diseases of the respiratory system Flashcards by kasia Tatara

What defines respiratory failure?

failure in gas exchange; either failure of oxygenation or failure in CO2 elimination

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How is respiratory failure diagnosed?

 Arterial blood gases (diagnosis of respiratory failure is based on arterial blood gases analysis 
   PaO2
    PaCO2, pH
 Chest imaging
 Chest x-ray
 CT sacn
 Ultrasound
 Ventilation–perfusion scan
 Respiratory mechanics
 Spirometry (FVC, FEV1, Peak flow)
 Respiratory muscle pressures
MIP (maximum inspiratory pressure)
MEP (maximum expiratory pressure)

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What are the different types of respiratory failure?

Type 1: partial; hypoxemic; pO245/50mmHg

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Compare Type 1 and Type 2 respiratory failure

Type 1: associated with acute disease of the lung
ex) pulmonary edema, cardiogenic, noncardiogenic(ARDS), pneumonia, pulmonary hemmorage, lung collapse

Type 2: total; drug overdose, neuromuscular disease, chest wall problems, lung deformity, COPD, bronchial asthma

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Compare acute respiratory failure to chronic respiratory failure

acute: develops over minutes to hours; pH quickly drops below 7.2
ex) ammonia, ARDS

chronic: develops over days, increase in HCO3, slight decrease in pH
ex) polycythemia, cyanosis, cor pulmonale, COPD

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What does the blood lactate concentration imply about the status of the lungs?

reflects the degree of tissue hypoxia
should be measured to fresh venous blood or capillaries
normal levels are between 0.5-1.5mmol/L
concentrations > 3-4mmol/L indicate lactic acidosis

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What is ARDS?

cyanosis refractory to O2 therapy
decreased lung compliance
diffuse infiltrates on chest radiograph

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What encourages ARDS?

 Shock
 Aspiration of gastric contents
 Trauma
 Infections
 Inhalation of toxic gases and fumes
 Drugs and poisons
 Miscellaneous

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What is the pathogenesis of ARDS?

inflammatory mediators causing damage to capillary endothelium, damage to alveolar epithelium, increased alveolar permeability results in alveolar edema and fluid accumulation

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What do the lab tests show in ARDS?

decrease in pO2 (increases with oxygen therapy)
pCO2 initially decreases then increases
tissue hypoxia leads to lactic acidosis: decrease in pH, decrease in HCO3, decrease in BE
increase in lactate concentration and increase in anion gap

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What is acute bronchitis? Signs and symptoms?

frequent bacteria airway infection

cough, expectoration, abnormalities upon auscultation

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What do the lab tests show about acute bronchitis?

increase in inflammatory markers: WBC, neutrophils,ESR, CRP

sputum culture sometimes necessary

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What is pneumonia?

Inflammation and infiltration of lung parenchyma. Typically caused by the infection and the associated immune response

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What is the etiology of pneumonia? Types of pneumonia?

bacterial, fungal, viral, protozoal

Hospital acquired: usually gram - strains
Klebisiella pneumo, Proteus, E.coli
severe course, poor prognosis

Community acquired: usually gram + strains
Diplococcus pneumo, Streptococcus
better course and prognosis

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What are the laboratory tests for pneumonia?

gasometry/acid base status (respiratory failure possible )
CBC with WBC differential; ESR/CRP
electrolytes, urea/BUN, creatinine
microbiological tests

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What are the materials for biological testing in pneumonia?

 Sputum
 Throat swabs
 Bronchoalveolar lavage (BAL)
 Blood

What is bronchial asthma?

chronic inflammatory disease of the respiratory system leads to paraoxysmal bronchial response resulting in bronchospasm and airway obstruction

What are the signs and symptoms of bronchial asthma?

Attacks of wheezing, breathlessness, chest tightness and coughing, occurring more frequently during the night and morning

What are the laboratory tests performed for bronchial asthma suspicion?

 Allergy diagnostics
 skin prick testing (SPT)
 immunglobulin E (total and allergen specific IgE)
 histamine, mast cell tryptase
 Immune complexes
 Exacerbation / Status asthmaticus
 gasometry / Acid-Base Status
 lactate
 Teophylline TDM

How is total serum IgE measured?

immunoassays are used
reference range is: <0.3mg/L
total IgE may be raised in non allergic situations: parasites, vasculitis, tumors

What is COPD?

Irreversible airflow obstruction, usually progressive, caused by an abnormal inflammatory response of lung to harmful dusts and gases

What are COPD lab test results?

gasometry: decrease in pH, pO2, satO2; increase in pCO2
CBC: increase in Ht, HBC, Hb
lactate
sputum culture
serum A-antitypsin deficiency ( patients <41 y.o)

What is pulmonary heart disease?

right heart failure developing in the course of COPD:
chronic respiratory failure, cyanosis, edema, hepatomegaly, dyspnea, cough

chronic increase in respiratory (increase in pCO2) and metabolic acidosis (decrease in pO2)

Why does oxygen therapy require tight monitoring?

because and increase in pO2 may cause respiratory depression, hypercapnea and respiratory acidosis

What is the course of infection in pulmonary tuberculosis?

interaction of mycobacteria with activated macrophages causing caseous necrosis formation...period of cellular immune response which initiates cavity formation the diagnosis of tuberculosis should be confirmed bacteriologically

What are the laboratory tests done to diagnose tuberculosis?

culture and molecular techniques

What are fast culture methods used in TB?

BACTEC: culture medium enriched with 14C or enzymes/substrates (radiometric, colorimetric, or flourescent measurements) LRP test

What are molecular methods used in diagnosing TB?

genetic probe/DNA PCR RFLP/DNA fingerprinting ``` more specifically:  Roche Amplicor (Cobas & “Manual”)  Abbott LCx (LCR)  GenProbe Direct (TMA)  BD ProbeTec ET (SDA) ```

What is sarcoidosis?

``` Idiopathic systemic disease characterized by accumulation of lymphocytes and monocytes in tissues to form caseous granuloma with subsequent changes in the morphology of affected organs ```

What are the lab tests performed when testing for sarcoidosis?

```  CBC  Protein; electrophoresis  CRP or ESR  Blood gases  Angiotensine converting enzyme (ACE) activity  Kidney function tests  Liver function tests ```

What do the lab results show with sarcoidosis?

``` down Lymphocytes up Globulins up CRP/ESR up serum and urinary up ACE up AP, ALT, Bilirubin Circulating immune complexes ```