Lecture 10 Resp non-neoplastic Flashcards
What are in the walls of trachea and bronchi?
Cartilage
What is in the wall of bronchioles?
Smooth muscle
What is in the upper airways?
Nose, accessory air sinuses, nasopharynx and larynx
What is in the lower airways?
Trachea, bronchi, bronchioles, terminal bronchioles, alveoli.
Define upper resp infections?
Acute inflammatory process that affects muscous membranes of the resp tract
Upper resp infection examples?
Rhinitis, laryngitis, tonsillitis and sinusitis.
What are the symptoms of an upper airway infection?
Malaise, headache, sore throat, discharge.
Upper resp infections are commonly…
Viral but can get secondary bacterial infections
How do virus’s cause symptoms?
Attach to resp mucosa, invading tissue causing necrosis, inflam and swelling
Define pneumonia
Inflammation of lung parenchyma caused by viral/bacterial infection where airsacs fill with pus& ?solid
How does pneumonia work?
Consolidation of affected part, exudate with inflam cells and fibrin in alveolar air spaces.
What causes pneumonia?
infectious agents, inhaled chemicals, chest wall trauma.
Clinical features of pneumonia?
Fever, rigours, SOB, pleuritic chest pain, purulent sputum, cough.
Morphology (forms) of pneumonia?
Lobar, multifocal/lobular (bronchopenumonia) or interstitial (focal diffuse)
What are the 6 categoies/settings for pneumonia?
Community acquired, hospital acquired, aspirational pneumonia, chronic pneumonia, necrotising pneumonia/lung abscesses. in immunocompromised
Which setting is relatively common?
Community
What is the most common cause for community acquired?
Strep.pnemonia
What 3 organisms cause community acquired?
Step. pnuemoniae, haemophilus influenzae, S.aureus
Morphology of community acquired?
Lobar or bronchopneumonia
What is hospital acquired pneumonia also know as?
nosocomial pneumonia
Define hospital acquired pneumonia
Any pneumonia contracted by patient at least 48-72 hrs postadmission
What organism usually cause hospital acquired?
Gram neg bacilli and S.aureas
Which pneumonia can be severe/fatal & is most common cause of death in ITU?
Hospital acquired pneumonia
Symptoms of hospital acquired pneumonia?
Fever, ^WCC, cough with purulent sputum. Chest x-ray changes
How does aspiration pneumonia develop?
After inhalation of foreign material. Elderly, strokes, dementia, anaesthetic
Morphology of aspiration pneumonia
Right middle and right lower lobe
What organisms causing aspiration pneumonia?
Oral flora +/- other bacteria
Define obstructive disorders?
Partial or complete obstruction at any level from the trachea to bronchioles
Examples of obstructive disorders?
Asthma, COPD (Emphysema and chronic bronchitis), Bronchiectasis
What is extrinsic asthma?
Responds to inhaled antigen - atopic
What is intrinsic asthma?
Non-immune, cold, exercise, aspirin.
What happens in the early phase of asthma?
Bronc constriction, ^ mucus, Vasodilation
What happens in late phase reaction?
Inflam, epithelial damage, more bronc-conc
Morphology of asthma?
Lung overinflation + small areas of atelectasis. Mucus plug in bronchi/bronchioles. Airway remodelled
Define chronic bronchitis
Persistent cough with sputum production, for at least 2 consecutive years, no cause found.
What causes chronic bronchitis (obstructive disorder)
Long-standing irritation from inhaled substances (e.g. smoke, dust, cotton, silica). 2) Hypertrophy of submuc glands& ^goblet cells. 3) mucus hypersecretion
Morphology of chronic bronchitis?
Mucous membrane hyperaemia, swelling, oedema. Excess mucus. Bronchioles narrowed (mucus plug, inflam&fibrosis).
Clinical signs of CB?
Persistent cough, productive sputum. Dyspnea on exertion. Hypercapnia, hypoxemia.
What can chronic bronchitis lead to?
Cor pulmonale, cadiac failure, atypical metaplasia/dysplasia
Define dyspnea?
Difficulty breathing
Define hypercapnia?
CO2 retention
Define hypoxemia?
Low O2 conc
Define Cor Pulmonale
Abnormal enlargementof right side of heart as result of lung/pulmonary vessel disease
Define emphysema?
Irreversible enlargement of the airspaces, distal to terminal bronchiole, wall destruction without obvious fibrosis
Types of emphysema?
Centriacinar / panacinar / paraseptl / irregular
Symptoms of emphysema?
Dyspnoea, cough, wheezing, weightloss, expiratory limitaions.
What are pink puffers?
People who die from cor pumonale, congestive heart failureor pneumothorax
Morphology of emphysema?
Largeapical bullae or blebs, voluminous lungs and large alveoli.
What substances are imbalances in emphysema?
Protease-antiprotease. Oxidants and anti-oxidants
Define bronchiectasis
Permanent destruction and dilation of airways associated with severe infections/obstructions
Morphology of bronchiectasis
Dilated (as walls have been destroyed), and inflamed. Loss of cilla, increase mucus.
Define aetiology
Causes of a disease
Aetiology of bronchiectasis
CF, Kartageners, post infectious: TB, measles, bronchial obstruction (TB/FB)
What is kartageners disease?
Defects in cilla action
Symptoms of bronchiectasis?
Persistent cough, purulent sputum +++, haemoptysis
What is haemoptysis?
Coughing up blood
Define restrictive lung disease
Reduced expansion with decreased total lung capacity, inflammation and fibrosis of the pulmonary connective tissue.
Define pneumonitis
Inflamof walls of alveoli
With restrictive lung disease FVC…
is reduced. (amount of air that can be blown out after maximal inspiration.
Clinical features of restrictive lung disease?
Dyspnea, tachypenea, end-inspiratory crackles. Cyanosis without wheezing. May lead to cor pulmonale.
Morphology of restrictive lung disease. Xrays?
Bilateral infiltrative lesions - small nodules, irregular lines (ground glass shadows). Scarring and gross destruction of lung -> honeycomb lung.
What disease results in ground-glass shadows and honeycomb lungs?
Restrictive lung disease
Give 3 restrictive disorders
Chest wall abnormalities, connective tissue disorders and penumonconioses
What are the two vascular disorders effecting breathing?
Pulmonary embolism and pulmonary oedema
Define pulmonary embolism
blockage of main or branch pulmonary artery by an embolus.
Where are emboli that cause pulmonary embolisms normally from?
DVT of the leg (95% of cases)
What does the body compromise when suffering from pulmonary embolism?
Respiratory compromise and haemodynamic compromise
Morphology of pulmonary embolism?
Central/peripheral emboli, pulmonary haemorrhage or pulmonary infarction
What is the clinical course for vascular embolism
Abrupt onset pleuritic chest pain, SOB, hypoxia, ^ pulmonary resistance -> right ventricular failure.
Define pulmonary oedema
Accumulation of fluid in the air spaces and paenchyma of the lungs
What is pulmonary oedema due to?
Alveolar injury, infections, shock/trauma.
What are the oedema of undetermined origin?
Neurogenic/high altitude
What causes haemodynamic oedema?
^ venous pressure (left ventricle failure), decreased oncotic pressure (from nephrotic syndrome) or liver failure.
Define dependent oedema
Initial fluid accumulation in basal regions
Morphology of pulmonary oedema
Engorged alveolar capilaries, intra-alveolar granular pink precipitate, alveolar microhaemorrhages, hemosiderin-laden macrophages, heavy wet lungs
Clinical features of pulmonary oedema?
SOB, punk frothy sputum, CXR findings.
Name the two expansion disorders
pneumothorax and atelectasis
Define pneumothorax
Air in pleural cavity -> collapse lung
What ^ the risk of pneumothorax?
Emphysema, asthma, TB, trauma and idiopathic
Define Atelectasis
Incomplete expansion of lungs which reduces oxygenation and predisposes to infection. REVERSIBLE
What are the two types of respiratory failure?
Type I- hypoxia with normal or low PCO2
Type II- hypoxia with high PCO2
What causes type I resp failure?
Pneumonia, pulmonary oedema, asthma, pulmonary fibrosis
What causes type II resp failure?
Asthma, COPD, reduced resp drive, neuromuscular disease, thoracic wall disease (kyphoscoliosis).`
Which type of resp disease should caution with O2 be taken?
Type II respiratory failure.
