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Patho > Ch 27- Alteration in Pulmonary Function > Flashcards

Ch 27- Alteration in Pulmonary Function Flashcards

1
Q

what does ventilation mean?

A

movement of air in and out of lungs

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2
Q

what does oxygenation mean?

A

loading oxygen molecules onto hemoglobin

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3
Q

what does respiration mean?

A

O2 and CO2 exchange of alveoli (external) and systemic capillaries (internal)

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4
Q

what does perfusion mean?

A

delivery of blood to a capillary bed in tissue

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5
Q

what does dyspnea mean?

A

breathlessness
- experience of breathing difficulty
- work of breathing is greater than the actual result
- signs: flaring of nostrils/use of accessory muscles/head bobbing in children

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6
Q

what does paroxysmal nocturnal dyspnea mean?

A

pulmonary condition that wakes you gasping for breath in the middle of the night

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7
Q

what is sputum?

A

the color provides information about progression of disease. Microscopic appearence allows microogranism identity

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8
Q

what does hemoptysis mean?

A

coughing up of blood= usually indicates infection or inflammation of the bronchiole
- if severe can indicate cancer

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9
Q

what does eupnea mean?

A

normal breathing

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10
Q

what are some abnormal breathing patterns?

A

-patterns of breathing automatically adjust to minimize WOB
- purpose of sigh: 2 tidal volume/ 10 times per hour, helps maintain normal breathing, equals out oxygen consumption and carbon dioxide expulsion

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11
Q

what does hypernea mean?

A

Kussmaul respiration occurs with strenuous exercise
- increased ventilation rate/ greatly increased tidal volume
- no pause at end of expiration

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12
Q

what is cheyne-stokes respiration?

A

Alternating deep/shallow breathing
- Includes periods of apnea, followed by increased volume ventilations, ventilation then returns to normal, triggering another period of apnea
- Cause: reduced blood flow to brain/reduced brain impulses to respiratory center

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13
Q

what does hypoventilation mean?

A
  • inadequate ventilation
  • Issue: co2 removal doesnt keep up with co2 production
  • Result: hypercapnia (increased co2 in blood stream)
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14
Q

what does hyper ventilation mean?

A

alveolar ventilation exceeding needs
- Issue: removal of more co2 than is produced
- Result: hypocapnia (reduced co2 in blood stream)

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15
Q

what does cyanosis mean?

A

bluish discoloration of skin
- Cause: develops when 5 grams of hemoglobin is desaturated
- Cyanosis is not evident until it is severe= insensitive indicator of respiratory failure

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16
Q

what are the 2 types of cyanosis?

A
  1. Peripheral cyanosis:
    - Cause: poor circulation in fingers/toes due to peripheral vasoconstriction
    - Best seen in nail beds
  2. Central cyanosis:
    - Cause: decreased arterial oxidation (low PaO2) from pulmonary disease
    -Best detected in buccal mucosa membranes and lips
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17
Q

what does clubbing mean?

A

-bulbous formation at end of fingertips and toes
- Cause: diseases that disrupt pulmonary circulation causing hypoxemia/rarely reversible

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18
Q

what is the pain from pulmonary disorders?

A
  • almost always localized in chest wall/ can be pinpointed by unique sound called the pleural fiction rub
  • pain can often be reproduced by pressing on sternum or ribs
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19
Q

what does pleural fiction rub mean?

A

pleural walls rub together due to reduced fluid in pleural cavity

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20
Q

what is hypercapnia?

A

increased CO2 in blood (increased PaCO2) caused by hypoventilation of alveoli

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21
Q

what does hypoventilation cause?

A
  • decreased drive to breath
  • depression of respiratory center
  • disease to medulla oblongata
  • result: increased work of breathing
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22
Q

what is the effect of hypoventilation?

A
  • electrolye (ionic) imbalances
    = Dysrhythmia (irregular heart rate)
  • severe= coma
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23
Q

what does hypoxemia mean?

A

decreased PaO2 in arterial blood

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24
Q

what are the 2 causes of hypoxemia?

A
  1. issues with delivery of O2 to alveoli and delivery of blood to lung
  2. thickening of alveolar membrane or destruction of alveoli
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25
Q

what 2 factors does the diffusion of O2 from alveoli to blood depend upon?

A
  1. amount of air entering alveoli
  2. amount of blood perfusing capillaries around alveoli
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26
Q

what does shunt mean?

A

normal perfusion/inadequate ventilation

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27
Q

what does alveolar dead space?

A

inadequate perfusion/normal ventilation

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28
Q

what is acute respiratory failure?

A

inadequate gas exchange such that:
- PaO2 is less than 60 mmHg
- PaCo2 is greater than 50
- pH less than or equal to 7.25
potential complication of any major surgical procedure
prevention: frequent turning and position changes/deep breathing exercises/early ambulation
most common conditions are pneumonia, edema, embolism

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29
Q

what is chest wall restrictions?

A
  • cause: deformity/obesity/neuromuscular disease
  • result: increased work of breathing/usually decrease in tidal volume
  • pain from injury, surgery, disease can cause hypoventilation
    = decreased tidal volume/increased breathing rate and can lead to respiratory failure
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30
Q

what is flail chest?

A

fracture of consecutive ribs with/without sternum damage
- Result: chest wall instability= paradoxical movement of chest when breathing

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31
Q

what is paradoxical breathing?

A

Inspiration: unstable portion of chest wall moves inward (normal movement would be outward)
Expiration: portion moves outward (normal movement would be inward)
- Result: impaired ventilation of alveoli

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32
Q

what are the 2 pleural abnormalities?

A
  1. Pneumothorax:
    - air/gas in pleural space
    - cause: rupture to visceral pleural
    - result: lung tends to collapse
  2. Pleural effusion:
    - fluid in pleural space/from blood or lymph
    - diagnosis: chest x ray or thoracentesis: needle aspiration
33
Q

what is an empyema?

A

infected pleural effusion by microorganism
- Indication: pus in pleural space
- Cause: pulmonary lymphatic tissue becomes blocked= contaminated lymphatic fluid moves into pleural space
- Result of surgery, or bronchial obstruction

34
Q

what does restrictive lung diseases mean?

A

difficulty with inspiration (expanding their lungs)

35
Q

what does obstructive lung diseases mean?

A

difficulty with expiration

36
Q

what does aspiration mean?

A

passage of fluids/solids into lungs
- Cause: abnormal swallowing mechanism/cough reflex impaired/ can lead to pneumonia

37
Q

what are restrictive lung diseases?

A

characterized by decreased lung compliance= increased work of breathing at tidal volume

38
Q

RLD- what is atelectasis?

A

collapse of lung
- tends to occur after surgery when using general anesthetic

39
Q

what are the 2 types of alveoli collapse?

A
  1. compression atelectasis: caused by external pressure (tumor or fluid)
  2. surfactant impairment: decreased production of surfactant
40
Q

RLD: what is bronchiectasis?

A

persistent abnormal dilation of bronchi (large airways)

41
Q

what are the causes of obstruction?

A
  • inflammation due to mucus plugs
  • chronic inflammation= destruction of elastic/muscular bronchi wall= permanent dilation
42
Q

what are the symptoms of restrictive lung diseases?

A
  • chronic productive cough
  • large amount of foul-smelling sputum
43
Q

RDL: what is bronchiolitis?

A

inflammatory obstruction of small airways

44
Q

what is bronchiolitis obliterans?

A

fibrosis of airways= scaring

45
Q

what is BOOP?

A

alveoli becomes filled with connective tissue

46
Q

what are the manifestations of bronchiolitis?

A
  • rapid ventilatory rate
  • dry non-productive cough
47
Q

RDL: what is pulmonary fibrosis?

A
  • excessive amount of fibrous/connective tissue at alveoli
  • Cause: scar tissue left from previous disease
  • Result: decreased lung compliance and external respiration
  • Results from multiple injuries at different lung sits associated with abnormal healing
  • Symptom: dyspnea on exertion
48
Q

RDL: what is pulmonary edema?

A

excessive water on lungs
- Cause: left side heart disease= reduced left side cardiac output= blood backed up from heart into lungs= increased blood pressure in pulmonary capillaries=fluid forced into interstitial space between capillary and alveoli
- when fluid flow exceeds lymph system capability to remove= pulmonary edema occurs

49
Q

RDL: what is COVID-19?

A

manifested as viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS)
- post mortem studies: mortality patients had undetectable viral loads (cytotoxic effects of virus not main cause of death, death caused by host’s runaway immune response
= management: intubation

50
Q

OLD: What is asthma?

A

chronic inflammatory disorder of bronchial mucosa
- inflammation= restriction of airways and hyper immune response to irritants

51
Q

What are the characteristics of an early asthma attack?

A
  • Classic immune response: dendritic cells/ helper T cells/ T cell and B cell
  • Result= inflammation, increased capillary permeability, increased fluid
52
Q

what are the characteristics of a late asthmatic attack?

A
  • begins 4-8 hours after early attack
  • latent release of inflammatory mediators from original site
  • Result: increased damage of epithelial cells= scaring/ increased mucus forming plugs/ increased airway resistance
53
Q

what is the manifestation of asthma?

A
  • Induviduals normal between attacks/ pulmonary function tests are normal
  • If bronchospasms not reversed by usual treatment: considered status asthmaticus and if PaCO2 greater than 70 mmHg= sign of impending death
54
Q

what is the pathophysiology of asthma?

A
  1. Inhaled antigen passes epithelial layer
  2. Antigen binds to mast cells= release of mediators
  3. Mediators= mucus production in airway/broncho spasm/edema from increased capillary permeability
  4. Dendritic cells present antigen to Helper T cells= activate B cells/ activated B cells antibodies
  5. Helper T cells also activate eosinophil/ neutrophils activated/ inflammation from both results in airway obstruction
55
Q

What is COPD characterized?

A
  • Persistent airflow limitation
  • Chronic inflammatory response to noxious particles or gas
  • Progressive
56
Q

what is COPD composed of?

A
  • Chronic Bronchitis
  • Emphysema
57
Q

What is Chronic bronchitis?

A

hypersecretion of mucus/chronic productive cough for at least 3 months of the year for 2 consecutive years

58
Q

what is the cause of chronic bronchitis?

A

inspired irritants= inflammation/thickening of mucous membrane= reduced radius of airways= obstruction
- Airways collapse early in exhalation= air trapped in distal portions of lung= hyperinflation= hypoventilation

59
Q

what is emphysema?

A

permanent enlargement of gas exchange airways/ destruction of alveolar walls
- obstruction due to destroyed walls of alveoli not mucus production or inflammation
- destruction= large alveolar spaces= greatly increases diffusion distance between alveoli and capillary

60
Q

what is the result of emphysema?

A
  • reduced O2 and CO2 diffusion
  • expiration becomes difficult because of loss of recoil of normal alveoli
61
Q

what is acute bronchitis?

A
  • acute infection/inflammation of airways
  • usually self limiting
  • occurs due to viral infection
  • sym: non productive cough aggravated by cold, dry air, dusty air
    TX: rest, aspirin ,cough suppressant, antibiotics
62
Q

what is pneumonia?

A
  • infection of lower respiratory tract caused by microorganisms
  • HAP: hospital acquired pneumonia
  • CAP: community acquired pneumonia
  • pathogen: streptococcus pneumoniae
63
Q

what is the pathophysiology of pneumonia?

A
  • guardian cells of lower respiratory tract are cellular alveolar macrophages
  • macrophages present antigens to adaptive immune system= activation T and B cells
  • Resulting immune response can fill alveoli with debris
64
Q

what is tuberculosis?

A

caused by mycobaterium tuberculosis
- leading cause of death from curable disease
- transmission person to person by airborne droplets

65
Q

what is the pathophysiology of tuberculosis?

A
  1. pathogen in lung gets engulfed by macrophage and manages to survive and multiply
  2. multiplication causes chemotactic response making more macrophages forming a tubercle
  3. macrophage dies releasing pathogen, forms a center in tubercle- DORMANT STAGE
  4. tubercle center enlarges (liquefaction)/ fills with air/ aerobic pathogen start to multiply outside macrophage
  5. Liquefaction continues/ tubercle ruptures/ pathogens disseminate throughout lung
66
Q

what is a pulmonary embolism?

A

occlusion of portion of pulmonary vascular bed by embolus

67
Q

what is the pathophysiology of a pulmonary embolism?

A

effect depends on:
- extent of pulmonary BF obstruction
- size of affect vessel
- nature of embolus
- resulting secondary effects

68
Q

what is an occlusion?

A

blocking or closing of blood vessel

69
Q

what is pulmonary artery hypertension?

A

mean pulmonary artery pressure greater than 25 mmHG at rest

70
Q

what is the pathophysiology of pulmonary artery hypertension?

A
  • endothelial dysfunction/ overproduction of vasoconstrictors
  • increased growth factors= fibrosis= thickening of vessel walls= narrowing of vessels/ gas exchange reduced
  • increase in pulmonary artery pressure= increased pressure in right ventricle= right ventricle hypertrophy= failure
71
Q

what is Cor pulmonale?

A

right ventricle enlargement due to hypertrophy or dilation or both
- the result of pulmonary artery hypertension

72
Q

what does an increase work of right ventricle mean?

A

an increased hypertrophy of normally thin-walled heart muscle
- pressure overload= dilation/hypertrophy= failure of right ventricle

73
Q

what is the primary factor of laryngeal cancer?

A

smoking/ risk increases when smoking combined with alcohol consumption

74
Q

what pathogen is linked to laryngeal cancer?

A

human papillomavirus (HPV)

75
Q

what are the manifestations of laryngeal cancer/

A
  • hoarseness
  • dyspnea, cough
  • cough following swallowing
76
Q

what is the pathophysiology of laryngeal cancer?

A
  • carcinoma of vocal cords most common site
  • metastasis occurs in lymph nodes, but distant metastasis is rare
77
Q

what is lung cancer?

A
  • tumors on respiratory tract epithelium
  • leading cause of death in canadians
  • common cause= smoking, gas exposure, second-hand smoke
78
Q

what is the pathophysiology of lung cancer?

A
  • tumour: result of growth factors and production of free radicals
  • bronchial mucosa: suffers “hits” from tobacco smoke= epithelial damage
  • progression: metastasis to brain, bone marrow and liver

Patho (7 decks)

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