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HLSC 222 Pathophysiology 🧫 > Chapter 27 > Flashcards

Chapter 27 Flashcards

1
Q

What is ventilation?

A

Movement of air in and out of lungs

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2
Q

What is oxygenation?

A

Loading oxygen molecules onto hemoglobin

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3
Q

What is respiration?

A

O2 and CO2 exchange of alveoli (External) and systemic capillaries (Internal)

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4
Q

What is Perfusion?

A

Delivery of blood to a capillary bed in tissue

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5
Q

What is Dyspnea?

A

Subjective experience of breathing difficulty
(breathlessness)

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6
Q

Dyspnea: Work of breathing?

A

Is greater than actual result

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7
Q

Dyspnea: Signs?

A

Flaring of nostrils, use of accessory muscles, head bobbing in children

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8
Q

What is Paroxysmal Nocturnal dyspnea?

A

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

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9
Q

What does sputum provide info for?

A

-Color of sputum provides info about progression of disease
-Microscopic appearance allows microorganism identity

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10
Q

What is Hemoptysis?

A

Coughing up of blood

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11
Q

What does Hemoptysis usually indicate?

A

Infection or inflammation of bronchiole
or if severe can mean cancer

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12
Q

What is Eupnea?

A

Normal breathing
-Rythmic and effortless

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13
Q

Eupnea includes a what with each breath?

A

A short expiratory pause

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14
Q

What is the purpose of sighs?

A

1.5 to 2 times normal tidal volume / 10 times per hour to help maintain normal breathing

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15
Q

What are abnormal breathing patterns?

A

Patterns of breathing automatically adjust to minimise work of breathing

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16
Q

What does sighing equal out?

A

Oxygen consumption and carbon dioxide expulsion

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17
Q

What is hyperpnea?

A

Kussmaul respiration that occurs with strenuous exercise

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18
Q

Hyperpnea: Ventilation rate and tidal volume?

A

Increased ventilation rate
Greatly increased tidal volume

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19
Q

During hyperpnea is there a pause?

A

There is no pause at the end of expiration

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20
Q

What is Cheyne-Stokes respiration?

A

Alternating deep and shallow breathing

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21
Q

Cheyne-stokes respiration includes periods of?

A

Includes periods of apnea (stopping breathing)

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22
Q

How long do the apnea periods last during Cheyne-stokes?

A

15-60 secs

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23
Q

What follows apnea periods during Cheyne-stokes?

A

Followed by increased volume ventilation, then returns to normal triggering another period of apnea

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24
Q

What causes Cheyne-stokes?

A

Reduced blood flow to the brain —> reduced brain impulses to respiratory centre

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25
Q

What determines hypo and hyper ventilation?

A

Blood gases

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26
Q

What is hypoventilation?

A

Inadequate ventilation

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27
Q

What issue is associated with Hypoventilation?

A

CO2 removal doesn’t keep up with CO2 production
-CO2 builds up

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28
Q

What is the result of hypoventilation?

A

Hypercapnia
-Increased CO2 in bloodstream

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29
Q

What is Hyperventilation?

A

Alveolar ventilation exceeding needs

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30
Q

What issue is associated with Hyperventilation?

A

Removal of more CO2 than is produced

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31
Q

What is the result of Hyperventilation?

A

Hypocapnia
-Reduced CO2 in bloodstream

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32
Q

What is Cyanosis?

A

Bluish discolouration of skin indicating (insensitively) respiratory failure

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33
Q

What causes cyanosis?

A

Develops when 5 grams of hemoglobin is desaturated

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34
Q

When does Cyanosis become evident?

A

Only evident when it is severe

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35
Q

What are the 2 types of Cyanosis?

A
  1. peripheral
  2. central
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36
Q

What causes peripheral cyanosis?

A

Poor circulation in fingers/toes due to peripheral vasoconstriction

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37
Q

What causes central cyanosis?

A

Decreased arterial oxidation (Low PaO2) from pulmonary disease

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38
Q

Where is peripheral cyanosis best detected?

A

In nail beds

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39
Q

Where is central cyanosis best detected?

A

In Buccal mucosa membranes (lip and cheek lining) and lips

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40
Q

What is Clubbing?

A

Bulbous formations at end of fingertips and toes

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41
Q

What causes Clubbing?

A

Diseases that disrupt pulmonary circulation causing hypoxemia

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42
Q

Is clubbing reversible?

A

rarely reversible

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43
Q

Where is pain from pulmonary disorders localised?

A

Chest wall

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44
Q

What unique sound is caused by pulmonary disorders?

A

Pleural friction rub
-helps pinpoint area affected

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45
Q

What is the pleural friction rub?

A

Pleural walls rub together due to reduced fluid in pleural cavity

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46
Q

How can pain caused by pulmonary disorders often be reproduced?

A

By pressing on sternum or ribs

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47
Q

What is Hypercapnia?

A

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

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48
Q

What does Hypoventilation cause?

A

Decreased drive to breath
Depression of respiratory center
Disease to medulla oblongata

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49
Q

What is the effect of hypoventilation on WOB?

A

Increased work of breathing

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50
Q

What does increased WOB (hypoventilation) lead to?

A

Electrolyte imbalances
Dysrythmia
if severe a coma

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51
Q

How can hypoventilation be confirmed?

A

testing blood gases

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52
Q

What is hypoxemia?

A

Decreased PaO2 in arterial blood

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53
Q

What are the 2 causes of Hypoxemia?

A

1.Related to issues with delivery of O2 to alveoli (ventilation) and delivery of blood to lung (perfusion
2. Thickening of alveolar membrane or destruction of alveoli

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54
Q

What 2 factors is diffusion of Oxygen from alveoli to blood dependent upon?

A
  1. Amount of air entering alveoli (ventilation: V)
  2. Amount of blood perfusing capillaries around alveoli (Q)
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55
Q

What is the most common cause of hypoxemia?

A

Abnormal ventilation/perfusion ratio (V/Q)

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56
Q

What is the normal PaO2?

A

80-100 mmHg

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57
Q

What is PaO2 of severe hypoxemia?

A

<40 mmHg

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58
Q

What is a shunt?

A

Normal perfusion but inadequate ventilation
-Alveolus collapses, low V/Q
-Hypoxemia

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59
Q

What is alveolar dead space?

A

Normal ventilation but inadequate perfusion
-High V/Q
-Hypoxemia

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60
Q

What is Acute respiratory failure?

A

Inadequate gas exchange affecting PaO2, PaCO2 and pH

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61
Q

Acute respiratory failure: PaO2?

A

PaO2 less than 60mmHG

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62
Q

How is acute respiratory failure decreased PaO2 treated?

A

Supplemental oxygen

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63
Q

Acute respiratory failure: PaCO2?

A

PaCO2 is greater than 50

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64
Q

How is acute respiratory increased PaCO2 treated?

A

Ventilatory support

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65
Q

Acute respiratory failure: pH?

A

Less than or equal to 7.25
normal is 7.40

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66
Q

What is a potential complication of any major surgical procedure?

A

Acute respiratory failure

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67
Q

How is acute respiratory failure prevented?

A

Frequent turning and position changes
Deep breathing exercises
Early ambulation

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68
Q

What are some common conditions of acute respiratory failure?

A

Pneumonia
Edema
Embolism

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69
Q

What causes Chest wall restrictions (CWR)?

A

Deformity
Obesity
Neuromuscular disease

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70
Q

What results from CWR?

A

Increased WOB
Decrease in tidal volume, increased breathing rate

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71
Q

What happens when someone with CWR experiences pain from injury, surgery or disease?

A

Hypoventilation

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72
Q

What can CWR lead to?

A

Respiratory failure

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73
Q

What is associated with CWR?

A

Flail chest

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74
Q

What is flail chest?

A

Fracture of consecutive ribs with or without sternum damage

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75
Q

What is the result of a flail chest?

A

Chest wall instability leading to paradoxical movement of chest when breathing

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76
Q

What is paradoxical breathing?

A

Inspiration: Unstable portion of chest wall moves inward (normal= outward)

Expiration: Portion moves outward (normal= inward)

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77
Q

What does paradoxical breathing result in?

A

Impaired ventilation of alveoli

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78
Q

What are some pleural abnormalities?

A
  1. Pneumothorax
  2. Pleural effusion
  3. Empyema
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79
Q

What is pneumothorax?

A

Air or gas in pleural space

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80
Q

What causes a pneumothorax?

A

Rupture to visceral pleura (layer closest to lung)

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81
Q

What is the result of a pneumothorax?

A

Lung tends to collapse

82
Q

What is a pleural effusion?

A

Fluid from blood or lymph in pleural space

83
Q

How is a pleural effusion diagnosed?

A

Chest x-ray
Thoracentesis (needle aspiration)

84
Q

What is Empyema?

A

Infected pleural effusion by microorganism

85
Q

What indicates Empyema?

A

Pus in pleural space

86
Q

What causes empyema?

A

Pulmonary lymphatic tissue becomes blocked leading to contaminated lymphatic tissue moving into pleural space

87
Q

What can lead to empyema?

A

Surgery or bronchial obstruction

88
Q

How is empyema treated?

A

Antibiotics and drainage of pleural space with a chest tube

89
Q

What is restrictive lung disease?

A

Characterized by decreased lung compliance
-Difficulty with inspiration (expanding lungs)

90
Q

restrictive lung disease: WOB at tidal volume?

A

WOB= Increased at tidal volume

91
Q

What are some types of restrictive lung diseases?

A

Aspiration
Atelectasis
Bronchiectasis
Bronchiolitis
Pulmonary fibrosis
Pulmonary edema
COVID-19

92
Q

What is aspiration?

A

Passage of fluids or solids into lungs

93
Q

What causes aspiration?

A

a. Abnormal swallowing mechanism
b. Impaired cough reflex
c. CNS or PNS abnormalities

94
Q

What can aspiration lead to?

A

Pneumonia

95
Q

How is aspiration treated?

A

Bronchoscopy

96
Q

What happens is aspiration is not treated?

A

Inflammation

97
Q

What is Atelectasis?

A

Collapse of lung

98
Q

What are the two types of alveoli collapse?

A
  1. Compression atelectasis
  2. Surfactant impairment (decreased production of surfactant)
99
Q

What causes compression atelectasis?

A

External pressure like a tumor or fluid

100
Q

When does Atelectasis tend to occur?

A

After surgery when using general anaesthetic

101
Q

How is atelectasis treated?

A

Deep breathing exercises to promote ciliary removal of secretions

102
Q

What is bronchiectasis?

A

Persistent abnormal dilation of bronchi (large airways are obstructed)

103
Q

What can cause bronchi to be obstructed leading to Bronchiectasis?

A

Inflammation due to mucous plugs
Chronic inflammation caused by destruction of elastic/muscular bronchi wall

104
Q

What does chronic inflammation of bronchi wall cause?

A

Permanent dilation

105
Q

What symptoms of Bronchiectasis?

A

Chronic productive cough
Large amount of foul-smelling sputum

106
Q

What is bronchiolitis?

A

Inflammatory obstruction of small airways

107
Q

What are 2 kinds of bronchiolitis?

A

Bronchiolitis obliterans
BOOP

108
Q

What is Bronchiolitis obliterans?

A

Fibrosis of airways causing scarring

109
Q

What is BOOP?

A

Alveoli becomes filled with connective tissue

110
Q

How does Bronchiolitis manifest?

A

Rapid ventilatory rate
Dry non-productive cough

111
Q

What is pulmonary fibrosis?

A

Excessive amount of fibrous/conenctive tissue at alveoli

112
Q

What causes pulmonary fibrosis?

A

Scar tissue left from previous disease e.g tuberculosis
-Multiple injuries at different lung sites associated with abnormal healing

113
Q

What results from pulmonary fibrosis?

A

Decreased lung compliance and external respiration (O2/CO2 exchange)

114
Q

What is a symptom of pulmonary fibrosis?

A

Dyspnea on exertion

115
Q

What is pulmonary edema?

A

Excessive water on lungs
(lung should be dry)

116
Q

What causes pulmonary edema?

A

Left side heart disease

117
Q

What is left side heart disease?

A

Left side of heart has reduced cardiac output and blood gets backed up from heart into the lungs and forced into interstitial space between capillary and alveoli

118
Q

Where does blood pressure increase during Left side heart disease?

A

In pulmonary capillaries bc blood igets backed up into lungs

119
Q

When does pulmonary edema occur?

A

When fluid flow exceeds lymph system capability to remove it

120
Q

What can severe COVID-19 manifest as?

A

Viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS)

121
Q

What causes death by ARDS?

A

Host’s runaway immune response not cytotoxic effects of virus

122
Q

How is ARDS managed?

A

Intubation

123
Q

What is obstructive lung disease?

A

Lung diseases causing difficulty with expiration

124
Q

What are some types of obstructive lung diseases?

A

Asthma
COPD

125
Q

What are signs and symptoms of obstructive lung disease?

A

Dyspnea
Wheezing

126
Q

What is asthma?

A

Chronic inflammatory disorder of bronchial mucosa

127
Q

When bronchial mucosa is inflamed what happens?

A

Airways restricted
Hyper-immune response to irritants

128
Q

What is an early asthmatic attack?

A

Classic immune response of dendritic cells, helper T cells, T cells and B cells

129
Q

What is the result of an early asthmatic attack?

A

Inflammation, increased capillary permeability and increased fluid

130
Q

What is a late asthmatic attack?

A

Latent release of inflammatory mediators from original site beginning 4-8 hours after an early attack

131
Q

What is the result of a late asthmatic attack?

A

Increased damage of epithelial cells causing scaring, increased mucus forming plugs and increased airway resistance

132
Q

How does asthma manifest?

A

In between attacks: individuals are normal, pulmonary friction tests are normal

133
Q

If asthmatic bronchospasm are not reversed by usual treatment what is it considered?

A

Status asthmaticus

134
Q

When PaCO2 is greater than 70mmHg with Asthma what is it a sign of?

A

Impending death

135
Q

How is asthma treated?

A

Mild asthma: Short acting inhalers
Persistent: Inhaled corticosteroids

136
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 release antibodies
  5. Helper T cells also activate eosinophil / neutrophils activated / inflammation from both results in airway obstruction
137
Q

What is COPD?

A

Chronic obstructive pulmonary disease

138
Q

What is COPD composed of?

A

Chronic bronchitis and emphysema

139
Q

What is the most common chronic lung disease?

A

COPD

140
Q

What is the fourth leading cause of death worldwide?

A

COPD

141
Q

What is COPD characterised by?

A

-Persistent airflow limitation
-Chronic inflammatory response to noxious particles or gas
-Progressive

142
Q

What is chronic bronchitis?

A

Hypersecretion of mucous, chronic productive cough for at least 3 months of the year fro 2 consecutive years

143
Q

What causes chronic bronchitis?

A

Inspired irritants causing inflammation/thickening of mucous membrane

144
Q

What does inflammation/thickening of mucous membrane cause? (COPD: chronic bronchitis)

A

Reduced radius of airways —> obstruction

145
Q

What is initially affected by chronic bronchitis?

A

Large airways but eventually all airways are affected

146
Q

How does chronic bronchitis cause hypoventilation?

A

Airways collapse early in exhalation so air become strapped in distal portions of the lung leading to hyperinflation

147
Q

What is emphysema?

A

Permanent enlargement of gas-exchange airways and destruction of alveolar walls

148
Q

What causes the emphysema obstruction?

A

Destroyed walls of alveoli
(NOT mucous production or inflammation)

149
Q

What does the destruction of alveolar walls (emphysema) cause?

A

Causes large alveolar spaces which greatly increase diffusion distance between alveoli and capillary

150
Q

What is the result of Emphysema?

A

Reduced O2 and CO2 diffusion
Expiration becomes difficult because of loss of recoil of normal alveoli

151
Q

What is a symptom of emphysema?

A

Shortness of breath

152
Q

What are some Respiratory tract infections?

A

Acute bronchitis
Pneumonia
Tuberculosis

153
Q

What is acute bronchitis?

A

Acute infection causing inflammation of airways

154
Q

Can one recover from acute bronchitis without medicine?

A

Usually they can. It is self-limiting

155
Q

What causes acute bronchitis?

A

Viral infection

156
Q

What are the symptoms of acute bronchitis?

A

Similar to pneumonia
-Non-productive cough aggravated by cold, dry air or dusty air

157
Q

How is acute bronchitis treated?

A

Rest
Aspirin
Cough suppressant
Antibiotics

158
Q

What is Pneumonia?

A

Infection of lower respiratory tract caused by microorganisms
-Many categories of pneumonia exist

159
Q

What is HAP?

A

Hospital acquired pneumonia

160
Q

What is CAP?

A

Community acquired pneumonia

161
Q

What is the second most common health care associated infection?

A

HAP
-1st is UTIs

162
Q

What pathogen most commonly causes pneumonia?

A

Streptococcus pneumoniae

163
Q

What is the infectious route of Strep. pneumoniae?

A

Inhalation of infected individual’s cough

164
Q

How is HAP spread?

A

Suctioning tubes can become colonized with bacterial biofilms
= suction results in seeding lung with bacteria

165
Q

What immune cells are found in the lower respiratory tract?

A

Guardian cells that are alveolar macrophages

166
Q

What do macrophages do in the spread of pneumonia?

A

They present antigens to adaptive immune system and T and B cells become activated. Immune response fills alveoli with debris.
-Microbes release toxins

167
Q

What causes a tuberculosis infection?

A

Mycobacterium tuberculosis

168
Q

What is the leading cause of death from a curable infectious disease?

A

Tuberculosis

169
Q

How is TB transmitted?

A

Person-to-person via airborne droplets

170
Q

What happens when the tuberculosis pathogen reaches the lung?

A

It is engulfed by macrophages and survives and multiplies within them.

171
Q

What occurs when reproduction of the tuberculosis pathogen happens within macrophages?

A

It causes a chemotactic response, leading to more macrophages responding and the formation of a tubercle.

172
Q

What is the dormant stage of tuberculosis?

A

Macrophages begin to die, releasing the pathogen, which forms a center in the tubercle, marking the dormant stage.

173
Q

What happens during the liquification stage of tuberculosis?

A

The tubercle center enlarges, fills with air, and aerobic pathogens start to multiply outside the macrophages

174
Q

What occurs when the liquification of the tubercle continues?

A

The tubercle ruptures, and the pathogens disseminate throughout the lung.

175
Q

What are some pulmonary vascular diseases?

A

Pulmonary embolism
Pulmonary Artery Hypertension
Cor Pulmonale

176
Q

What is a pulmonary vascular disease?

A

Pulmonary blood flow is disrupted causing occlusions (blood vessel blocked) leading to the destruction of vascular bed

177
Q

What is a Pulmonary Embolism?

A

Occlusion of portion of pulmonary vascular bed by embolus

178
Q

What does the effect of a pulmonary embolism depend on?

A

Extent of pulmonary blood flow obstruction
Size of affected vessel
Nature of embolus
Resulting secondary effects

179
Q

What is Pulmonary Artery Hypertension?

A

Mean pulmonary artery pressure is greater than 25mmHg at rest

180
Q

What initiates the pathophysiology of Pulmonary Artery Hypertension?

A

Endothelial dysfunction leads to the overproduction of vasoconstrictors.

181
Q

How does increased growth factor production contribute to Pulmonary Artery Hypertension?

A

It leads to fibrosis and thickening of vessel walls.

182
Q

What is the consequence of fibrosis and thickening of vessel walls in Pulmonary Artery

A

It results in narrowing of vessels, reducing gas exchange.

183
Q

What is the effect of increased pulmonary artery pressure in Pulmonary Artery Hypertension?

A

It leads to increased pressure in the right ventricle.

184
Q

What cardiac condition may arise due to right ventricle hypertrophy in Pulmonary Artery Hypertension?

A

Right ventricle hypertrophy may lead to failure, known as Cor Pulmonale.

185
Q

What is Cor pulmonale?

A

Results from Pulmonary artery hypertension. Right ventricle enlargement due to hypertrophy or dilation or both

186
Q

What occurs because of the increased work on right ventricle during Cor pulmonale?

A

Increased hypertrophy of normally thin-walled heart muscle

187
Q

When the heart muscle becomes hypertrophied (cor pulomnale), what is the result?

A

A pressure overload leading to dilation and hypertrophy causing the failure of the right ventricle

188
Q

What are some Malignancies of the respiratory tract?

A

Laryngeal cancer
Lung cancer

189
Q

What is the primary risk factor for laryngeal cancer?

A

Smoking.
Alcohol + Smoking = increased risk

190
Q

What pathogen is linked to laryngeal cancer?

A

Human papilloma virus

191
Q

What is the most common site for laryngeal cancer?

A

Vocal cords

192
Q

Where does metastasis of laryngeal cancer occur?

A

Lymph nodes
-Distant metastasis is rare

193
Q

How does laryngeal cancer manifest? sign/symptoms

A

Hoarseness, dyspnea, cough
Cough after swallowing

194
Q

How is Laryngeal cancer treated/diagnosed?

A

Biopsy —> Chemo, radiation

195
Q

What is Lung cancer?

A

Tumors on respiratory tract epithelium

196
Q

What is the leading cause of death in Canadians?

A

Lung cancer

197
Q

What is the most common causes of lung cancer?

A
  1. Smoking
  2. Gas exposure
  3. Second-hand smoke
198
Q

What is responsible for causing 90% of lung cancers?

A

Tobacco smoke which contains 30 carcinogens

199
Q

What causes the lung cancer tumours?

A

Growth factors and production of free radicals

200
Q

How is the Bronchial mucosa damaged by lung cancer?

A

Suffers hits from tobacco smoke causing the epithelial layer to take damage

201
Q

Is lung cancer progressive?

A

Yes, metastasis to brain, bone marrow and liver

HLSC 222 Pathophysiology 🧫 (16 decks)

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