Ch 15: Lung Flashcards
what are the three cell types found in alveoli
type 1 alveolar/pneumocyte cells
type 2 alveolar/pneumocyte cells
alveolar macrophages
what are type 1 alveolar/pneumocyte cells
found in alveoli - most common (95%)
flat, plate-like, simple squamous cells
what are type 2 alveolar/penumocyte cells
found in alveoli
rounded, simple cuboidal cells
make surfactant and help to repair the epithelium if type 1 cells die
what are alveolar macrophages
found in alveoli
mobile phagocytes that engulf pathogens
what is surfactant
chemical made by type 2 alveolar/pneumocyte cells
phospholipids that decrease surface tension within alveoli by breaking hydrogen bonds
works to prevent them from collapsing
what are pores of Kohn
perforations between alveoli that permit the passage of air, bacteria, and exudate between the alveoli
what is the respiratory membrane made of
type 1 alveolar cells
alveolar basement membrane fused to capillary basement membrane
capillary endothelial cells
what are the 4 main symptoms of pulmonary issues
cough
chest pain
abnormal sputum
clubbing
where is the protective reflex that makes you cough located
carina
how long does an acute cough last
2-3 weeks
how long does a chronic cough last
over 8 weeks
what are the three main areas where chest pain occurs
pleura
airways (bronchi)
chest wall
what is hemoptysis
coughing up bloody sputum from lungs that comes from tracheobronchial branches
what is clubbing
painless, bulbous enlargement of end of digit
what are the four conditions associated with clubbing
lung cancer
chronic hypoxemia
GI disorders
endocrine disorders
what are the three main types of abnormal breathing patterns
dyspnea
cyanosis
hypoventilation/hyperventilation
what is dyspnea
sensation of being unable to get enough air; feeling short of breath
can be caused by many different things
what is cyanosis
bluish discoloration of skin and mucous membranes
caused by disorders involving deoxygenated or abnormal hemoglobin
what are the two categories of disorders involving deoxygenated hemoglobin
peripheral and central
what are peripheral deoxygenated hemoglobin disorders
mostly caused by poor circulation and seen in upper and lower extremities
what are central deoxygenated hemoglobin disorders
caused by decreased arterial oxygenation
seen in entire body and visible mucosa
what is hypoventilation
not breathing enough times per minute or
inadequate alveolar ventilation
breathing too shallow
leads to too much carbon dioxide build up in the blood which makes the blood acidic
what is hyperventilation
breathing too quickly
exceeding alveolar ventilation
leads to too much carbon dioxide leaving the blood which makes the blood basic
what is hypercapnia
increase in partial pressure of carbon dioxide above 44mmHg
usually caused by failure of the lungs to ventilate properly (hypoventilation)
what is hypoxemia
decrease in partial pressure of oxygen in the blood
caused by mismatch between ventilation and perfusion
what is neonatal atelectasis (collapse)
incomplete expansion of fetal lungs makes them collapse
leads to poorly aerated areas
what is acquired atelectasis (collapse)
collapse of previously inflated lung, usually due to trauma
leads to poorly aerated areas
what are the three forms of acquired atelectasis
resorption (obstruction)
compression
contraction (cicatrization)
which two types of acquired atelectasis are reversible if treated
resorption (obstruction) and compression
if left untreated, can lead to hypoxemia and infection
what is resorption (obstruction) atelectasis
airway is obstructed which traps the oxygen within the alveoli
leads to diminished lung volume and a mediastinal shift toward the collapsed lung
what are the two causes of resorption atelectasis
excessive secretions (mucous plugs)
exudates within smaller bronchi (aspirating foreign bodies)
what is compression atelectasis
compression of lung
what are the three causes of compression atelectasis
partial or complete accumulation of fluid
tumors
air within pleural cavity
what is contraction atelectasis
lung shrinks
what are the two causes of contraction atelectasis
pulmonary or pleural fibrosis
what are the four signs of atelectasis
dyspnea
cough
fever
leukocytosis (elevated WBC)
what are the four treatments for atelectasis
correct underlying cause
change positions frequently
early ambulation (walking soon after a surgery)
deep breathing exercise
how do deep breathing exercises help treat atelectasis
incentive spirometer is used
promotes ciliary clearance
redistributes surfactant
promotes air exchange through the pores of Kohn
what is pulmonary edema
excessive interstitial fluid in the alveoli which leads to wet and heavy lungs
what are the three main causes of pulmonary edema
hemodynamic (cardiac related)
alveolar wall injury
undetermined origin
what are the three causes of hemodynamic edema which causes pulmonary edema
increased hydrostatic pressure
decreased oncotic pressure
lymphatic obstruction
what is the most common cause of increased hydrostatic pressure which leads to hemodynamic edema and ultimately pulmonary edema
left-sided congestive heart failure causes fluid to back up in the lungs
what is a common cause of decreased oncotic pressure which leads to increased hydrostatic pressure and ultimately pulmonary edema
hypoalbuminemia
what are the three signs of pulmonary edema
dyspnea
tissue hypoxia
increased work of breathing
what are 5 clinical presentations on physical exam of pulmonary edema
inspiratory crackles (alveoli popping)
dullness to percussion in base of lung
pink, frothy sputum
hypoventilation
worsening hypoxia
what are the two main treatments of pulmonary edema
correct underlying caused
if sever, mechanical ventilation
what is acute lung injury (ALI)
abrupt onset of hypoxemia and bilateral pulmonary edema (no cardiac failure) due to diffuse alveolar-capillary membrane damage
what are three predisposing conditions of acute lung injuries
shock
oxygen therapy
sepsis
what is acute respiratory distress syndrome (ARDS)
a form of severe acute lung injury
rapid onset of life-threatening respiratory insufficiency, cyanosis, and severe hypoxemia
what is the mechanism or acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)
injury of pneumocytes or respiratory membrane leads to edema, inflammation, and pulmonary damage
what are the five steps of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)
1.) injury to membrane causes endothelial activation by alveolar macrophages
2.) activation of neutrophils
3.) damage to alveolar/endothelial cells
4.) vascular leakage and loss of surfactant leads to accumulation of fluid and formation of hyaline membranes
5.) injury is resolved
in which two diseases are hyaline membranes seen
acute lung injury (AIL) and acute respiratory distress syndrome (ARDS)
what are the two categories of lung diseases
restrictive and obstructive
what are restrictive (chronic diffuse interstitial) lung diseases
reduced expansion of lung parenchyma (stiffness) and decreases total lung capacity
pulmonary function test remains normal
what are obstructive lung diseases
diffuse airway disease which leads to increase in resistance to airflow
caused by partial or complete obstruction
pulmonary function test is decreased
what are the two categories of restrictive pulmonary disorders
chest wall disorders
chronic interstitial and infiltrative diseases
what are four examples of chest wall disorders of restrictive pulmonary disorders
severe obesity
pleural disfunction
kyphoscoliosis
neuromuscular disease (poliomyelitis)
what is poliomyelitis
type of chest wall disorder
viral infection that affects CNS and leads to paralysis
what are two examples of chronic interstitial and infiltrative diseases of restrictive pulmonary disorders
pneumoconiosis
interstitial fibrosis
what are restrictive pulmonary disorders characterized by
decrease in lung compliance
what is pulmonary fibrosis
excessive amount of fibrosis or connective tissue in the lung parenchyma
two types: idiopathic or secondary
what is idiopathic pulmonary fibrosis (IPF)
progressive interstitial pulmonary fibrosis and respiratory failure
occurs mostly in males over 60
what is the mechanism of idiopathic pulmonary fibrosis
an environmental factor causes persistent epithelial injury to at risk epithelium which causes its activation
activated epithelium calls for help of cells like macrophages and neutrophils
injured epithelium releases pro-fibrogenic factors which cause deposition of fibrin and therefore fibrosis
what are the three symptoms of interstitial pulmonary fibrosis
dyspnea on exertion
dry cough
fine crackles
what are the two methods to diagnose interstitial pulmonary fibrosis
CT scan
lung biopsy
what are the five ways to treat interstitial pulmonary fibrosis
pulmonary rehabilitation
psychosocial support
palliative care
drugs to stop fibrotic process
lung transplant
what is pneumoconiosis
excessive inhalation of inorganic dust particles that reach the alveoli
ex. coal dust, silica, asbestos, benzene, and insecticides
what is the mechanism of pneumoconiosis
macrophages engulf exogenous, inhaled particles but cannot break them down so they die
dead macrophages release proteolytic enzymes which damage surrounding tissues, leading to chronic inflammation, damage, and fibrosis of alveolar walls
what are the five symptoms of pneumoconiosis
cough
chronic sputum production
dyspnea
decreased lung volumes
hypoxemia
what are the three ways to diagnose pneumoconiosis
history of exposure
chest X-ray
lung biopsy
what are the two ways to treat pneumoconiosis
palliative (alleviating) care
prevention of further exposure
what are the three types of obstructive pulmonary disease
chronic obstructive pulmonary disease (COPD)
asthma
bronchiectasis
what are the two types of chronic obstructive pulmonary disease (COPD)
emphysema
chronic bronchitis
what is the third leading cause of death in the world
chronic obstructive pulmonary disease (COPD)
what is the biggest cause (80%) of COPD
smoking
which two groups of people are most susceptible to COPD
women
African americans
what is the mechanism of chronic obstructive pulmonary disease (COPD)
exposure of noxious particles or gases leads to airways or alveolar abnormalities
leads to persistent respiratory symptoms and limited airflow
what is emphysema
a type of COPD
irreversible enlargement of airspaces, wall destruction, and fibrosis of everything below terminal bronchioles (mostly acini)
causes dyspnea
what are the four major types of emphysema
centriacinar
panacinar
paraseptal
irregular
which two types of emphysema cause significant airflow obstruction
centriacinar and panacinar
what is centriacinar (centrilobular) emphysema
most common type of emphysema (95%)
occurs mostly in heavy smokers with COPD
affects central/proximal portion of respiratory bronchioles
most lesions appear in upper lobes
what is panacinar (panlobular) emphysema
caused by a deficiency in alpha1-antitrypsin deficiency but worsened by smoking
enlargement of everything from respiratory bronchioles to alveoli
lesions most commonly found in lower zones, anterior margins, and base of lungs
what is paraseptal acinar (distal acinar) emphysema
mostly seen in young adults with spontaneous pneumothorax
distal parts of acini, near thorax, and fibrotic areas are most affected
lesions more common in upper half of lungs
enlarged airspaces with cyst like structures
what is irregular emphysema
airspace enlargement with fibrosis
acini not usually involved
what are the four main mechanisms of emphysema
toxic injury and inflammation
protease-antiprotease imbalance
oxidative stress
microbial infection
what are the two main factors that lead to alveolar wall destruction in cases of emphysema
smoking or air pollutant and genetic predisposition
1% of emphysema cases are caused by what
alpha1-antitrypsin deficiency
seen in panacinar emphysema
what is chronic bronchitis
-symptoms
-what is normally effects
a type of COPD
symptoms: constant constant cough (3 months) and sputum production
affects mainly the bronchus
what are the three main symptoms of airway obstruction caused by chronic bronchitis
hypoxemia
pulmonary HTN
cor pulmonale
what are the three major causes of chronic bronchitis
smoking (90%)
chronic infections
chemical irritants (dust from silica)
what are the four main mechanisms of chronic bronchitis
mucus hypersecretion
acquired CFTR dysfunction
chronic airway inflammation
infection
what are the two mechanisms of mucus hypersecretion of chronic bronchitis
hyperplasia of mucous glands
hypertrophy of goblet cells
both lead to excess mucous secretion
what is the mechanism of CFTR dysfunction of chronic bronchitis
dysfunction of acquired cystic fibrosis transmembrane conductance regulator (CFTR) leads to secretion of abnormal, dehydrated mucous
what are the two mechanisms of chronic airway inflammation of chronic bronchitis
fibrosis of mucous membrane
increased bronchial wall thickening
what is the mechanism of infections of chronic bronchitis
infections produce acute exacerbations
what are four clinical features of emphysema
barrel chested
dyspena
prolonged expiration
hyperventilation
what are two clinical features of chronic bronchitis
cough and wheezing
polycythemia due to retaining too much CO2
what are the three things that lead to death in those with COPD
heart failure
pneumonia
pulmonary thromboembolism
what does the X-ray look like in someone with emphysema
hyperinflation of lungs with flattened diaphragms
what is asthma
chronic inflammatory, obstructive pulmonary disorder of the airways
seen mostly in low income countries or some ethnic groups
affects mostly bronchi
two types: atopic or non-atopic
what is the mechanism of asthma
type 1 hypersensitivity reaction
what is atopic asthma
most common
evidence of allergen sensitization and immune activation
what is non-atopic asthma
no evidence of allergen sensitization
what are six triggers of bronchospasm in asthma
environmental allergen (atopic)
respiratory infections (virus - non-atopic)
irritants (smoke)
cold air
stress
exercise
what are some characteristics of the airway of an asthmatic
dilation
basement membrane thickening
macrophages
smooth muscle cell proliferation
excess mucous
airway remodeling
what are the symptoms of asthma
episodic wheezing, breathlessness, chest tightness and cough
what is bronchiectasis
-cause
-what does it mainly effect and how
-symptoms
a type of obstructive pulmonary disease
permanent dilation of the bronchi and bronchioles due to destruction of elastic and smooth muscle components
bronchi are easily collapsible
usually caused by persistent infections
causes cough, purulent sputum, and fever
what do pleural disease impact
ventilation and oxygenation
what are two examples of pleural diseases
pneumothorax and pleural effusion
what is a pneumothorax
presence of air or gas in pleural cavity which disrupts equilibrium between the elastic recoil forces of the lung and chest wall
leads to collapsed lung
can be classified as either open or tension
what are the two types of pneumothorax
primary (spontaneous) and secondary (traumatic)
what is a spontaneous (primary) pneumothorax
spontaneous rupture of a sub-pleural bleb (blister)
occurs unexpectedly in healthy individuals who are usually male and around 20-40 years old
what is a traumatic (secondary) pneumothorax
perforating injury to chest wall, usually both layers of pleura, that causes collapsed lung
what is an open pneumothorax
air pressure in the pleural space equals atmospheric pressure
any air drawn in is forced back out out
hard to fully inflate lung
what is a tension pneumothorax
-what does it cause
pleural rupture acts as a one way valve
intrapleural pressure goes above atmospheric pressure
causes compression of mediastinal structures and contralateral lung
life-threatening
what are three main complications of a tension pneumothorax
severe hypoxemia
tracheal deviation away from affected lung
hypotension
what are six clinical signs of a pneumothorax
sudden pleural pain
tachypnea (rapid breathing)
dyspnea (open)
severe hypoxemia
tracheal deviation away from affected lung
hypotensio
what are two treatments for a pneumothorax
aspiration by inserting a chest tube with suction
pleurodesis (talc) surgery (drug to adhere pleural membranes)
what is a pleural effusion
collection of fluid over 15 mL in pleural cavity due to some disease
what is pleuritis
a type of inflammatory pleural effusion
exudate fluid builds up in pleural cavities and causes inflammation
what are the three types of pleuritis
serous
serofibrinous
fibrinous
what are some causes of exudative fluid
bacterial infection
cancer
pulmonary infarction
viral pleuritis
what is empyema
purulent pleural exudate build up in pleural cavity due to bacterial or mycotic infections
pus is yellow-green and creamy
resolves or becomes dense, fibrous adhesions
what three types of bacteria cause empyemas
S. aureua
E. coli
K. pneumoniae
what is pus
purulent exudate rich in leukocytes (mostly neutrophils)
what are the three types of noninflammatory pleural effusions
hydrothorax
hemothorax
chylothorax
what is a hydrothorax
type of noninflammatory pleural effusion
clear, or straw colored transudate fluid builds up in the pleural cavity
can be uni or bilateral
what are the three main causes of a hydrothorax
heart failure
cirrhosis
renal failure
what is transudate
extravascular fluid with low protein (albumin) concentration, few to no cells, and low specific gravity
seen in a hydrothorax
what is a hemothorax
type of noninflammatory pleural effusions
escape of blood into pleural cavity due to trauma, surgery, or rupture of aortic aneurysm
what is a chylothorax
type of noninflammatory pleural effusion
accumulation of lymphatic, milky fluid in pleural cavity
caused by thoracic duct trauma or obstruction by malignancy
what are two things a pleural effusion can cause
compression atelectasis (collapsed lung) and displaced mediastinal contents
how is a pleural effusion diagnosed
chest X-ray
what are two ways to treat a pleural effusion
treat underlying cause and thoracentesis
