Lecture 8 - Respiratory Pathologies

Question 1

Respiratory System Pathologies

Answer 1

1. Common cold (head cold, infectious rhinitis, upper respiratory infection)
2. Sinusitis
3. Pharyngitis (sore throat) Viêm họng
4. Laryngitis Viêm thanh quản
5. Laryngeal cancer
6. Influenza
7. Infectious mononucleosis (Epstein-Barr Viral infection, glandular fever, kissing disease) bạch cầu đơn nhân truyền nhiễm

Question 2

1. Common Cold

Answer 2

Description: Upper respiratory tract infection causing acute inflammation of the mucosa niêm mạc of the nose and pharynx (throat) and sometimes the larynx (voice box). Very contagious. May spread to the ears, sinuses or lungs.

Etiology (cause): virus enters through the mouth or nose (airborne) or by host touching a contaminated object (fomite), most commonly caused by the rhinovirus. This stimulates the body’s immune response and causes inflammation and the symptoms. Over 200 different viruses can cause the common cold.

Pathogenesis: influx of polymorphonuclear cells (PMNs) sự tràn vào của các tế bào đa nhân, a cytokine release and vascular leakiness

Clinical Features: the symptoms are caused by the body’s response to the virus not by the virus itself. Symptoms begin after 3 days of exposure: sneezing, watery eyes, nasal congestion, thick yellow nasal discharge, coughing, headache, sore throat, low fever and chills

Treatment: bedrest, fluids, over the counter (OTC) medications

Question 3

2. Sinusitis

Answer 3

Description: chronic (over 12 weeks) or acute (4 weeks) inflammation of the mucosa of the nasal sinuses. Usually acute and lasts 4 weeks.

Etiology (cause): often caused by viral or bacterial upper respiratory tract infection, may also be caused by allergens, atmospheric khí quyển changes or polyps.

Pathogenesis: in response to the presence of a microorganism vi sinh vật, inflammation begins in the mucosa and causes swelling which obstructs blood flow and drainage of mucus and causes goblet cells tế bào cốc to overproduce so mucus chất nhầy builds up.

Clinical Features: headache and facial pain that intensifies tăng cường when leaning over, facial swelling, yellow green discharge, coughing and sore throat, sometimes fever when acute.

Treatment: saline nasal spray, corticosteroids, decongestants thuốc thông mũi, OTC analgesics thuốc giảm đau

Question 4

3. Pharyngitis

Answer 4

Description: inflammation of the pharynx or throat, “sore throat” usually caused by a virus or bacteria. Usually involves the tonsils (tonsillitis), spreads via droplets in the air,

Etiology: cold or flu viruses mostly or bacteria (group A streptococcus)

Pathogenesis: virus replicates in the mucosal cells damaging and invading nearby cells

Clinical Features: pain or scratchiness sự trầy xước in the throat, redness, fever, runny nose, dry cough, headache, swollen lymph nodes, hoarseness khàn tiếng in voice. Untreated streptococcus pharyngitis viêm họng liên cầu khuẩn may lead to serious complications,

Treatment: often none required, if bacterial; antibiotics

Question 5

4. Laryngitis

Answer 5

Definition or description: inflammation of the larynx (voice box), often a symptom from something else like a cold, the flu or pneumonia viêm phổi. May be acute (1 week) or chronic (longer than 1 week).

Etiology (cause): most commonly, respiratory infections, or strain from yelling, or reflux disease bệnh trào ngược where acids from the stomach rise up and cause inflammation. Long term smokers have scar tissue and permanent damage

Pathogenesis: virus replicates in mucosal tissues, invades and damages nearby cells causing irritation or immune response cause edema in and around the larynx affecting vibration and voice production

Clinical Features: loss of voice, hoarseness, fever, painful swallowing (dysphagia), dry scratchy throat, coughing and sneezing

Treatment: rest, medications like corticosteroids (reduce swelling), antibiotics, analgesics

Question 6

5. Laryngeal Cancer

Answer 6

Definition or description: malignant cells form in the larynx, common in men aged 50 to 70 years. Discovered early due to early symptoms in voice box or throat. May spread to lungs. Heavy cigarette smoking, heavy drinking, occupational exposure (dry cleaning agents or asbestos) to toxic substances chất độc hại and gastroesophageal reflux disease (GERD) are all risk factors.

Etiology (cause): unknown, but risk factors above are most likely involved
Pathogenesis: cancer cells grow uncontrollably and damage nearby tissues.

Clinical Features: sore throat or cough that does not go away, persistent hoarseness, painful swallowing (dysphagia) or lump in throat.

Treatment: most common: radiation therapy, then surgery, then chemotherapy, immunotherapy liệu pháp miễn dịch

Question 7

6. Influenza Virus

Answer 7

Definition or description: virus infection of the upper respiratory tract that may invade the lower respiratory tract. Very contagious and spreads in 1-3 days. The elderly, infants and immunocompromised individuals are at high risk for complications. Approximately 3500 people die every year of the flu, most deaths are from a secondary infection causing pneumonia.

Etiology (cause): the influenza virus strains A, B or C is transmitted by infected droplets or by touching a contaminated object (fomite). It infects the nose, throat and lungs.

Pathogenesis: symptoms are caused by our immune systems response and by the virus replicating in the respiratory epithelium biểu mô causing inflammation

Clinical Features: chills, fever, sore throat, inflammation of the respiratory mucosa, respiratory congestion, sneezing, coughing, muscle ache, fatigue, headache.

Treatment: isolate, rest, fluids, OTC analgesics, antiviral drugs, prevent
complications for the high risk

Question 8

7. Infectious Mononucleosis

(Epstein-Barr Virus)

Answer 8

Definition or description: also known as the “kissing disease”, viral infection that is contagious and affects mainly 15-21 year olds

Etiology (cause): epstein-barr virus (in the herpes family of viruses), or cytomegalovirus. Transmitted by saliva, respiratory droplets or by touching a contaminated object (fomite).

Pathogenesis: a lifelong infection, immune system is activated

Clinical Features: slow, gradual onset, sore throat, fatigue, headache, loss of appetite, fever, erythema in throat and soft palate vòm miệng, cough, enlarged lymph nodes, skin rash, may develop strep throat or tonsillitis, or rarely splenomegaly lách to. May be implicated có liên quan in multiple sclerosis (MS) bệnh đa xơ cứng.

Treatment: rest, fluids, self care

Question 9

Lower Respiratory Tract Infections

Answer 9

1. Pleurisy Viêm màng phổi ( pleuritis)
2. Pneumonia
3. Tuberculosis
4. Lung cancer

Question 10

1. Pleurisy (Pleuritis)

Answer 10

Definition or description: inflammation of the pleural membranes màng phổi surrounding the lungs.
Wet: increase in intrapleural fluids (pleural effusion)
Dry: decrease in intrapleural fluids

Etiology (cause): secondary to other pathologies like pneumonia, tuberculosis, pulmonary embolism tắc mạch phổi or injury.

Pathogenesis: parietal pleura màng phổi thành is innervated by pain sensors and are activated by the surrounding inflammation

Clinical Features: burning or stabbing đâm pain during inspiration caused by friction created by the swollen pleural membranes rubbing against each other. Other symptoms are shallow breathing, coughing, fever and chills.

Treatment: nonsteroidal anti-inflammatories (NSAIDS)

Question 11

2. Pneumothorax

Tràn khí màng phổi
(Collapsed Lung)

Answer 11

Description: a collapsed lung. Air leaks into the space between your lung and the chest wall, this air pushes on the outside of the lungs and they collapse. It could be a part of the lung or a whole lung. Most common in smokers, if you have lung disease or if you are on mechanical ventilation. thông gió cơ học

Etiology: blunt force chấn thương cùn trauma to the chest, lung disease or mechanical ventilation

Pathogenesis: air compresses the lung

Clinical Features: shortness of breath, sudden chest pain

Treatment: chest X rays are needed to diagnose, needle is inserted between the ribs and removes the excess air (this is called needle aspiration).

Question 12

3. Pneumonia

Answer 12

Definition or description: inflammation of the air sacs in the lungs (alveoli) caused by a bacterial or viral infection, often preceded đi trước by a cold or flu. Air sacs and bronchioles fill with fluid, debris mảnh vụn and cellular wastes like pus which aids in the duplication sự nhân đôi or replication of the pathogen and its spreading into the lungs. Pneumonia is the most common infectious cause of death, affecting the elderly, infants and immunocompromised individuals. There are many types of pneumonia. It may be acute (bacterial or viral) or chronic (cystic fibrosis bệnh xơ nang or tuberculosis). Also may be lobar (affecting one lobe or a part of one lobe) or bronchial (affecting the bronchi).

Etiology (cause): 75% bacterial, but also viruses, fungi, protozoa động vật nguyên sinh, parasites or inhalation of a toxin or aspiration of vomitus nôn mửa.

Pathogenesis: immune defences break down and allow pathogens to invade and multiply nhân lên in the lungs causing an immune response that accumulates white blood cells that fill the air sacs in the lungs.

Clinical Features: fever, chills, shortness of breath, headache, chest pain, fatigue, in walking pneumonia - milder symptoms

Treatment: antibiotics, cough medicine, fever reducers (antipyretics) and analgesics.

Question 13

4. Pleural Effusion

Answer 13

Description: build up of excess fluid between the layers (parietal and visceral) of the pleura lining the lungs called the pleural cavity khoang màng phổi or space.

Etiology: heart failure, cirrhosis xơ gan, pneumonia, cancer, infection, pulmonary embolism, tuberculosis, autoimmune tự miễn dịch diseases

Pathogenesis: increased pressures or leaky capillaries increase fluids faster than they can be absorbed

Clinical Features: may be asymptomatic, shortness of breath, chest pain, fever, cough

Treatment: chest X ray to diagnose, needle aspiration to remove the fluid called a thoracentesis chọc dịch lồng ngực, chest tube to drain the fluids, pleural drain (for long term or chronic

Question 14

Pulmonary Arterial Hypertension

Tăng huyết áp động mạch phổi

Answer 14

Description: high blood pressure that affects the arteries in the lungs. These arteries are narrowed, blocked or destroyed. This slows blood flow throughout the lungs and raises blood pressure in the arteries. The heart has to work harder to pump blood through the lungs. Usually worsens with time and is chronic.

Etiology: idiopathic vô căn, gene mutation đột biến gen, prescription drugs, congenital heart disease, cells that line pulmonary arteries are damaged and become stiff swollen and thick.
Pathogenesis: the above slows down blood flow into the lungs

Clinical Features: symptoms develop slowly over time, fatigue, syncope ngất, dyspnea (shortness of breath), chest pain or pressure, swelling, blue skin, racing pulse.

Treatment: depending on the cause: many medications, especially vasodilators and warfarin (1 loại thuốc chống đông máu )to prevent blood clots, or surgery

Question 15

Pulmonary Edema

Phù phổi

Answer 15

Description: excess dư thừa fluid in the lungs collecting in the air sacs, making it difficult to breath due to lack of oxygen. May be serious

Etiology: congestive heart failure (most common cause), heart attack, damaged valves, pneumonia, kidney failure

Pathogenesis: due to blood pressure increases in veins bringing blood from the heart into lungs causing fluid to be pushed into the alveoli.

Clinical Feature: shortness of breath, difficulty breathing when lying down (CI), wheezing, lower leg swelling, fatigue,

Treatment: oxygen, medications

Question 16

Respiratory Failure Type I and II

Answer 16

Description: respiratory system fails to maintain its gas exchange functions.

Type 1: hypoxemic thiếu oxy, impaired at the alveolar/capillary membrane or respiratory exchange membrane.
Type 2: hypercapnic tăng CO2, respiratory pump

Etiology: many, CNS depression, respiratory muscle failure, airway obstruction, alveoli abnormalities

Pathogenesis: alveoli or muscle failure reduce gas exchange capacity

Clinical Features: fever, cough, chest pain, sputum đờm production, dyspnea, confusion, tachycardia, cyanosis chứng xanh tím, headache, behavioural changes, coma hôn mê,

Treatment: depending on cause, usually oxygen

Question 17

Tuberculosis

Answer 17

Definition or description: a contagious, bacterial lung infection.

That may also affect the liver, bone marrow or spleen. Most widespread disease in the world (2 million deaths annually).

Primary: macrophages, lymphocytes and other immune cells encapsulate the bacteria and form a granulosum hạt or a tubercle, inhibiting its spread, but not killing it. The tubercle forms a cheesy material called caseation hoại tử (a form of caseous necrosis trường hợp hoại tử), scar tissue forms, further encapsulating the bacteria. The tubercles and the nearby lymph nodes are called the “Ghon Complex” and provide immunity and may remain dormant nằm im for life. The tubercles leave permanent scars that show up on chest X Rays.

Secondary: reactivation of primary tuberculosis by rupturing the tubercle and releasing the bacterium into the bloodstream, HIV causes this often, also cancer, diabetes, medications like immunosuppressants or corticosteroids. More severe, with blood vessel damage as well as lung tissue damage called cavitation. Also spreads throughout the body via the bloodstream affecting many other tissues.

Etiology (cause): mycobacterium tuberculosis or rarely mycobacterium bovis (non-pasteurized milk) transmitted via infected droplets (coughed up blood or phlegm đờm)

Pathogenesis: forms encapsulated tubercles in the lungs, if activated causes damage to local blood vessels and tissues and may spread throughout the body.

Clinical Features: diagnosed by positive tuberculin lao tố test (presence of antibodies), sputum culture and chest X Rays. If vaccinated for TB, the tuberculin test will also be positive.
Primary: 95% asymptomatic, vague mơ hồ symptoms of fatigue, weight loss, low fever
Secondary: cough with sputum (may contain blood), high fever, night sweats shortness of breath and generalized anxiety.

Treatment: a cocktail (mixing) of 4 anti-TB drugs for 6-9 months

Question 18

Lung Cancer

Answer 18

Definition or description: cancerous growth in the lungs, leading cause of cancer deaths in western industrialized countries, survival rate is low and overall cure rate is only 15%.

Primary lung cancer: highly invasive and metastasizes early especially to the liver, kidneys, adrenals and to bone tissue.

Secondary lung cancer: more common than primary, venous return and lymphatic vessels bring cancer cells from the body to the heart and then to the lungs where they lodge into small blood vessels and replicate and cause damage. Smokers over 50 are at highest risk.

Etiology (cause): tobacco smoke contains many
carcinogens chất gây ung thư and is the cause of 80-90% of all lung
cancers, second hand smoke increases risk by 30%, environmental or occupational exposure to silica, coal dust, radon, vinyl chloride or asbestos are also causes.

Pathogenesis: repeated exposure to a carcinogen leads to dysplasia chứng loạn sản of lung epithelium, damaging normal cells, causing decreased protein synthesis, disrupts the cell cycle and promotes cancer cell reproduction and growth..

Clinical Features: often asymptomatic or common symptoms with smokers. By the time the symptoms are severe enough to seek medical attention the cancer has already metastasized đã di căn to other tissues in the body. Symptoms: persistent cough, blood streaked sputum, shortness of breath (dyspnea), chest pain, wheezing, hoarseness, clubbed fingers, recurring pneumonia viêm phổi tái phát and bronchitis.

Treatment: surgery, chemotherapy & radiation

Question 19

Chronic Obstructive Pulmonary Disease (COPD)

Answer 19

COPD is a group of respiratory diseases characterized by persistent or recurring tái phát obstruction of airflow. General symptoms for COPD include a productive cough, wheezing & shortness of breath. COPD sufferers are at an increased risk for respiratory tract infections. The leading cause of COPD is smoking. Between 15-20% of long term smokers will develop COPD. Damage to the respiratory lining from COPD causes a reduction of elastic recoil độ giật đàn hồi needed to fully exhale. When you cannot properly exhale, air gets trapped in your lungs, creating difficulty in breathing normally. Smoke in the lungs causes hardening and the tissues become less elastic. This prevents the lungs from expanding or shrinking. The most common forms of COPD are emphysema and chronic bronchitis.

Chronic Obstructive Pulmonary Diseases:

Chronic Bronchitis
Bronchiectasis (Giãn phế quản)
Emphysema
Cystic Fibrosis (Bệnh xơ nang)
Asthma
Obstructive Sleep (Khó thở khi ngủ)
Pneumoconiosis (bệnh bụi phổi)

Question 20

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Bronchitis

Answer 20

Description: inflammation of the bronchial mucosa causing swelling and hypersecretion of mucus, which impairs ciliary action and narrows the airways, eventually causing irreversible fibrotic xơ hóa không hồi phục changes in the bronchial lining lót phế quản. Can be acute and chronic. Children of parents who smoke are at risk for developing chronic bronchitis.

Etiology:
Acute: usually caused by viral infections of the respiratory tract
Chronic: cigarette smoking is the most common cause of chronic bronchitis (90% of cases)

Pathogenesis: Immune response in the airway lumen causes inflammation and hypersecretion of mucus

Clinical Findings:
Acute: productive cough, lots of mucus, low fever, chills, subsides in one week with the URTI.
Chronic: productive cough more pronounced in the morning (secretions have pooled over the last 8 hours of sleep), chest pain main develop from coughing, fatigue, wheezing and shortness of breath, cyanosis of lips and fingers.

A “blue bloater” is named from the bluish color (cyanosis) of the lips & skin (from lack of oxygen), as well as edema commonly seen in persons suffering from chronic bronchitis.

Treatment: Quit smoking, avoid second hand smoke or other irritants, inhalers to open airways and help clear away mucus (bronchodilators, steroids), oxygen therapy, chest physiotherapy.

A “blue bloater” is named from the bluish color (cyanosis) of the lips & skin (from lack of oxygen), as well as edema commonly seen in persons suffering from chronic bronchitis.

A “pink puffer” is named for the reddish complexion and puffing or breathing through pursed lips to control shortness of breath as seen in persons suffering from emphysema.

Question 21

Chronic Obstructive Pulmonary Disease (COPD)

Emphysema

Answer 21

Description: permanent enlargement of lower airways with destruction of the alveolar walls, making them less stretchable. Obstruction of airflow is caused by lung tissue damage not from mucus overproduction and inflammation. Affects mostly the alveoli and the distal branches of the bronchioles.

Etiology: caused by long term exposure to airborne irritants like cigarette smoke or other air pollutants. The major cause is cigarette smoking.

Pathogenesis: when the alveoli lose their elasticity, this creates large, permanently inflated alveoli that are dysfunctional. Distal branches of the bronchioles may be affected as well. Additionally, over-inflation causes the septa of several alveoli to rupture, forming one large air space instead of many small ones. These structural alterations limit gas exchange.

Clinical Findings: Shortness of breath and wheezing with prolonged expiration. Added exertion during expiration increases the size of the rib cage, resulting in a “barrel chest”. The person frequently leans forward with arms braced on the knees (called tripod position) to increase lung capacity. Because there is no over-secretion of mucus, as seen in chronic bronchitis and asthma, the person with emphysema experiences little coughing and modest khiêm tốn, if any, mucus production

The person is often fatigued, and he or she is often thin because of weight loss. Clubbing of the fingernails & toenails may occur.

A “pink puffer” is named from the reddish or pink complexion and the puffing seen in emphysema.

Treatment: inhalers (bronchodilators, steroids) relax constricted airways and reduce inflammation, antibiotics, chest physiotherapy.

A “blue bloater” is named from the bluish color (cyanosis) of the lips & skin (from lack of oxygen), as well as edema commonly seen in persons suffering from chronic bronchitis.

A “pink puffer” is named for the reddish complexion and puffing or breathing through pursed lips to control shortness of breath as seen in persons suffering from emphysema.

Question 22

Chronic Obstructive Pulmonary Disease (COPD)

Asthma

Answer 22

Description: A chronic, inflammatory disorder of the airways characterized by bronchial obstruction. An asthmatic attack happens when the bronchiole muscle walls are in spasm. The most common chronic disease in children (10% prevalence rate) and is the #1 reason for school absenteeism sự vắng mặt. Incidence has increased over the last 20 yrs.

Etiology: unknown, bronchioles are susceptible dễ bị tổn thương to spasm because they have less hyaline trong suốt and smooth muscle tissue in their walls. Triggers: allergens (like pollen, dust mites, cockroaches gián and their droppings, molds and pet dander), other air pollutants (like cigarette smoke and perfumes), exercise, aspirin, cold air, emotional upset, recurrent upper respiratory tract infection (URTI) or genetics.

Pathogenesis: inflammation of the mucosa of the bronchioles with edema, bronchospasm, increased mucus production. All three narrow and obstruct the airways.

Clinical Findings: wheezing, prolonged expiration, shortness of breath, sensation of chest tightness and coughing with mucus (worse at night and early morning). Cyanosis (bluish skin color) or pallor (paleness or lack of skin color) at the beginning of an attack with profuse perspiration đổ mồ hôi nhiều. The person may appear anxious or be unable to speak more than a few words without stopping to breathe. Most asthma attacks are mild with freedom from symptoms between episodes. Some asthma attacks are severe & become medical emergencies.

Treatment: inhalers (bronchodilators and steroids) used daily as prevention and avoid triggers., chest physiotherapy.

Question 23

Chronic Obstructive Pulmonary Disease (COPD) –

Pneumoconiosis (black lung disease)

Answer 23

Description: an interstitial lung disease caused by irritating dust particle inhalation. Develops gradually over a long period of time. Dust deposits into tissues causing chronic inflammation, fibrosis and infection. Because it is occupational (8 hours a day, 5 days per week) our tissues can not remove all the dust particles so they accumulate. Separate diseases named by the dust particle:

Asbestosis: dust particle is asbestos, the most common type of pneumoconiosis bệnh bụi phổi
Anthracosis: dust particle is coal dust, also called “Black Lung” disease
Silicosis: dust particle is crystalline kết tinh silica dust

Etiology: exposure to irritant dust particles with accumulation in lung tissues.

Pathogenesis: inhaled dust particles cause an inflammatory reaction and the tissue becomes fibrotic.

Clinical Findings: Similar to those of chronic bronchitis including coughing, sore throat, wheezing, shortness of breath, tightness in the chest, weight loss, fever, finger clubbing and fatigue.

Treatment: quit smoking, avoid dust exposure, oxygen therapy, inhalers (bronchodilators, steroids), chest physiotherapy

Question 24

Chronic Obstructive Pulmonary Disease (COPD)

Bronchiectasis Giãn phế quản

Answer 24

Description: Irreversible dilation of the bronchi from infection or inflammation of the airways, which weakens the bronchial walls. Sacs form in these weakened areas and also fill up with fluid. These sacs become stagnant pools of mucus vũng chất nhầy ứ đọng and breed giống bacteria and infection, obstructing airflow. Common bacteria causing infection are staphylococci, streptococci and influenza. Also is commonly a complication of chronic bronchitis or cystic fibrosis bệnh xơ nang.

Etiology: may be congenital (born with a weakness in the bronchial wall), may be autoimmune or may be caused by a pre-existing lung pathology like chronic bronchitis, cystic fibrosis or tuberculosis. Can also be a complication of ulcerative colitis, Crohn’s disease or AIDS.

Pathogenesis: sacs full of mucus breed bacteria and cause inflammation

Clinical Findings: chronic cough, overproduction of mucus, shortness of breath, wheezing, fatigue, fever, spitting up blood (hemoptysis), foul-smelling breath (halitosis) hơi thở có mùi hôi (chứng hôi miệng), clubbing of the fingernails and toenails.

Treatment: antibiotics, expectorants thuốc long đờm, inhalers (bronchodilators, steroids), oxygen therapy and surgery.

Question 25

Bronchiolitis

Answer 25

Description: common lung viral infection in young children and infants, causing inflammation and congestion in the bronchioles. Often in winter months. Bronchioles swell and become clogged decreasing the amount of air they transport into the alveoli, decreasing oxygen transport. Rare form in adults usually severe.

Etiology: viruses (common: respiratory syncytial virus hợp bào hô hấp, adenoviruses, influenza viruses)

Pathogenesis: inflammation of the lining in the bronchioles where epithelial cells are causes mucus production, necrosis and damage or death to those cells causing airway obstruction.

Clinical Features: often mild, dyspnea, wheezing, cyanosis, fatigue, sunken ribs xương sườn chìm, nasal flaring, fast breathing and cough.

Treatment: rest, fluids, clean air, if severe, hospitalization

Question 26

Chronic Obstructive Pulmonary Disease (COPD)

Cystic Fibrosis Bệnh xơ nang

Answer 26

Description: a progressive genetic disorder that causes hypersecretion of cells that produce mucus, saliva & digestive juices. These secretions narrow and obstruct the respiratory and digestive tracts. Many other organ systems are affected also. The most commonly fatal genetic disease in Caucasian children affecting boys and girls equally. Average life expectancy is 32 yo. Death results from respiratory failure.

Etiology: defective gene must be inherited by both parents is located on the seventh chromosome. It causes a faulty transport of salt in and out of cells. This causes the mucus secretions to be thick and sticky.

Pathogenesis: because of less salt in the process of producing the mucus, it causes dehydration in the mucus, making it thicker and stickier.

Clinical Findings: Overproduction of thick mucus that causes chronic obstruction, inflammation and infection of the respiratory tract with associated persistent cough, wheezing, shortness of breath, a barrel chest & clubbing of the fingernails & toenails, frequent lung infections, poor growth, male infertility. Because of digestive tract involvement, these individuals often have bulky, foul-smelling stools, poor nutrition and small stature.

Treatment: no cure, symptom management, prevention, and medications. Antibiotics are prescribed for lung infections, mucus-thinning drugs, anti inflammatories, stool softeners and bronchodilators. Postural drainage techniques are employed to loosen and help expel phlegm trục xuất đờm. Oxygen therapy is also used. Enzyme replacements are used to help with digestion; vitamin supplement and a high-protein diet are advised to improve nutrition.

Question 27

Chronic Obstructive Pulmonary Disease (COPD)

Obstructive Sleep Apnea Khó thở khi ngủ

Answer 27

Description: just an obstruction, not really a disease, a
temporary cessation đình chỉ of breathing (lasting 15 seconds).

More often in men than women. Hypoxia is common.
As well as oxygen being low, carbon dioxide is too high. Levels slowly build up in the blood while sleeping, the brain senses these changes and wakes you to breathe normally. May wake up 20-30 timer per hour.

Obstructive sleep apnea: more common, occurs when upper airflow is blocked, associated with obesity.
Central Sleep Apnea: less common (less than 10%), occurs when brain fails to transmit signals to the breathing centre and the intercostal muscles. May also be associated with cardiovascular diseases like hypertension.

Etiology: loose, sagging tissues block airway
Obstructive sleep apnea is most often caused by a physical blockage. Obesity causes extra tissue to develop in the throat that hangs and sags when relaxed, sleeping and lying prone which narrows the airway. Mucus build up may also cause an obstruction.
Central sleep apnea may be caused by neurological problems (abnormalities in the respiratory centre in the brain), medications, living in high altitudes độ cao, may be idiopathic vô căn.

Pathogenesis: carbon dioxide levels slowly build up in the blood while sleeping, the brain senses these changes and wakes you to breathe normally. May wake up 20-30 timer per hour.

Clinical Findings: excessive daytime sleepiness, loud snoring, episodes of breathing cessation during sleep followed by snorting khịt mũi or gasping thở hổn hển. Other symptoms include morning headaches, waking with a dry mouth and sore throat and possibly depression.

The person with sleep apnea frequently doesn’t feel rested after waking.

Treatment:
Continuous Positive Airway Pressure (CPAP).

This device delivers just enough pressure to keep the airway open.

Question 28

Chronic Obstructive Pulmonary Disease (COPD)

Pulmonary Edema

Answer 28

Description: excess amounts of fluid in the lungs causing them to swell and interferes with their ability to contract and expand during inspiration. This also decreases the amount of gas exchange. It is often a complication to another pathology.

Etiology: the most common cause is congestive heart failure (CHF) where the left ventricle is weakened allowing blood to pool and back up into the left atrium and the lungs (also called left sided heart failure). Less common causes: inhalation of toxic gas, drug overdose, high altitudes độ cao, respiratory tract infections like pneumonia and tuberculosis, kidney and liver diseases.

Pathogenesis: the left ventricle is weakened allowing blood to pool and back up into the left atrium and the lungs (also called left sided heart failure). The blood pressure increases in these vessels taking blood into the lungs, so much so, that it pushes the fluids into the air spaces of the alveoli.

Clinical findings: difficulty breathing or shortness of breath worsened when laying flat (orthopnea khó thở khi nằm), wheezing, coughing with frothy, bloody sputum. The person is anxious; he or she feels as if they are drowning or suffocating.

Treatment: oxygen therapy, diuretics (decrease blood pressure), morphine (anxiety and shortness of breath).

Question 29

Chronic Obstructive Pulmonary Disease (COPD)

Pulmonary Embolism Thuyên tắc phổi

Answer 29

Description: a blood clot of foreign material occludes the pulmonary artery partially or completely. This blood clot usually begins in the veins of the lower extremity (DVT) and works its way back up to the heart and into the first narrowing, the pulmonary artery in the lungs. Pulmonary embolism is the leading cause of death in hospitals.

Etiology: 90% of pulmonary emboli originate as a thrombi from leg veins called a deep vein thrombosis (DVT). Thrombi could be made of fat, broken bones (usually the femur), tumor debris from a malignant mass, or an air bubble injected into a vein from an IV. Also our bodies tend to form clots during: inactivity (flights, bedridden, obesity, pregnancy), or they are acquired with oral contraceptives, or they can be from vessel damage from injury, surgery or stroke.

Pathogenesis: thrombi detaches usually in veins of lower extremity and travels to the heart and lodges đọng lại in a pulmonary artery or a smaller branch.

Clinical findings: symptoms do not show up until the embolism has lodged in a vessel, clinical signs depend on the size of the clot and where it is. Small emboli produce symptoms of coughing, shortness of breath and mild, transient tạm thời chest pain. Larger emboli produce symptoms of shortness of breath and chest pain that intensifies with deep breathing or while coughing. Other symptoms are dizziness, lightheadedness or fainting, irregular heartbeat and sweating. Eventually, fever is present with the production of bloody sputum. Massive emboli may lead to a sudden onset of symptoms such as rapid breathing (tachypnea) and a crushing chest pain with rapid but weak pulse. Loss of consciousness and death may follow.

Treatment: blood thinners (anticoagulants), clot dissolvers (thrombolytics)

Question 30

Acute Respiratory Distress Syndrome

Answer 30

Description: Severe life threatening condition of widespread inflammation in the lungs causing fluid build-up and imminent sắp xảy ra respiratory failure. Usually occurs in people who are critically ill or who have sustained massive injuries, 30% of all admissions to intensive care unit will develop ARDS. May also be from respiratory infection like pneumonia. The widespread inflammation caused by ARDS leads to impaired gas exchange and multiple organ failure and death in approx 1/3 of the people who develop it.

Etiology: most commonly from widespread infection called sepsis nhiễm trùng huyết, but also caused by trauma, burns, head or chest injury, near drowning, shock, aspiration, inhalation of toxic gas, adverse reaction to medication, drug overdose, tuberculosis, severe pneumonia or sometimes idiopathic vô căn.

Pathogenesis: fluid buildup or edema causing hypoxemia and impaired carbon dioxide excretion.

Clinical Findings: severe shortness of breath (dyspnea), rapid breathing (tachypnea), coughing, nasal flaring and severe hypoxemia.

Treatment: hospitalization: ventilator support, oxygen therapy, prone positioning, sedation thuốc an thần, ICU, fluids management.