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Respiratory Sytem > Clinical Application Of Lung Ventilation And Mechanics > Flashcards

Clinical Application Of Lung Ventilation And Mechanics Flashcards

1
Q

What is Atelectasis (Lung collapse)?

Suggest 2 causes related to surfactant

Is it considered reversible?

A
  • Collapse of alveoli
  • Impaired pulmonary surfactant production
  • Impaired pulmonary surfactant function

Yes

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2
Q

Name 3 types of Atelacasis

A
  • Neonatal (Incomplete expansion of lungs)
  • Compression (mainly in adults)
  • Resorption (mainly in adults)
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3
Q

Describe Compression Atelactasis

Suggest 3 causes

A
  • Alveoli collapse due to being compressed
  • Tumour
  • Air in pleural cavity (Pneumothorax)
  • Fluid/ blood in pleural cavity (Pleural Effusion/ Haemothorax)
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4
Q

Describe Resorption Atelactasis

State 3 causes

A
  • Airway obstruction (air in alveoli is resorbed by blood but not replaced hence collapse)
  • Tumour (Bronchial carcinoma)
  • Foreign Body
  • Mucus plugs
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5
Q

In what 2 ways does Atelactasis impair respiratory function

A
  • Collapsed alveoli don’t take part in gas exchange
  • Collapsed alveoli more susceptible to infection (e.g pneumonia), can produce pus which prevents other alveoli from taking part in gas exchange
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6
Q

What is a common setting in which Atelactasis occurs?

List 6 risk factors

A
  • Post op, typically within 24hrs
  • Older age
  • Underlying lung disease
  • Obesity
  • General anaesthesia
  • Chest/ abdominal surgery
  • Poor post op pain control-> Suppressed cough and shallow breathing
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7
Q

What is 1 key intervention used to prevent Post-op Atelactasis

A
  • Good pain management (allows patient to cough and take deep breaths)
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8
Q

What does the term ‘lung collapse’ on its own usually mean?

A

Resorption Atelactasis (due to airway obstruction)

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9
Q

Interstitial Lung Disease is a term for 200 diseases (some are reversible)

What are 3 things these diseases characterised by?
What does it lead to if not treated?

A
  • Fibroblast proliferation
  • Collagen deposition
  • Thickening of Pulmonary Interstitium (increased O2 diffusion distance)
  • Pulmonary fibrosis if untreated
  • Diffuse Pulmonary/ Lung Fibrosis (Involves tissue injury and fibrosis)
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10
Q

What is the Pulmonary Interstitium?

What are 4 contents?

A

Space between Alveoli and capillaries

  • Elastin fibres
  • Collagen fibres (less stretchy than elastin)
  • ECM
  • Fibro
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11
Q

What is Interstitial Lung Disease characterised by?

A

Stiffer lungs with reduced lung volumes (Reduced compliance, increases Elastance)

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12
Q

Give 3 examples of ILD (Interstitial Lung Disease)

A
  • Asbestosis
  • Untreated Hypersensitivity Pneumonitis (Immunologically mediated, caused by repetitive inhalation of antigens, notably to birds)
  • Pneumoconiosis: A general term for a class of ILDs (where dust inhalation has caused interstitial fibrosis)

(Asbestosis and Pneumoconiosis are Occupational/ Environmental causes)

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13
Q

How are RV, FRC, TV, Total Lung Capacity, Vital Capacity and Diffusing Capacity (DCLO) affected in Interstitial Lung Disease?

A

All reduced

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14
Q

Describe the airway diameter in Interstitial Lung Disease

A

Not narrowed, as fibrous tissue exerts radial traction on small bronchioles

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15
Q

What percentage of causes of Interstitial Lung Disease are Idiopathic?

Name 1 CT disease that causes it

A

20%

Rheumatoid Arthritis

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16
Q

What is Farmer’s Lung?

A

Repetitive inhalation of mouldy hay-> Interstitial Lung Disease

17
Q

List 4 symptoms of Interstitial Lung Disease

A
  • Reduced exercise tolerance with dyspnoea on exertion
  • Dry cough
  • Malaise and fatigue
  • Shortness of breath at rest
18
Q

List 5 signs of Interstitial Lung Disease

A
  • Tachypnoea
  • Tachycardia
  • Reduced chest movement
  • Fine crackles (‘Velro’ crackles)
  • Finger clubbing (increased growth of nail bed soft tissue, cant see through gap between 2 adjacent fingers)
19
Q

What is Respiratory Distress Syndrome?

Who is it usually seen in?

A

Premature babies particularly those <30, due to lack of surfactant

20
Q

When is Surfactant produced by type II pneumocytes?

A

In increasing quantities from 32 weeks

21
Q

Describe RDS

A
  • Insufficent surfactant-> High surface tension
  • Lungs harder to expand at birth, some alveoli
    remain collapsed
  • More effort to breathe-> Impaired ventilation
22
Q

What are 3 signs of RDS in babies?

A
  • Cyanosis
  • Grunting
  • Intercostal and Subcostal recession (muscles pull sharply inwards)
23
Q

How do we treat RDS?

A
  • Surfactant replacement via an Endotracheal tube

- Supportive treatment with oxygen and assisted ventilation

24
Q

What is the primary cause of COPD?

A
  • Smoking and/ or inhaled pollutants interacting with genetic variability
25
Q

What is COPD characterised by?

What do all conditions share?

A

Chronic respiratory symptoms interacting with associated pulmonary abnormalities

Impaired airflow that is not fully reversible

26
Q

What 2 medical conditions are included in the classic definition of COPD

A
  • Chronic Bronchitis
  • Emphysema

(They actually co-exist)

27
Q

What is Chronic Bronchitis?

What are 6 features?

A

Inflammation of Bronchi and Bronchioles

  • Reduced Cilia
  • Hypersecretion of Mucus
  • Reduced effectiveness of cilia
  • Impaired clearance of mucus
  • Altered surface tension in airways (due to mucus)
  • Epithelial remodelling
28
Q

What is the clinical diagnosis of Chronic Bronchitis

A
  • Cough producing sputum for more than 3 months, lasting for more than a year
29
Q

What happens in Emphysema?

What are 5 features?

A

Loss of elastin and breakdown of alveolar walls

  • Increased lung compliance
  • Decreased elastic recoil
  • Non reversible narrowing of small airways (less radial traction)
  • Loss of alveolar SA for gas exchange
  • Air trapping (air can’t exit alveoli due to reduced elastic recoil)

(Harder for lungs to return to original volume after easier expansion)

30
Q

In Emphysema, how do the lungs appear at rest?

A

Hyper inflated, with the appearance of a ‘Barrel Chest’

31
Q

What are 3 symptoms of Emphysema?

A
  • Breath shortness
  • Reduced exercise tolerance
  • Cough
32
Q

What is a rarer cause of Emphysema? (Smoking is a common cause)

When does it present?

A
  • Alpha-1 Antitrypsin deficiency, leads to Elastin destruction. (Alpha 1 antitrypsin is an Antiprotease)
  • Presents at an early age
33
Q

What happens to pleural pressure if the chest wall/ lung is breached and enters the pleural space

A
  • Air flow into pleural space down pressure gradient
  • Until intrapleural pressure= atmospheric pressure
  • This breaks the pleural seal, so lungs collapse towards hilum and chest’s elastic recoil can’t counter it
34
Q

What is Hypoventilation?

A

Failure to breathe rapidly/ deeply enough due to poor expansion of Thoracic Cavity/ Lungs

35
Q

List 4 causes of Hypoventilation

What is the defining feature?

A
  • Respiratory muscle weakness
  • Severe thoracic wall deformity
  • Very stiff lungs
  • Severe airway obstruction

Hypercapnia

36
Q

What are 5 causes of Respiratory Muscle weakness?

A
  • Brainstem injury
  • Spinal cord trauma
  • Intercostal nerve damage/ abnormalities
  • Neuromuscular Junction defect (Myasthenia Gravis)
  • Upper airway obstruction

Respiratory Sytem (21 decks)

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