HLTH 2501: obstructive lung diseases Flashcards
cystic fibrosis
is an inherited disorder that involves several mutations to the CFTR and also a protein involved in chloride ion transport into the cell membrane
CFTR
cystic fibrosis transmembrane conductance regulator
major effect of cystic fibrosis
exocrine glands cause abnormally thick secretions often obstructing passageways in the lungs and pancreas
obstruction in the lungs due to cystic fibrosis
mucus obstructs the airflow in the bronchioles, causing air trapping or atelectasis; infections are also common here due to the stagnant mucus that is good for bacterial growth
common causative organisms for secondary infections in cystic fibrosis
P aeruginosa and S aureus
what will eventually develop with cystic fibrosis?
respiratory failure or right-sided CHF
cystic fibrosis in the digestive tract
in infants, the small intestine is blocked by mucus at birth; in the pancreas and liver, the ducts of the exocrine glands become blocked, leading to a deficit of pancreatic enzymes and bile in the intestine, resulting in malabsorption and malnutrition; damage to the islets of Langerhans may also occur, leading to diabetes mellitus
meconium ileus
occurs in newborns with cystic fibrosis, in which the small intestine is blocked by mucus
general effects of cystic fibrosis in the digestive tract
malabsorption, malnutrition, and dehydration
salivary glands and cystic fibrosis
are mildly affected, with secretions that are abnormally high in NaCl and mucus plugs in the submaxillary and sublingual glands
sweat glands and cystic fibrosis
they produce sweat high in NaCl content
what can obstruction of bile ducts in the liver result in?
biliary cirrhosis
reproductive system and cystic fibrosis
thick mucus may obstruct the vas deferens in males or the cervix in females, leading to sterility or infertility
genetical inheritance for cystic fibrosis
the mutated gene is CFTR and is located on the seventh chromosome and is transmitted as an autosomal recessive disorder
signs of cystic fibrosis
meconium ileus at birth, salty skin, steatorrhea, distended abdomen, failure to gain weight, chronic cough, common respiratory infections, and failure to meet normal growth milestones
testing for cystic fibrosis
can be done through genetic testing to identify the CFTR mutations at birth, sweat or stool can also be analyzed, as well as X-rays, pulmonary function tests, and blood gas analysis
treatment for cystic fibrosis
replacement of pancreatic enzymes and bile salts, a well balanced diet (high calorie, high protein, low fat, and vitamin supplementation), avoiding dehydration, intensive chest PT, bronchodilators, humidifiers, and regular moderate aerobic exercise
example of a pancreatic enzyme replacement drug
pancrelipase
what is often the cause of death for cystic fibrosis?
respiratory failure
lung cancer
is the third most common cancer in the US and is most often malignant tumors that are primary or secondary
why are the lungs a common site for secondary tumors?
because the venous return and lymphatics bring tumor cells from many distant sites in the body to the heart and then into the pulmonary circulation
two main groups of lung cancers
small cell lung cancer (13%) and nonsmall cell lung cancer (84%); differences between these groups are cellular morphology, rate of metastasis, and treatment
small cell lung cancer
the cells are smaller and round, spread rapidly, and have a higher mortality rate; often is associated with smoking and is resistant to chemo
nonsmall cell lung cancer
the cells are larger, the spread is less aggressive, and responds well to chemo
subtypes of nonsmall cell lung cancer
adenocarcinoma, squamous cell carcinoma, and large cell carcinoma
the most common type of lung tumor
bronchogenic carcinoma; this arises from the bronchial epithelium
squamous cell carcinoma
usually develops in the epithelial lining of a bronchus near the hilum and projects into the airway
adenocarcinomas
are from glands that secrete mucin and are found on the periphery of the lung, making them harder to detect in the early stages
oat cell carcinoma
are located near a major bronchus in the central part of the lung; tend to be invasive and metastasize early
mesothelioma
has received attention from legal firms as it may be caused by asbestos exposure
pleural mesothelioma
most often affects the pleura surrounding the lungs; usually is fatal
first change in the lungs for lung cancer
is metaplasia which is a change in the epithelial tissue often associated with smoking or chronic irritation, leaving the tissue vulnerable to irritants and inflammation
second change in the lungs for lung cancer
dysplasia or carcinoma in situ develops
common site for tumors spreading from the lungs
brain, bone, and liver
effects of tumors in the lungs
obstruction of airway flow causing abnormal breath sounds and dyspnea, inflammation that causes a cough, vulnerability to secondary infections, pleural effusion, paraneoplastic syndrome, and systemic effects of cancer
paraneoplastic syndrome
may accompany bronchogenic carcinoma when the tumor cell secretes hormones or hormone like substances such as ADH or adrenocorticotropic hormone
what do tumors on the periphery of the lung often result in?
hemothorax (blood in the pleural space), pneumothorax (air in the pleural cavity), and pleural effusion (fluid in the pleural cavity)
risk factors for developing lung cancer
smoking, second hand smoke, genetic factors, chronic obstructive pulmonary disease, exposure to carcinogens such as silica, vinyl chloride, or asbestos
4 possible categories of signs of lung cancer
those related to the direct effects of tumor on the respiratory structures, those representing the systemic effects of cancer, those caused by associated paraneoplastic syndromes, and those resulting from metastatic tumors at other sites
early signs related to respiratory involvement of lung cancer
persistent cough, dyspnea, wheezing, hemoptysis (coughing up blood), pleural effusion, pneumothorax, hemothorax, chest pain, hoarseness, facial or arm edema, headache, or atelectasis
systemic signs of lung cancer
weight loss, anemia, and fatigue
paraneoplastic syndrome signs of lung cancer
is indicated by the signs of an endocrine disorder related to the specific hormone secreted
signs of a metastasis of lung cancer
specific to the site; ex. bone spread can cause bone pain or a pathologic fracture
diagnostic testing for lung cancer
X-ray, CT, MRI sputum cytology, or biopsy; helical CT and MRI are most effective
treatment for lung cancer
radiofrequency ablation, surgery, radiosurgery, immunotherapy, chemo, radiation, and photodynamic therapy
radiofrequency
can treat lung cancer via destroying single, small tumors
radiosurgery
uses multiple focused beams to destroy a tumor; not actually surgery
photodynamic therpay
a chemical is injected and migrates to tumor cells, where it is activated by laser light and destroys the cancer cells
aspiration
involves the passage of food, fluid, vomitus, drugs, or other foreign materials into the trachea and lungs
what lung is often the location for aspirated material?
the right lung because it descends at a steeper angle?
what usually prevents aspiration from happening?
a cough will remove materials from the upper tract and the vocal cords and epiglottis prevent entry
common effect of aspiration
obstruction of passageways; can be through direct obstruction or an irritant causing inflammation
what is the result of obstruction due to aspiration?
interference with gas exchange and a risk for developing pneumonia
what happens when a large object causes obstruction?
the trachea is blocked and so is airflow and this is life-threatening
what happens when solid objects are lodged in a bronchus?
it can lead to non aeration and collapase of the area distal to the obstacle
ball-valve effect
occurs due to obstruction from solid objects, in which air can pass down on inspiration but not out on expiration, leading to a buildup of air
what happens when a dried bean causes obstruction?
it can swell and become more firmly lodged
what happens when a sharp, pointed object is aspirated?
it can traumatize the mucosa and initiating an acute inflammatory response that creates more obstruction; the inflammation can also trigger bronchoconstriction
what happens when fatty foods are aspirated?
can cause inflammation and edema and if not removed, it can cause a granuloma or fibrous tissue to develop
aspiration pneumonia
occurs when inflammation occurs due to chemicals, predisposing the development of infection later
potential complications of aspiration
respiratory distress syndrome, pulmonary abscess if microbes are present, and systemic effects if toxic materials are absorbed into the blood
who is aspiration common in?
young children
what materials can cause a thin film to spread over the lungs?
those contains hydrocarbons such as turpentine
what materials can cause inflammation in the delicate lung tissue if aspirated?
baby powder
who are at high risk for aspiration problems?
children with tracheoesophageal fistula or cleft palate
why may aspiration occur?
when the swallowing or gag reflex is depressed, following anesthesia or stroke, those in a coma, those with neurologic damage, or some drugs
why does a lying down position increase the risk for aspiration?
because the gravitational force is of no value in moving food quickly and completely down the esophagus, causing residual liquid to remain in the mouth and drip into the trachea
cafe coronary
occurs when aspiration occurs when combining eating with talking
signs of aspiration
coughing, choking, marked dyspnea, stridor, hoarseness, wheezing, tachycardia, tachypnea, nasal flaring, marked hypoxia, no sounds, and possibly cardiac or respiratory arrest
aspiration treatment
heimlich maneuver back blows, using a finger probe, and sometimes energy tracheotomy
heimlich maneuver
used to treat aspiration; stand behind the victim with encircling arms, position a fist, thumb side against the abdomen below the serum, place the other hand over the fist and thrust forcefully inward and upward
back blows for aspiration
administered between the infant’s shoulder blades while the bod is supported over an arm or leg, with the head lower than the trunk
sleep apnea
occurs when pharyngeal tissues collapse during sleep, leading to repeated, momentary cessation of breathing
who is commonly affected by sleep apnea?
men, those with obesity, and increasing age
how is sleep apnea diagnosed?
the partner will notice loud snoring sounds with intermittent gasps for air
complications of sleep apnea
chronic hypoxia, fatigue, type 2 diabetes, pulmonary hypertension, right side CHF, cerebrovascular accident, erectile dysfunction, depression, and daytime sleepiness
how to prevent sleep apnea?
avoid alcohol and sleeping pills
treatment for sleep apnea
continuous positive airway pump (CPAP), oral appliances, and sleeping in a supine position
CPAP
continuous positive airway pump which delivers humidified room air at a pressure that maintains open airway
asthma
is a disease that involves periodic episodes of severe but reversible bronchial obstruction in persons with hypersensitive or hyperresponsive airways
what may frequent asthma attack lead to?
irreversible damage in the lungs and chronic asthma (chronic obstructive lung disease)
2 types of asthma
extrinsic asthma and intrinsic asthma
extrinsic asthma
involves acute episodes triggered by a type I hypersensitivity reaction to an inhaled antigen
what can cause extrinsic asthma?
allergens and is often associated with a family history of allergic conditions like allergic rhinitis or eczema
intrinsic asthma
is onset during adulthood and other types of stimuli (not allergens) trigger a hyperresponsive response of tissues in the airway
what can cause intrinsic asthma?
respiratory infections, exposure to cold, exercise, drugs like aspirin, stress, and inhalation of irritants like cigarette smoke
what occurs during an asthma attack?
inflammation of the mucosa with edema, contraction of smooth muscle, and increased secretion of thick mucus in the passages; this causes obstruction of the airways
what does the antigen react with in extrinsic asthma?
immunoglobulin E; this causes histamine, kinins, and prostaglandins to cause inflammation, edmea, constriction, and increased mucus secretion
what cranial nerve is stimulated in a extrinsic asthma attack?
vagus X; this causes reflex bronchoconstriction
second stage of an extrinsic asthma attack
occurs a few hours later and chemical mediators like leukotrienes result in prolonged inflammation, constriction, and epithelial damage
how does an intrinsic asthma attack develop?
T lymphocytes are activated due to an internal antigen, causing the tissues to be hyperresponsive and for inflammation to develop
what does partial obstruction of the small bronchi and bronchioles result in?
air trapping and hyperinflation of the lungs, causing residual volume to increase and a risk of the bronchial wall to collapse; coughing and removing mucus becomes difficult
total obstruction in asthma
results when the mucus plug completely blocks the flow of air in the already narrowed passage; this can lead to atelectasis or non aeration of the tissue distal to the obstruction
hypoxia and asthma
can arise due to partial and total obstruction; O2 demands and muscle demands; respiratory and metabolic acidosis can result; and vasoconstriction in the pulmonary vessels can also occur, increasing the workload on the right side of the heart
status asthmaticus
is a persistent severe attack of asthma that does not respond to therapy; can lead to severe hypoxia, acidosis, cardiac arrhythmias and CNS depression
chronic asthma
may develop from irreversible damage in the lungs when frequent and severe attacks form a pattern
results of chronic asthma
bronchial walls thicken, infections are common, fibrous tissue develops in atelectatic areas, and complications following attacks are common
causes of asthma
is genetic and related to a familiar history of hay fever, asthma, and eczema; viral respiratory infections may precipitate attacks; other factors are sedentary lifestyles, poor ventilation, staying indoors, air pollution, and increased exposure to allergens
signs of asthma
cough, marked dyspnea and chest tightness, inability to breath, wheezing, rapid and laboured breathing, thick mucus, tachycardia, pulsus paradoxus, hypoxia, respiratory alkalosis initially followed by respiratory acidosis, and possibly respiratory failure
pulsus paradoxus
is when the pulse differs on inspiration and expiration
respiratory alkalosis and acidosis during asthma
first respiratory alkalosis develops due to hyperventilation, but as air gets trapped and fatigue causes decreased respiratory effort, respiratory acidosis develops
treatment for preventing asthma
avoiding allergens and triggers, good ventilation, regular swimming or exercise, and prophylactic medication
treatment during an acute asthma attack
controlled breathing techniques, reducing anxiety, inhalers, and glucocorticoids like beclomethasone
inhalers
are bronchodilators that are usually a beta2-adrenergic agents such as salbutamol; isoproterenol and epi can also be used
treatment for status asthmaticus
hospital care when the patient doesn’t respond to a bronchodilator
prophylaxis treatment for asthma
leukotriene receptors such as zafirlukast or cromolyn sodium
leukotriene receptor antagonists
are prophylaxis treatment for asthma, ex. zafirlukast; work to block inflammatory responses in the presence of stimuli
cromolyn sodium
is prophylaxis treatment and the drug inhibits the release of chemical mediators from sensitized mast cells in the respiratory passages and also decreases the number of eosinophils
