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Disease Mechanisms > Ch 15: Lung > Flashcards

Ch 15: Lung Flashcards

1
Q

what are the three cell types found in alveoli

A

type 1 alveolar/pneumocyte cells
type 2 alveolar/pneumocyte cells
alveolar macrophages

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2
Q

what are type 1 alveolar/pneumocyte cells

A

found in alveoli - most common (95%)
flat, plate-like, simple squamous cells

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3
Q

what are type 2 alveolar/penumocyte cells

A

found in alveoli
rounded, simple cuboidal cells
make surfactant and help to repair the epithelium if type 1 cells die

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4
Q

what are alveolar macrophages

A

found in alveoli
mobile phagocytes that engulf pathogens

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5
Q

what is surfactant

A

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

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6
Q

what are pores of Kohn

A

perforations between alveoli that permit the passage of air, bacteria, and exudate between the alveoli

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7
Q

what is the respiratory membrane made of

A

type 1 alveolar cells
alveolar basement membrane fused to capillary basement membrane
capillary endothelial cells

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8
Q

what are the 4 main symptoms of pulmonary issues

A

cough
chest pain
abnormal sputum
clubbing

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9
Q

where is the protective reflex that makes you cough located

A

carina

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10
Q

how long does an acute cough last

A

2-3 weeks

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11
Q

how long does a chronic cough last

A

over 8 weeks

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12
Q

what are the three main areas where chest pain occurs

A

pleura
airways (bronchi)
chest wall

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13
Q

what is hemoptysis

A

coughing up bloody sputum from lungs that comes from tracheobronchial branches

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14
Q

what is clubbing

A

painless, bulbous enlargement of end of digit

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15
Q

what are the four conditions associated with clubbing

A

lung cancer
chronic hypoxemia
GI disorders
endocrine disorders

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16
Q

what are the three main types of abnormal breathing patterns

A

dyspnea
cyanosis
hypoventilation/hyperventilation

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17
Q

what is dyspnea

A

sensation of being unable to get enough air; feeling short of breath
can be caused by many different things

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18
Q

what is cyanosis

A

bluish discoloration of skin and mucous membranes
caused by disorders involving deoxygenated or abnormal hemoglobin

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19
Q

what are the two categories of disorders involving deoxygenated hemoglobin

A

peripheral and central

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20
Q

what are peripheral deoxygenated hemoglobin disorders

A

mostly caused by poor circulation and seen in upper and lower extremities

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21
Q

what are central deoxygenated hemoglobin disorders

A

caused by decreased arterial oxygenation
seen in entire body and visible mucosa

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22
Q

what is hypoventilation

A

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

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23
Q

what is hyperventilation

A

breathing too quickly
exceeding alveolar ventilation
leads to too much carbon dioxide leaving the blood which makes the blood basic

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24
Q

what is hypercapnia

A

increase in partial pressure of carbon dioxide above 44mmHg
usually caused by failure of the lungs to ventilate properly (hypoventilation)

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25
Q

what is hypoxemia

A

decrease in partial pressure of oxygen in the blood
caused by mismatch between ventilation and perfusion

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26
Q

what is neonatal atelectasis (collapse)

A

incomplete expansion of fetal lungs makes them collapse
leads to poorly aerated areas

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27
Q

what is acquired atelectasis (collapse)

A

collapse of previously inflated lung, usually due to trauma
leads to poorly aerated areas

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28
Q

what are the three forms of acquired atelectasis

A

resorption (obstruction)
compression
contraction (cicatrization)

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29
Q

which two types of acquired atelectasis are reversible if treated

A

resorption (obstruction) and compression
if left untreated, can lead to hypoxemia and infection

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30
Q

what is resorption (obstruction) atelectasis

A

airway is obstructed which traps the oxygen within the alveoli
leads to diminished lung volume and a mediastinal shift toward the collapsed lung

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31
Q

what are the two causes of resorption atelectasis

A

excessive secretions (mucous plugs)
exudates within smaller bronchi (aspirating foreign bodies)

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32
Q

what is compression atelectasis

A

compression of lung

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33
Q

what are the three causes of compression atelectasis

A

partial or complete accumulation of fluid
tumors
air within pleural cavity

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34
Q

what is contraction atelectasis

A

lung shrinks

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35
Q

what are the two causes of contraction atelectasis

A

pulmonary or pleural fibrosis

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36
Q

what are the four signs of atelectasis

A

dyspnea
cough
fever
leukocytosis (elevated WBC)

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37
Q

what are the four treatments for atelectasis

A

correct underlying cause
change positions frequently
early ambulation (walking soon after a surgery)
deep breathing exercise

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38
Q

how do deep breathing exercises help treat atelectasis

A

incentive spirometer is used
promotes ciliary clearance
redistributes surfactant
promotes air exchange through the pores of Kohn

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39
Q

what is pulmonary edema

A

excessive interstitial fluid in the alveoli which leads to wet and heavy lungs

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40
Q

what are the three main causes of pulmonary edema

A

hemodynamic (cardiac related)
alveolar wall injury
undetermined origin

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41
Q

what are the three causes of hemodynamic edema which causes pulmonary edema

A

increased hydrostatic pressure
decreased oncotic pressure
lymphatic obstruction

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42
Q

what is the most common cause of increased hydrostatic pressure which leads to hemodynamic edema and ultimately pulmonary edema

A

left-sided congestive heart failure causes fluid to back up in the lungs

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43
Q

what is a common cause of decreased oncotic pressure which leads to increased hydrostatic pressure and ultimately pulmonary edema

A

hypoalbuminemia

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44
Q

what are the three signs of pulmonary edema

A

dyspnea
tissue hypoxia
increased work of breathing

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45
Q

what are 5 clinical presentations on physical exam of pulmonary edema

A

inspiratory crackles (alveoli popping)
dullness to percussion in base of lung
pink, frothy sputum
hypoventilation
worsening hypoxia

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46
Q

what are the two main treatments of pulmonary edema

A

correct underlying caused
if sever, mechanical ventilation

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47
Q

what is acute lung injury (ALI)

A

abrupt onset of hypoxemia and bilateral pulmonary edema (no cardiac failure) due to diffuse alveolar-capillary membrane damage

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48
Q

what are three predisposing conditions of acute lung injuries

A

shock
oxygen therapy
sepsis

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49
Q

what is acute respiratory distress syndrome (ARDS)

A

a form of severe acute lung injury
rapid onset of life-threatening respiratory insufficiency, cyanosis, and severe hypoxemia

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50
Q

what is the mechanism or acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

A

injury of pneumocytes or respiratory membrane leads to edema, inflammation, and pulmonary damage

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51
Q

what are the five steps of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

A

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

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52
Q

in which two diseases are hyaline membranes seen

A

acute lung injury (AIL) and acute respiratory distress syndrome (ARDS)

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53
Q

what are the two categories of lung diseases

A

restrictive and obstructive

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54
Q

what are restrictive (chronic diffuse interstitial) lung diseases

A

reduced expansion of lung parenchyma (stiffness) and decreases total lung capacity
pulmonary function test remains normal

55
Q

what are obstructive lung diseases

A

diffuse airway disease which leads to increase in resistance to airflow
caused by partial or complete obstruction
pulmonary function test is decreased

56
Q

what are the two categories of restrictive pulmonary disorders

A

chest wall disorders
chronic interstitial and infiltrative diseases

57
Q

what are four examples of chest wall disorders of restrictive pulmonary disorders

A

severe obesity
pleural disfunction
kyphoscoliosis
neuromuscular disease (poliomyelitis)

58
Q

what is poliomyelitis

A

type of chest wall disorder
viral infection that affects CNS and leads to paralysis

59
Q

what are two examples of chronic interstitial and infiltrative diseases of restrictive pulmonary disorders

A

pneumoconiosis
interstitial fibrosis

60
Q

what are restrictive pulmonary disorders characterized by

A

decrease in lung compliance

61
Q

what is pulmonary fibrosis

A

excessive amount of fibrosis or connective tissue in the lung parenchyma
two types: idiopathic or secondary

62
Q

what is idiopathic pulmonary fibrosis (IPF)

A

progressive interstitial pulmonary fibrosis and respiratory failure
occurs mostly in males over 60

63
Q

what is the mechanism of idiopathic pulmonary fibrosis

A

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

64
Q

what are the three symptoms of interstitial pulmonary fibrosis

A

dyspnea on exertion
dry cough
fine crackles

65
Q

what are the two methods to diagnose interstitial pulmonary fibrosis

A

CT scan
lung biopsy

66
Q

what are the five ways to treat interstitial pulmonary fibrosis

A

pulmonary rehabilitation
psychosocial support
palliative care
drugs to stop fibrotic process
lung transplant

67
Q

what is pneumoconiosis

A

excessive inhalation of inorganic dust particles that reach the alveoli
ex. coal dust, silica, asbestos, benzene, and insecticides

68
Q

what is the mechanism of pneumoconiosis

A

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

69
Q

what are the five symptoms of pneumoconiosis

A

cough
chronic sputum production
dyspnea
decreased lung volumes
hypoxemia

70
Q

what are the three ways to diagnose pneumoconiosis

A

history of exposure
chest X-ray
lung biopsy

71
Q

what are the two ways to treat pneumoconiosis

A

palliative (alleviating) care
prevention of further exposure

72
Q

what are the three types of obstructive pulmonary disease

A

chronic obstructive pulmonary disease (COPD)
asthma
bronchiectasis

73
Q

what are the two types of chronic obstructive pulmonary disease (COPD)

A

emphysema
chronic bronchitis

74
Q

what is the third leading cause of death in the world

A

chronic obstructive pulmonary disease (COPD)

75
Q

what is the biggest cause (80%) of COPD

A

smoking

76
Q

which two groups of people are most susceptible to COPD

A

women
African americans

77
Q

what is the mechanism of chronic obstructive pulmonary disease (COPD)

A

exposure of noxious particles or gases leads to airways or alveolar abnormalities
leads to persistent respiratory symptoms and limited airflow

78
Q

what is emphysema

A

a type of COPD
irreversible enlargement of airspaces, wall destruction, and fibrosis of everything below terminal bronchioles (mostly acini)
causes dyspnea

79
Q

what are the four major types of emphysema

A

centriacinar
panacinar
paraseptal
irregular

80
Q

which two types of emphysema cause significant airflow obstruction

A

centriacinar and panacinar

81
Q

what is centriacinar (centrilobular) emphysema

A

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

82
Q

what is panacinar (panlobular) emphysema

A

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

83
Q

what is paraseptal acinar (distal acinar) emphysema

A

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

84
Q

what is irregular emphysema

A

airspace enlargement with fibrosis
acini not usually involved

85
Q

what are the four main mechanisms of emphysema

A

toxic injury and inflammation
protease-antiprotease imbalance
oxidative stress
microbial infection

86
Q

what are the two main factors that lead to alveolar wall destruction in cases of emphysema

A

smoking or air pollutant and genetic predisposition

87
Q

1% of emphysema cases are caused by what

A

alpha1-antitrypsin deficiency
seen in panacinar emphysema

88
Q

what is chronic bronchitis
-symptoms
-what is normally effects

A

a type of COPD
symptoms: constant constant cough (3 months) and sputum production
affects mainly the bronchus

89
Q

what are the three main symptoms of airway obstruction caused by chronic bronchitis

A

hypoxemia
pulmonary HTN
cor pulmonale

90
Q

what are the three major causes of chronic bronchitis

A

smoking (90%)
chronic infections
chemical irritants (dust from silica)

91
Q

what are the four main mechanisms of chronic bronchitis

A

mucus hypersecretion
acquired CFTR dysfunction
chronic airway inflammation
infection

92
Q

what are the two mechanisms of mucus hypersecretion of chronic bronchitis

A

hyperplasia of mucous glands
hypertrophy of goblet cells
both lead to excess mucous secretion

93
Q

what is the mechanism of CFTR dysfunction of chronic bronchitis

A

dysfunction of acquired cystic fibrosis transmembrane conductance regulator (CFTR) leads to secretion of abnormal, dehydrated mucous

94
Q

what are the two mechanisms of chronic airway inflammation of chronic bronchitis

A

fibrosis of mucous membrane
increased bronchial wall thickening

95
Q

what is the mechanism of infections of chronic bronchitis

A

infections produce acute exacerbations

96
Q

what are four clinical features of emphysema

A

barrel chested
dyspena
prolonged expiration
hyperventilation

97
Q

what are two clinical features of chronic bronchitis

A

cough and wheezing
polycythemia due to retaining too much CO2

98
Q

what are the three things that lead to death in those with COPD

A

heart failure
pneumonia
pulmonary thromboembolism

99
Q

what does the X-ray look like in someone with emphysema

A

hyperinflation of lungs with flattened diaphragms

100
Q

what is asthma

A

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

101
Q

what is the mechanism of asthma

A

type 1 hypersensitivity reaction

102
Q

what is atopic asthma

A

most common
evidence of allergen sensitization and immune activation

103
Q

what is non-atopic asthma

A

no evidence of allergen sensitization

104
Q

what are six triggers of bronchospasm in asthma

A

environmental allergen (atopic)
respiratory infections (virus - non-atopic)
irritants (smoke)
cold air
stress
exercise

105
Q

what are some characteristics of the airway of an asthmatic

A

dilation
basement membrane thickening
macrophages
smooth muscle cell proliferation
excess mucous
airway remodeling

106
Q

what are the symptoms of asthma

A

episodic wheezing, breathlessness, chest tightness and cough

107
Q

what is bronchiectasis
-cause
-what does it mainly effect and how
-symptoms

A

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

108
Q

what do pleural disease impact

A

ventilation and oxygenation

109
Q

what are two examples of pleural diseases

A

pneumothorax and pleural effusion

110
Q

what is a pneumothorax

A

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

111
Q

what are the two types of pneumothorax

A

primary (spontaneous) and secondary (traumatic)

112
Q

what is a spontaneous (primary) pneumothorax

A

spontaneous rupture of a sub-pleural bleb (blister)
occurs unexpectedly in healthy individuals who are usually male and around 20-40 years old

113
Q

what is a traumatic (secondary) pneumothorax

A

perforating injury to chest wall, usually both layers of pleura, that causes collapsed lung

114
Q

what is an open pneumothorax

A

air pressure in the pleural space equals atmospheric pressure
any air drawn in is forced back out out
hard to fully inflate lung

115
Q

what is a tension pneumothorax
-what does it cause

A

pleural rupture acts as a one way valve
intrapleural pressure goes above atmospheric pressure
causes compression of mediastinal structures and contralateral lung
life-threatening

116
Q

what are three main complications of a tension pneumothorax

A

severe hypoxemia
tracheal deviation away from affected lung
hypotension

117
Q

what are six clinical signs of a pneumothorax

A

sudden pleural pain
tachypnea (rapid breathing)
dyspnea (open)
severe hypoxemia
tracheal deviation away from affected lung
hypotensio

118
Q

what are two treatments for a pneumothorax

A

aspiration by inserting a chest tube with suction
pleurodesis (talc) surgery (drug to adhere pleural membranes)

119
Q

what is a pleural effusion

A

collection of fluid over 15 mL in pleural cavity due to some disease

120
Q

what is pleuritis

A

a type of inflammatory pleural effusion
exudate fluid builds up in pleural cavities and causes inflammation

121
Q

what are the three types of pleuritis

A

serous
serofibrinous
fibrinous

122
Q

what are some causes of exudative fluid

A

bacterial infection
cancer
pulmonary infarction
viral pleuritis

123
Q

what is empyema

A

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

124
Q

what three types of bacteria cause empyemas

A

S. aureua
E. coli
K. pneumoniae

125
Q

what is pus

A

purulent exudate rich in leukocytes (mostly neutrophils)

126
Q

what are the three types of noninflammatory pleural effusions

A

hydrothorax
hemothorax
chylothorax

127
Q

what is a hydrothorax

A

type of noninflammatory pleural effusion
clear, or straw colored transudate fluid builds up in the pleural cavity
can be uni or bilateral

128
Q

what are the three main causes of a hydrothorax

A

heart failure
cirrhosis
renal failure

129
Q

what is transudate

A

extravascular fluid with low protein (albumin) concentration, few to no cells, and low specific gravity
seen in a hydrothorax

130
Q

what is a hemothorax

A

type of noninflammatory pleural effusions
escape of blood into pleural cavity due to trauma, surgery, or rupture of aortic aneurysm

131
Q

what is a chylothorax

A

type of noninflammatory pleural effusion
accumulation of lymphatic, milky fluid in pleural cavity
caused by thoracic duct trauma or obstruction by malignancy

132
Q

what are two things a pleural effusion can cause

A

compression atelectasis (collapsed lung) and displaced mediastinal contents

133
Q

how is a pleural effusion diagnosed

A

chest X-ray

134
Q

what are two ways to treat a pleural effusion

A

treat underlying cause and thoracentesis

Disease Mechanisms (19 decks)

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