HLTH 2501: chronic obstructive pulmonary disease, restrictive disorders and vascular disorders Flashcards
chronic obstructive pulmonary disease
is a group of common chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in the airways of lungs
types of COPD
emphysema, chronic bronchitis, and acute asthma
restrictive lung diseases
silicosis, asbestosis, and farmer’s lung; these are restrictive because the irritant causes interstitial inflammation and fibrosis, resulting in loss of compliance or ‘stiff lung’
results of COPD
irreversible and progressive damage to the lungs and respiratory failure may result due to severe hypoxia or hypercapnia; can also lead to right-sided CHF
another name for right-sided CHF
cor pulmonale
emphysema
is destruction of the alveolar walls and septae, leading to large, permanently inflated alveolar air spaces
why do alveoli destruct in emphysema?
a deficiency of alpha 1 -antitrypsin, genetic factors, cigarette smoking, and air pollution
alpha 1-antitrypsin
is a protein that inhibits the activity of proteases which are destructive enzymes released by neutrophils during an inflammatory response; ex. elastase
what occurs in emphysema
alveolar wall breakdown, fibrosis and thickening of the bronchial walls, difficulty with expiration, and loss of tissue
what occurs when the alveolar walls breakdown in emphysema?
loss of SA for gas exchange, loss of pulmonary capillaries, loss of elastic fibres, altered ventilation-perfusion ratio, and decreased support for other structures like the small bronchi
how do the bronchial walls thicken and fibrosis in emphysema?
due to chronic irritation and the frequent infections associated with smoking and increased mucus production
result of fibrosis and thickened bronchial walls in emphysema?
narrowed airways, weakened walls. and interface with passive expiratory airflow
what is the result of progressing difficulty with expiration in emphysema?
air trapping, increased residual volume, overinflation of the lungs, fixation of the ribs in an inspiratory position, and the diaphragm will appear flattened on x-rays
what does loss of tissue in emphysema result in?
adjacent alveoli fuse, forming large air spaces; there may be holes in the lungs; tissue or pleural membrane may rupture, resulting in pneumothorax; hypercapnia occurs; infections develop often; and cor pulmonale may develop
blebs
air filled-spaces in the lungs cause by damaged alveoli fusing, forming air spaces
cor pulmonale in emphysema
this may develop as a result of loss of tissue because the pulmonary blood vessels are destroyed and hypoxia causes pulmonary vasoconstriction; the increased pressure increases resistance to the right ventricle, causing it to eventually fail
signs of emphysema
dyspnea, hyperventilation with a prolonged expiration, barrel chest position, anorexia, fatigue, clubbed finger, and secondary polycythemia
barrel chest
occurs with hyperventilation in emphysema and is a position of sitting and leaning forward to facilitate breathing
testing for emphysema
chest X-rays and pulmonary function tests (these looks at residual volume and total lung capacity)
treatment for emphysema
avoidance of respiratory irritants, immunization against influenza and pneumonia, appropriate exercise to facilitate breathing, learning breathing techniques (pursed lip breathing), adequate nutrition and hydration, bronchodilators, and lung reduction surgery
chronic bronchitis
is characterized by significant changes in bronchi resulting from chronic irritation from smoking or exposure to industrial pollution; this results in inflammation, obstruction, repeated infections, and chronic coughing
how does chronic bronchitis develop?
exposure to irritants causes the mucosa to be inflamed and swollen, causing hypertrophy and hyperplasia of the mucus glands and increased mucus secretion; fibrosis and thickening of the bronchial walls also occurs, causing obstruction
complications of chronic bronchitis
low O2 leads to cyanosis; dyspnea and fatigue interfere with nutrition and communication; and cor pulmonale may develop
causes of chronic bronchitis
cigarette smoking, urban area (air pollution), and sometimes asthma
signs of chronic bronchitis
constant cough (worse in the am), tachypnea with and shortness of breath, purulent and thick secretions, hypoxia leading to cyanosis, hypercapnia, secondary polycythemia, weight loss, and signs of cor pulmonale
treatment for chronic bronchitis
reducing exposure to irritants, influenza and pneumonia vaccines, antimicrobials, bronchodilators, chest therapy, and low-flow oxygen and nutritional supplements
bronchiectasis
is usually a secondary problem and is a irreversible dilation of the medium-sized bronchi
what may cause bronchiectasis?
CF, COPD, childhood. infection, aspiration of foreign bodies, of a congenital weakness in the bronchial wall
two types of dilations in bronchiectasis
saccular or elongated (fusiform)
how does bronchiectasis develop?
recurrent inflammation and infection in the airways leads to the weakening of the muscle and elastic fibres in the bronchial wall, in which fibrous adhesions may pull the wall outward, dilating it
infections and bronchiectasis
in dilated and ballooning areas, large amounts of fluid collect and become infected; the infections can cause a loss of cilia and metaplasia in the epithelium, causing additional fibrosis
what organisms often cause infection in bronchiectasis?
streptococci, staphylococci, pneumococci, and H influenzae
signs of bronchiectasis
chronic cough, copious production of purulent sputum, rales and rhonchi, foul breath, dyspnea, hemoptysis, weight loss, anemia, and fatigue
treatment for bronchiectasis
antibiotics, bronchodilators, and chest PT
restrictive lung disorders
a group of diseases in which lung expansion is impaired and total lung capacity is reduced
restrictive lung disorders two groups
those in which an abnormality of the chest wall limits lung expansion and those in which lung disease impairs expansion
restrictive disorders in which an abnormality of the chest wall limits expansion
includes conditions like kyphosis, scoliosis, poliomyelitis, ALS, muscle dystrophy, or botulism
botulism
respiratory muscle paralysis
restrictive disorders in which lung disease impairs expansion
is when the tissues providing the supportive framework are effected; includes idiopathic pulmonary fibrosis, pulmonary edema, and occupational disease from inhaled irritants
pneumoconioses
are chronic restrictive diseases resulting from long-term inhalation of irritating particles like asbestos
how does pneumoconiosis develop?
the normal defence in the upper tract cannot handle the overload of foreign material with long-term exposure; inflammation and fibrous tissue then develop, causes loss of function and frequent infections
types of pneumoconiosis
coal workers disease, silicosis, asbestosis, and farmer’s lung
coal workers disease
is caused by coal dust in mines
silicosis
is caused by silica in stone-cutting, sand-blasting and mines
farmers lung
is caused by fungal spores from hay
effects of asbestos fibres
frequent cause pleural fibrosis and increase the risk of lung cancer
signs of pneumoconiosis
dyspnea, effort for inspiration, and cough
pulmonary edema
refers to fluid collecting in the alveoli and instersital area; this reduces gas exchange
why does excess fluid develop in pulmonary edema?
inflammation in the lungs (increases capillary permeability), low plasma proteins (decreases plasma osmotic pressure), and pulmonary hypertension
results of pulmonary edema
inference of gas exchange, hypoxemia, decreased action of surfactant, difficulty expanding lungs, capillary rupture, and blood sputum
causes of pulmonary edema
left sided CHF, hypoproteinemia (caused by kidney or liver disease), inflammation from inhalation of toxic gases or tumors, or blocked lymphatic drainage from fibrosis
signs of mild pulmonary edema
cough, orthopnea, and rales
signs of severe pulmonary edema
hemoptysis, frothy and bloody sputum, labored breathing, hypoxemia, cyanosis, and paroxysmal nocturnal dyspnea
treatment for pulmonary edema
treating causative factors, positive pressure mechanical ventilation, and upper position elevated position
pulmonary embolus
is a blood clot or mass of other material that obstructs the pulmonary artery or a branch of it, blocking the flow of blood through the lung tissue
what are most pulmonary embolus a result of?
are thrombi or blood clots originating from the deep leg veins; this may be caused by phlebothrombosis or thrombophlebitis
effects of a small pulmonary emboli
are often silent or asymptomatic but multiple small ones can be dangerous
signs of a small pulmonary emboli
chest pain, cough, and dynspea
effects of a medium sized pulmonary emboli
can cause respiratory impairment and pulmonary infarction; reflex vasoconstriction also occurs, obstructing the vessel further
signs of a medium sized emboli
chest pain, tachypnea, dyspnea, hemoptysis, fever, and hypoxia
effects of a large sized pulmonary emboli
can cause right sided CHF, decreased CO (shock), and sudden death
signs of a large size emboli
severe crushing chest pain, low BP, rapid weak pulse, and loss of consciousness
risk factors for thrombi forming in the legs
immobility, trauma or surgery to the legs, childbirth, CHF, dehydration, and cancer
fat emboli
occur from loss of bone marrow resulting from a fracture of a large bone (ex. femur)
types of emboli
thrombi from the leg veins, fat emboli, vegetations resulting from endocarditis in the right side of the heart, amniotic fluid, tumor cells, or air
signs of a fat emboli
show separate signs like acute respiratory distress, a rash on the trunk, and neurologic signs like confusion
diagnosis for pulmonary edema
X-ray, lung scan, MRI, and pulmonary angiography; the source can be identified using doppler ultrasound or venography
treatment of pulmonary edema
includes assessing risk factors, compression stockings, filter surgically inserted in the inferior vena cava, heparin to remove clots, or mechanical ventilation
