Ch 22 - Respiratory tract infections, neoplasms, and childhood disorders Flashcards
What is Respiratory tract infections? Common cold? Rhinosinusitis?
Can involve the upper respiratory tract, the lower or both. Signs of respiratory tract infections depend on the function of the structure involved, the severity of the infectious process, and the person’s general health status and age. Viruses are the most common causes.
Common cold - is a viral infection of the upper respiratory tract. most adults have a cold 2-3 times a year. School kids up to 12 per year. Usually begins with a sore and scratchy throat followed by profuse and watery rhinorrhea, nasal congestion, sneezing and coughing. Fever is common in kids but not adults. Most common rhinoviruses, parainfluenza viruses RSV coronaviruses and adenoviruses. Rapidly spread. First 3 days contagious highly. Incubation is 5 days. Treatment - rest and antipyretic drugs. Antihistamines or decongestant or both, don’t shorten the cold but relieves symptoms.
Rhinosinusitis - inflammation of the nasal passages, sinusitis is inflammation of the paranasal sinuses. Causes - conditions that obstruct the narrow ostia. It develops when a viral upper respiratory tract infection or allergic rhinitis obstructs theostiomeatal complex and impairs the mucociliary clearance mechanism.
Clinical - acute, subacute, chronic. may last 5-7 days and acute bacterial rhionsinusitis up to 4 weeks. Subacute from 4 - 12 weeks and chronic from 12 weeks on. Maybe viral, bacterial or both.
Mani - facial pain, headache, purulent nasal discharge, dec sense of smell, fever.
Diagnosis - symptom history and physical exam includes inspection of the nose and throat. Headache that is usually worse when bending forward, coughing or sneezing. CT and MRI can be used but usually with suspected neoplasms.
Treatment - depends on the cause, antibiotics, intranasal corticosteroids, mucolytic agents and symptom relief measures. Measures to promote drainage by reducing nasal congestion.
Complications - because they are close to the brain and orbital wall, can lead to intracranial and orbital wall complications edema abscess formation. Can be a medical emergency
Influenza?
Is on e of the most important causes of acute upper respiratory tract infections. Three types ABC is considered an epidemic usually infections kids but deaths occur in the over 65. Adults are infectious from the day before symptom onset to 5-10 days. kids can shed up to 6 days before. Can develop 3 types; uncomplicated upper respiratory infection, viral pneumonia, and respiratory viral infection followed by bacterial infection. The virus first targets and kills the mucus secreting which is why rhinorrhea happens.
Mani - fever and chills; malaise; muscle aching; headache; profuse watery nasal discharge; nonproductive cough and sore throat. Rapid onset, symptoms peak in 3-5 days and disappear by 7-10 days. Viral pneumonia is a complication.
Diagnosis and treatment - based on symptoms, can use lab tests to determine. Antibiotics don’t help.
Treatments - analgesics and cough meds. OTC. Drinking large amounts of liquids. No aspirin in kids per Reye syndrome. Can use oseltamivir and should be started within 36 hours. .
Immunization - They must be changed yearly per changes in the virus
Pneumonias?
Describes inflammation of the parenchymal structures of the lung, like alveoli and bronchioles. these diseases remain a leading cause of morbidity and mortality.
Classification - According to the type of agent causing the infection, and distribution of the infection. typical results from infection by bacterial that multiply extracellularly in the alveoli and cause inflammation and exudation of fluid into the air filled alveolar spaces. Atypical can be caused by viral and mycoplasma
Community acquired - is used to describe infections from organisms found in the community rather than the hospital or nursing home.
Hospital acquired - is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Ventilator acquired pneumonia. Most are bacterial.
Acute bacterial typical pneumonia?
The elderly and debilitated are affected by mortality with pneumonia. From loss of cough reflex, damage to ciliated endothelium that lines the respiratory tract, or impaired immune defenses predispose to colonization and infection of the lower respiratory system. two types;
Pneumococcal - causes pyogenic infections, primarily in the lungs, ears, sinuses and meninges. Most common bacterial pathogens. Is gram positive diplococcus signs vary widely, depending on age and health status. By malaise; severe, shaking chills; fever. coughing brings up a watery sputum and breath sounds are limited or rust colored to purulent.
Treatment - antibiotics, but has built up a penicillin resistance. To vaccines are available for it pneumococcal conjugate vaccine protects against 13 types of bacteria. Young and person over 50 with compromised immune systems.
Legionnaires’ Disease - is a form of bronchopneumonia caused by gram negative rod. when water is aerosolized into droplets and inhaled. Malaise, weakness, lethargy, fever and dry cough. CNS function, GI tract involvement, arthralgias and elevation in temp. Diarrhea, hyponatremia and confusion. The disease causes consolidation of lung tissues and impairs gas exchange. Impairs the inc temp usually inc HR in this disease it doesn’t elevate.
Primary atypical pneumonia?
Are characterized by patchy involvement of the lung, largely confined to the alveolar septum and pulmonary interstitium. Atypical denotes a lack of lung consolidation, production of moderate amounts of sputum, moderate elevation of WBC count, and lack of alveolar exudate. Symptoms - fever, headache, muscle aches and pains. Cough is dry and hacking and nonproductive. Diagnosis is based on history, physical findings and chest xrays.
tuberculosis?
Remains one of the deadliest diseases. HIV and TB has increased infections. Is an airborne infection of the M tuberculosis mycobacterium. In immunocompetent persons, the cell-mediated immune response results in the development of a gray white, circumscribed granulomatous lesion, called a Ghon focus, that contains the tubercle bacilli, modified macrophages, and other immune cells.
Primary is a form of the disease that develops in previously unexposed, and therefore unsensitized, person. Is initiated as a result of inhaling droplet nuclei that contain the tubercle bacillus. they are usually asymptomatic and go on to develop latent infection in the T cells and macrophages surround the organism in granulomas that limit their spread. Symptoms can be abrupt, high fever, pleuritis, and lymphadenitis. Miliary TB describes minute lesions, resembling millet seeds, resulting from this type of dissemination that can involve almost any organ, particularly the brain, meninges, liver, kidney and bone marrow.
secondary TB - represents either reinfection from inhaled droplet nuclei or reactivation of a previously healed primary lesion. Present with low grade fevers, night sweats, easy fatigability, anorexia, and weight loss. Is initially dry but later becomes productive with purulent and sometimes blood-tinged sputum.
Diagnosis - Cultures or DNA amplification techniques. Culture must be early morning sputum specimens, gastric aspiration, or bronchial washings during bronchoscopy. Xrays and CT. The TB skin test, measures the delayed hypersensitivity response to an intradermal injection of TB,
Treatment - by eliminating the tubercle bacilli while preventing the spread of infection and development of drug resistant forms of the disease. It is an aerobic organism that multiples slowly and remains relatively dormant in oxygen poor caseous material. Duration is prolonged due to the slow growing nature of the TB that impairs the effectiveness of antibiotics. 1. administer multiple drugs to which the organism are susceptible, 2 to add at least two new drugs when treatment failure is suspected, 3. to provide the safest and most effective therapy in the shortest period of time 4. to ensure adherence to therapy.
Fungal infections?
Are asymptomatic, they can be severe or even fatal in persons who have experienced a heavy exposure, have underlying immune deficiencies or develop progressive disease that is not recognized or treated.
Yeasts or molds - deep fungal infections may produce pulmonary and systemic infections and are sometimes fatal. Usually from environmental dust or spores in the ground or bird droppings. Three forms 1. acute primary disease 2. chronic cavitary pulmonary disease 3. disseminated infection. Striking similarity to TB lesion secondary form. High fever, generalized lymph node enlargement, hepatolsplenomegaly, muscle wasting, anemia, leukopenia, and thrombocytopenia. hoarseness, ulcerations of the mouth and tongue, nausea, vomiting, diarrhea and abd pain.
Treatment - PO and IV antifungal
Cancer of the lung?
Leading cause of cancer related death in US and world. Smoking is the leading cause and the inc in lung cancer maybe from this.
Types - adenocarcinoma, squamous cell lung carcinoma, large cell carcinoma and small cell carcinoma (small is usually mets by when found)
Non small cell adenocarcinoma - is a malignant epithelial cell tumor with glandular differentiation usually women non smokers. Squamous is usually male smokers. Large cell carcinomas have large, polygonal cells have poor prognosis because they spread to distant sites early.
Small cell by a distinctive cell type small round to oval cells that are approx. the size of a lymphocyte. Strongest association with smoking . It is highly malignant, tends to infiltrate widely, disseminate early, and is rarely resectable.
Clinical - they are aggressive, locally invasive, and widely metastasizing tumors.
Mani - depending on location, distant mets, and the occurrence of paraneoplastic syndromes. Divided into 3 categories 1. those due to involvement of the lung and adjacent structures 2. the effects of local spread and mets. 3. nonmets paraneoplastic mani. Anorexia and weight loss. Most common mets to the brain, bone and liver.
Diagnosis and Treatment - careful history and physical exam, CT, bronchoscopy, cytologic of the sputum, Biopsy of lung tissue. MRI PET Classified like other tumors type, nodal involvement and mets.
Treatment - is surgery, radiation and systemic chemo.
for NSCLC. For SCLC is chemo and radiation, prophylactic cranial irradiation if suspected brain involvement.
Respiratory disorders in children?
Most common illness in infancy and childhood. 1. lung development 2. respiratory disorders in the neonate 3. respiratory infections in children.
Lung development - The lungs take much longer to mature. Is a major cause of morbidity and mortality in infants born prematurely. Even at term the lungs are not fully mature. It continues well into childhood. 4 stages: embryonic, pseudoglandular, canalicular, saccular and alveolar stages
ventilation in the neonate - requires coordinated interaction between the muscles of the upper airways, including those of the pharynx and larynx, the diaphragm, and the intercostal muscles of the chest wall.
Airway resistance - normal lung inflation requires uninterrupted movement of air through the extrathoracic airway and intrathoracic airways.
Lung volumes and gas exchange - the functional residual capacity, which is the air left in the lungs at the end of normal expiration, plays an important role in the infant’s gas exchange. 1. it holds the airways open throughout all phases of respiration, 2. it favors the reabsorption of intrapulmonary fluids and 3. it maintains more uniform lung expansion and enhances gas exchange
Control of ventilation - fetal arterial oxygen pressures PO2 normally range from 25 - 30 mm Hg, and CO2 pressures PCO2 range from 45 to 50 mm Hg .independent of any respiratory movements.
Alterations in Breathing Patterns?
Most disorders in the infant or small child produce a dec in lung compliance or an inc in airway resistance manifested by changes in breathing patterns, rib cage distortion, audible respiratory sounds and use of accessory muscles. Grunting is an audible noise emitted during expiration. Nasal flaring helps reduce the nasal resistance and maintain airway patency. Inspiratory retractions are often observed with airway obstruction in infants and small children. Stridor - turbulence of air moving through the obstructed airway produces an audible crowing sound during inspiration.
Respiratory disorders in the neonate? Respiratory Distress Syndrome RDS
The transition requires functioning of the surfactant system, conditioning of the respiratory muscles, and establishment of parallel pulmonary and systemic circulations. Respiratory disorders develop in infants who are born prematurely or who have other problems that impair this transition.
Respiratory Distress Syndrome - RDS is one of the most common in premature infants. Pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse. Surfactant synthesis - is influenced by several hormones, Insulin and cortisol. Insulin tends to inhibit surfactant which is why diabetic moms have kids at risk for RDS. Multiple signs - central cyanosis, breathing become more difficult, and retraction occur. Grunting sound accompany expiration. Fatigue may develop fast. Incubator to keep warm, Continuous monitoring is needed of O2 and pulse, blood glucose monitoring.
Treatment - oxygen supplement, continuous positive airway pressure through NP, and often assisted mechanical ventilation. Exogenous surfactant therapy is used to prevent and treat RDS
Bronchopulmonary dysplasia BPD?
Is a chronic lung disease that occurs in infants, usually preterm infants treated with mechanical ventilation or prolonged oxygen supplementation. Is a disease of infants < 1000g at less than 28 weeks gestation. Include alveolar hypoplasia, variable alveolar wall fibrosis, and minimal airway disease. Is characterized by chronic respiratory distress, persistent hypoxemia when breathing room air, reduced lung compliance, increased airway resistance and severe expiratory flow limitation. Usually demonstrates tachycardia, rapid and shallow breathing, chest retractions, cough and poor weight gain.
Treatment - nutritional support, maintenance of adequate oxygenation, and prompt treatment of infections. Severe requires mechanical ventilation and administration of supplemental oxygen.
Most adolescents and young adults who had severe BPD during infancy have some degree of pulmonary dysfunction, consisting of airway obstruction, airway hyperreactivity or hyper inflation.
Upper airway infections? Lower airway infections? Signs of impending respiratory failure?
Croup - by inspiratory stridor, hoarseness, and a barking cough. Is usually caused by a virus, and is normally not emergent and relieves with cool moist air, but can cause an airway obstruction.
Spasmodic croup - manifests with symptoms similar to those of acute viral croup but without fever and cam be relieved from humidification.
Epiglottitis - is a dramatic, potentially fatal condition by inflammatory edema of the supraglottic area, including the epiglottis and pharyngeal structures. Presents with an acute onset of sore throat and fever. Appears pale, toxic and lethargic and sits with mouth open and chin thrust forward. Can move to Respiratory distress fast.
Treatment is adequate airway and antibiotics.
Lower airway infections - produce air trapping with prolonged expiration.
Acute bronchiolitis is a viral infection of the lower airways, most commonly caused by the respiratory syncytial virus. Fever and diminished appetite. Cyanosis, pallor, listlessness, and sudden diminution in or absence of breath sounds indicate impending respiratory failure. Adequate hydration are needed.
