Exam 4 - Restrictive Flashcards
What is the hallmark of restrictive lung disease?
the inability to increase lung volume in proportion to an increase in alveolar pressure
RLD affects lung expansion and compliance!
2
What factors can cause RLD?
- connective tissue disease
- environmental
- pulm fibrosis
- increase fluid in alveoli or interstitial space
- diseases that limit excursion of diaphgram/ chest
2
RLD leads to reduced surface area for gas diffusion, causing what 2 complications?
V/Q mismatch and hypoxia
2
As lung elasticity worsens, what symptoms manifest in the patients?
hypoxia, inability to clear secretions and hypoventilation
2
In RLD, what changes do you see in FEV/FVC testing and diffusing capacity tests?
What changes in lung volumes?
- reduced FEV1, low FVC= normal or increased ratio!
- reduced diffusing capacity for for CO
- all lung volumes are decreased, especially TLC
2
What is the principal feature of RLD?
decreased TLC!
4
TLC is used to classify Restrictive Lung disease. What is the predicted value of:
mild disease
moderate
severe
mild 65-80%
moderate 50-65%
severe: <50%!
4
Causes of RLD chart
What causes pulmonary edema?
intravascular fluid leakage into the interstitium and alveolar space!
6
Acute pulmonary edema can be caused by what 2 changes in the capillary?
increased capillary pressure or increased capillary permeability
Both of these lead to “capillary stress failure”
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What does pulm edema look like on CXR?
What pattern is seen w/ increased cap pressure?
bilateral, symmetric perihelar opacities!
Butterfly pattern seen w/ increased capillary pressure vs permeability
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Pulm edema caused by increased capillary permeability is characterized by what 2 factors in edema fluid?
a high concentration of protein and secretory products in edema fluid
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In increased permeability pulm edema, what happens to the alveoli?
You get diffuse alveolar damage associated with ARDS
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What are the clinical manifestations of cardiogenic pulmonary edema
cardiogenic pulm edema is seen in decompensated HF
dyspnea
tachypnea
elevated cardiac pressures
SNS activation
7
Cardiopulmonary edema should be suspected if pt has what changes in cardiac pressures?
a decreased systolic or diastolic pressure!
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Risk for cardiogenic pulm edema is increased w/ conditions that increase preload.
What 2 valve dysfunctions cause this?
aortic and mitral valve regurg!
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Risk for cardiogenic pulm edema is also increased w/ conditions that increase afterload or SVR?
What 3 diseases do this?
LV outflow tract obstruction
mitral stenosis
reno vascular HTN
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Negative pressure pulm edema results after the relief of upper airway obstruction.
What are common causes?
aka post obstructive pulm edema
laryngospasm, epiglotttis, tumors, obesity, hiccups, OSA
8
When is the onset of pulm edema after the relief of obstruction?
What are the s/s ?
up to 2 hours post obstruction!
s/s: tachypnea, cough, SpO2 below 95%
may be confused w aspiration or PE!
8
Describe the changes in pressures that occur that cause increased transcapillary pressure gradient leading up to pulm edema
The development of negative intrapleural pressure decrease the interstitial hydrostatic pressure, this increases VR and LV afterload
-this leads to SNS activation, HTN and central displacement of blood
8
What is the treatment of negative pressure pulm edema?
How long does it take to resolve
supplemental O2 and maintence of patent airway!
Mechanival ventilation may be needed
Might resolve in 12-24 hr
9
What is an intrapulmonary shunt?
Right-to-left pulmonary shunting: perfusion of nonventilated alveoli
s30
Neurogenic Pulmonary Edema:
- Develops in a ______ fraction of acute brain injury pts.
- occurs ________ - ________ after CNS injury and may manifest during the periop period.
- A massive outpouring of _____ impulses from the injured CNS causesgeneralized ____________ and blood volume shifting into the _________ circulation.
- the increased pulmonary capillary pressure c/b translocation of blood volume leads to the transfer of fluid into the _________ _________.
- Pulmonary _______ & hypervolemia can also injure blood vessels in the lungs.
- small
- minutes - hours
- SNS
- vasoconstriction
- pulmonary circulation
- interstitium
- alveoli
- HTN
10
What condition can be seen in pts using e-cigarettes and vaping?
EVALI (E-Cigarette Vaping Associated Lung Injury)
S17