Smoking- 90% - 20 pack years or more - Number of packs per days times years smoking
  • Occupational exposure - coal miners
  • Alpha-1 antitrypsin deficiency - Genetic
  • Social deprivation
49
Q

How is COPD diagnosed?

A
  • Detailed MDT history
  • Clinical signs - Cough , breathless , sputum, risk factors , other causes.
  • Spirometry - gold standard - Diagnose , categorise and monitor
  • Chest x ray
50
Q

What is the Early disease classification of COPD?

A
  • few symptoms
  • Morning cough
  • Winter chest infection
  • Breathless on vigorous exercise
  • Reduced Spirometry
51
Q

What is the Moderate disease classification of COPD?

A
  • Range of symptoms , cough , wheeze , breathless with moderate exertion
  • Clinical examination - wheeze , barrel chest, flattened diaphragm on CXR
52
Q

What is the severe disease Classification of COPD?

A
  • Severe symptoms - Cyanosis - blue nose and mouth
  • Weight lose
  • Accessory muscle use
  • peripheral oedema
53
Q

How is Spirometry used in COPD classification?

A
  • FEV1 % - Predicted values

Mild - 80%
Moderate - 50-80%
Severe -30-50%
Very severe - <30%

  • FVC% - Predicted
  • > 50 %
54
Q

What is the Treatment for COPD ?

A
  • Smoking cessation
  • 4 x likely to quit with help , advice and Nicotine replacement.
  • Stop smoking services
  • Physio - refer to smoking cessation
55
Q

What is the medication for COPD?

A
  • Inhalers
  • Steroids and Antibiotics
  • Mucolytics- breakdown sputum
  • Flu and Pneumonia vaccines
56
Q

How is pulmonary rehab used of COPD?

A
  • Exercise
  • education
  • Self management
  • Diet
  • Lifestyle modifications
57
Q

What is Idiopathic Pulmonary Fibrosis?

A
  • Restrictive disease
  • Inflammation and Scarring in the lungs
  • Progressive conditions
  • Progression on scarring is the fibrosis
  • Reduces gas exchange
  • Lung tissue becomes less compliant , lung tissue becomes stiff
58
Q

Causes of Pulmonary Fibrosis?

A
  • Approx 5,00 people diagnosed a year
  • More common in men 6/10
  • Older people
  • Unknown cause - idiopathic
  • Smoking link
  • Occupationally exposure link
  • Infection and Viruses - herpes /hep C
  • GORD - Gastrol-oesophageal reflux
  • Few cases - genetic link
59
Q

Symptoms of Pulmonary fibrosis?

A
  • Breathlessness , come cases very severe
  • Gradually get worse over years or very quickly
  • No Cure
  • Poor prognosis , 3 years post diagnosis
  • Constant cough
  • Tired , reduced gas exchange
  • Clubbing of fingers and toes
  • Is not infectious
60
Q

How do we Diagnose Pulmonary Fibrosis?

A
  • MDT patient history
  • Clinical signs
  • Spirometry
  • Bronchoscopy - look at lung tissue via a small camera
  • Chest x-ray , followed by CT
61
Q

How do we treat Pulmonary Fibrosis?

A
  • Not generally treated with inhalers
  • 02 therapy
  • Pulmonary rehab - manage breathlessness , maintain and improve exercise tolerance
  • Meds - sedatives , morphine or Oramorph
  • Treatments for heartburn and blocked nose , antiacids
  • Lung Transplant - very rare
62
Q

What medications are used to treat pulmonary fibrosis ?

A
  • Pirfenidone - Mild - moderate IPF , slow down inflammation and build up scar tissue , some side effects - sick , tired , diarrhea
  • Nintedanib - jan 2016 , reduced rate of flare up , some side effects , nausea , vomiting , pain , decreased appetite etc.
63
Q

How is Pulmonary Rehabilitation used for Pulmonary fibrosis?

A
  • Exercise
  • Education
  • Self management
  • Diet
  • Lifestyle modifications
64
Q

How can patients help themselves?

A
  • Stop smoking
  • Have the early flu jab
  • Have vaccinations
  • Avoid those with chest infections and colds
  • Stay fit and active
  • Eat a healthy balanced diet
  • Get in touch with british lung foundation
65
Q

What is Coronary heart disease?

A
  • Narrowing or complete blocking of the arteries that supply the heart
  • Angina
  • Myocardial infarction
  • Heart Failure
66
Q

What is the Prevalence of CHD ?

A
  • Most common cause of death worldwide
  • 66,000 Deaths a year in the Uk
  • 1 in 7 men , 1 in 12 women
  • North england and scotland being higher.
  • 1 death every 8 mins
  • 2.3 million people living with the disease.
67
Q

Give CHD risk factors-

A
  • age
  • Gender
  • Social deprivation
  • Smoking
  • diet
  • Exercise
  • Alcohol
  • Psychosocial well being
  • Blood pressure
  • Cholesterol
  • Obesity
  • Hypertension
  • Diabetes
  • Ethnicity
  • Family history
68
Q

What is Angina?

A
  • Chest pain due to an inadequate supply of oxygen to the heart muscle
  • Tends to be Transient
  • Types =
  • Stable
  • Unstable
  • Variant
  • Microvascular
69
Q

What is the treatment for Angina?

A
  • Nitrates , anticoagulants - causing headaches as they target non - specific blood vessels.
  • lifestyles changes
  • Surgery - angioplasty.
70
Q

What is Myocardial Infarction?

A
  • Blood supply to the heart seriously reduced or cut off.

- Resulting in ischaemia of the heart muscle and scar formation.

71
Q

How is MI diagnosed?

A
  • Cardiac enzyme testing - Troponin , Creatinine Kinase

- ECG - Inversion of T wave and enlarged Q Wave and ST elevation.

72
Q

Symptoms of MI -

A
  • Sweating , cold
  • Dizzy
  • Pain , discomfort
  • pain and pressure on the chest
  • SOB
  • Nausea and vomiting
  • Increase / irregular heart beat
73
Q

Prognosis of MI

A
  • Sudden death - 20%
  • Heart failure - scar tissue
  • Cariogenic shock
  • Arrhythmias - irregular heart beat.
  • Thrombus formation
  • Rupture
  • 68% will have further complications
  • 13% Will still die
  • Depending of site and degree of damage.
74
Q

How is MI treatment ?

A
  • Vasodilation drugs
  • Beta-blockers
  • PTCA
  • Stenting
  • Laser
  • Physio are heavily involved in cardiac rehab and preop care, cardiac rehab in patient or outpatient. Critical care to discharge.
75
Q

Where do MIs usually occur?

A
  • Left ventricle has the highest demand and therefore is the most common site of ischaemia
  • 50-70% involves left coronary artery /territory
76
Q

What is Heart failure?

A
  • Unable to adequately pump the blood around the body - usually because the heart has become weak and stiff.
77
Q

What are some other causes of heart failure? (not- MI)

A
  • Damaged valves
  • Infections
  • Arrhythmias
  • Chemotherapy
  • Excessive alcohol
  • Anaemia
  • Thyroid disease.
78
Q

What are the main symptoms of heart failure?

A
  • SOB on exertion +/- at rest
  • Swollen feet , ankles , stomach and lower back
  • Fatigue or feeling sick
79
Q

What are the treatments for heart failure as there is no cure?

A
  • Diuretics
  • pacemakers
  • Implantable cardioverter defibrillator ( ICD)
80
Q

What is heart valve disease?

A
  • can affect any 4 valves
  • Causes - CHD , Rheumatic fever , cardiomyopathy , MI , endocarditis and ageing
  • Symptoms - SOB , Ankle/feet swelling , fatigue
  • Can affect the flow of blood via valve stenosis or narrowing/ valve incompetence or regurgitation or a leaky valve.
81
Q

What is a Coronary Bypass graft ?

A
  • used to treat Coronary heart disease
  • bypassing a blocked portion of a coronary artery using another piece of blood vessel
  • can be single or multiple arteries
  • lasting 8-12 years
82
Q

Give a brief overview of the CABG procedure

A
  • incision via median sternotomy
  • Cold solution results in cardioplegia
  • heart kept going through cardiopulmonary bypass
  • less invasive techniques = key hole surgery
  • Cardioplegia
  • end of graft attached above the blockage
  • 3-6 hours
83
Q

Give some common graft sites for CABG

A
  • Saphenous vein
  • Radial artery
  • R and L internal thoracic artery
  • R gastroepiploic artery
  • interior epigastric artery
84
Q

Give some complications to CABG

A
  • preoperative MI
  • low cardiac output
  • AF, 40% of patients - atrial fibrillation
  • lower lobe collapse
  • chest infection/ pneumonia
  • non union of sternum
  • late graft stenosis
  • pericardial tamponade- blood collecting around and compressing the heart
  • pulmonary oedema/ pleural effusion
  • renal impairment and failure
  • chronic pain
  • CVA 1-5%
  • Psychosis - air bubbles into the brain
  • wound infection
85
Q

Give the way in which physiotherapy management is used in cardiac surgery

A
  • secretion clearance
  • decrease WOB
  • increase lung volume
  • early mobilisation
  • stair climbing day 3/4
  • home 4/5
  • rehab 2 weeks post
86
Q

Give the 5 types of valve replacement

A
  • Mechanical , 15-25 years , anticoags, made of pyrolytic carbon
  • Tissue , bioprosthetic , animal donors, 10-20 years
  • Donor , least common , last 10-20 years
  • Ross procedure, aortic value replaced with pulmonary valve , which is then also replaced
  • TAVI/TAVR- Transcatheter aortic valve implantation or replacement
87
Q

What are the complications of a Valve replacement ?

A
  • stroke
  • clotting
  • valves getting damaged
  • chest infection
  • non union
  • pulmonary oedema
88
Q

When is a heart transplant needed ?

A
  • in severe CHD
  • Cardiomyopathy
  • Congenital heart disease
89
Q

Complications of a heart transplant

A
  • transplant rejection
  • Graft failure
  • Cardiac allograft vasculopathy - artery narrowing
  • vulnerability to infections , immunosuppressants
  • same as CABG and valve surgery surgery
90
Q

Management post heart transplant

A
  • follow ups
  • immunosuppressants
  • Exercise
  • diet
  • Pregnancy
91
Q

Causes of heart valve disease -

A
  • congenital heart disease
  • Rheumatic fever
  • Cardiomyopathy
  • MI
  • Endocarditis

Pathology SEM 2 (3 decks)

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