Lesson 8 Respiratory Flashcards by Chun Wing Wong

Respiratory system

Upper respiratory system
Nose, pharynx,

Lower respiratory system
Larynx, trachea, bronchi, lung

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Respiratory clinical manifestations

Sneezing

Coughing

Dyspnea

Cyanosis

Hemoptysis
Coughing blood or bloody secretion

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Pulmonary disease clinical manifestations

Pain: pleural pain胸膜
Pulmonary pain (trachea, bronchi inflammation)
Chest wall pain( chest wall muscle sore/ rib fracture)

Clubbing fingers:
Painless, firm, fibrotic enlargement

Abnormal sputum
Yellowish-green (bacteria infection)
Rusty: (pneumococcal pneumonia)

Wheezing

Hypoxemia

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OPD
obstructive pulmonary disease including?

Asthma
Chronic bronchitis

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Asthma
Why?
Type
Manifestation

Airway obstructed due to inflammation response to allergens

Acute/ chronic

Dyspnea
Wheezing
Tachycardia
Tachypnea( fast breathing)

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Parthophysiology of asthma

Bronchi and bronchioles respond to 3 changes
1.mucosa inflammation
2.Bronchoconstriction: contraction of smooth muscle
3. Increased secretion of thick mucus
-) create obstructed airways
-) interfere with airflow and oxygen
-) respiratory acidosis, co2 retention
-) respiratory failure

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Treatment of asthma

Inhalation of bronchodilator: Salbutamol
Corticosteroids
Non-steroidal drug: leukotriene
Block histamine that form exudate and bronchi constriction
Oxygen therapy

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COPD
Chronic obstructive pulmonary disease
Cause?
How is the damage?

By progressive degeneration and obstruction of airway

Cause irreversible damage to lung

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Emphysema is what
Clinical
Cause

Chronically enlarged gas-exchange airway

Loss of elastic recoil
Increased residual volume

Cause: smoking or dusty

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Chronic bronchitis
What is
Symptoms.

Leads to what

Hypersecretion of mucus snd chronic productive cough for at least 3 months

Mucus is thicker than usual

Chronic irritation and inflammation lead to fibrosis and thickening of bronchial wall and further obstruction.

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Pneumonia
By What type?
Why
3 types

What: by bacteria, fungal and viral
Why: organism directly enter the lung

Streptococcus pneumonia 肺炎鏈球菌
Pneumococcal pneumonia 肺炎球菌
Viral pneumonia 病毒性肺炎

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Type of pneumonia
Name
Area
What bacteria/ virus
Partho?
Onset?
Symptoms?

Lobar pneumonia
Area: all of 1-2 lobes
By: streptococcus pneumonia
Partho: inflammation of alveolar wall, leakage of cells, fibrin and fluid into alveoli -) consolidation
Acute onset
High fever snd productive cough, rusty sputum

Bronchopneumonia
Area: small patches
By multiple bacteria
Inflammation and purulent exudate in alveoli
Insidious onset
Mild fever and yellow-green sputum

Interstitial pneumonia
Area: small patches
By Influenze virus mycoplasma
Interstitial inflammation around alveoli
Variable onset
Variable fever and headache, non productive cough

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Treatment for pneumonia

Ventilation and oxygen
Stay hydrated( 2-3L)
Encourage breathing exercise
Antibiotic for bacterial infection

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Tuberculosis
Cause by what bacteria?

Patho?

Clinical menifestation?

Treatment

Caused by mycobacterium tubercolosis
First is lung but may invade to other organ e.g. lymph nodes, bone and kidney
Mivrobe survive in dried sputum for weeks

Patho: susceptible person inhaled mycobacteria snd infected
Bacteria transmitted through airway into alveoli
Start multiply
Body’s immune system responds and caused inflammatory reaction.

Clinical menifestation:
May asymptomatic
Low fever, anorexia, weight loss, anxiety

Late stage: dyspnea, chest pain, hemoptysis

Antibiotic
Isoniazid+ rifampin

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Acute bronchitis

Acute infect of inflammation of the airway
Viral illness
Symptom similar but no pulmonary consolidation

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Pulmonary vascular disease- pulmoary embolism
Why
Forms what
Where usually have
S/s

Occlusion by tissue fragment or lipid or air bubble
Form thrombus
産科/ 骨科,
Chest pain, dypsnea, increaased rr, pleuritc pain

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Acute pulmonary distressed syndrome

Respiratory failure with acute lung inflammation
Diffuse alveolocapillary injury
Atelectasis 肺不張
Cause： sepsis/ multiple trauma
S/s: rapid, shallow breathing
Decreased lung compliance
Hypoxemia 低血氧

Common drug for respiratory system

Expectorant- easy removal of secretion
MES

Antihistamine- block H1 receptors
Chloepheniramine

Antimicrobials- treatment for infection
Penicillin

Bronchodilator- stimulate b2 receptor to open bronchioles
Ventolin

Renal disorder

Renal failure
Nephrotic syndrome
Renal calculus
Glomerulonephritis

Genitourinary disorder

Urinary incontinence
Urinary tract infection
Cystitis
Bladder camcer
Prostate disease

SUPER IMPORTANT

Clinical manifestation of genitourinary system

Pain commonly in lower abdomen
Dysuria(排尿困難）
Frequency
Urgency
Anuria
Hematuria
Urinary incontinence
Urinary retention

Urinsry tract obstruction
Definition
Two types？

Definition： blockage of urinary flow
Striture：narrow is caused by contraction of smooth muscle我stenosis： narrpw is caused by lesion that reduce space in urinar tract

Severity of urinary tract obstruction:

Location
Duration
Cause
Completeness

Kidney stone
Risk factors
Parthophisiology of stone formation

Risk factors: gender, location, fluid intake
Partho: urinary concentrations such as calcium oxalate, calcium phosphate increase in the urinary tract
Grow into a stone through crystallisation

Clinic manifestation of kidney stone Test？ Treatment？

Manifestation: renal colic 腎絞痛（ intense spasm of pain in flank area.） Diagnostic test: **urogram** Abdominal CT Treatment: stone removal

Urinal tract infection What is it? Common pathogens?

UTI is an inflammation of urinary epithelium following invasion and colonisation by some pathogens Escherichia Coli Staphylococcus saprophyticus Enterobacter spp

Upper UTI*3 Lower UTI*3

Upper: pyeolonephritis Interstitial nephritis Renal abscess Lower: Cystitis Prostatis Urethritis

Urethritis Definition Cause

Definition: inflammation of urethra Cause:bacteria infection, gonorrhea Spermicidal jelly Scented napkin

Inflammation process (4)

1.Bacteria invade 2. Attach and colonize the host 3. Evade the host defense mechanism 4. Initiate inflammation

Urethritis s/s

Low abdomen pain Dysuria Urgency Frequency Red, swollen urethra

Urethritis treatment (2)

Antibiotics agent (ampicillin) Urinary analgesic agent( phenazopyridine) (relief burning sensation)

Cystitis Definition Patho Manifestation Treatment

Definition: inflammation of bladder Patho: ascending bacteria from urethra Obstructive urinary pattern Manifestation: dysuria, frequency, urgency, suprapubic pain Treatment: antimicrobial, increase fluid intake

Acute pyelonephritis Whats happening inside Cause Chronic

Acute infection of kidney Enlarged kidney and even abscess in renal capsule Cause: upward spread of bacteria Systemic infection Urinary tract obstruction Chronic: repeating acute pyelonephritis Client with renal infection is more likely to get chronic pyeolonephritis S/s Progressive scarring the kidney Renal failure Dysuria Systemic signs appear more on pyelonephritis’s Urine analysis is similar to cystitis (but have leukocyte)

Glomerulonephritis Definition Why wui gum? Patho?

Inflammation of glomerulus Immune disorder leads to inflammation of glomerulus Antigen-antibody complex from infection is trapped in glomerulus Inflammatory damage leads to reduce of function Increase permeability and cell proliferation Reduce of protein and erythrocyte

Development of glomerulonephritis

1. Streptococcus infection 2. Antibody formation 3. Antigen-antibody complex (few weeks later) 4.1 Increase permeability-) Hematuria, albuminuria -) recoverable 4.2 glomerulus swelling, cell proliferation-) congestion, stimulation of renin secretion. 4.3 glomerulus swelling -) acute renal failure-) recover or die Cell proliferation-) chronic glomerulonephritis-) chronic renal failure

Chronic gluemrulonephritis patho

Scarring and fibrosis of kidney tissue Kidney reduced size to its 1/5 Scarring turn surface of kidney rough and irregular Decrease filtration rate Chronic renal failure

Glomerulonephritis s/s Treatment?

Urine colour become dark and cloudy Increased BP(血管多咗嘢 Flank or back pain Symptoms of inflammation Treatment: Sodium restrictor Glucocorticoids: reduce inflammation Antihypertensive: reduce BP Antibiotic: kill bacteria

Renal failure What is it What affected

Kidney cannot remove metabolism Affect endocrine and metabolic actions Affect fluid, electrolye, scid base balance

Acute renal failure what mean?

Rapid loss of renal function Usually reverisible but prolonged wui irreversible increase serum creatine ( 血管垃圾）blood urea nitrogen Leads to life threatening ( water & electrolyte imbalance )

Renal failure physio and treatment

Progressive reduction of functioning renal tissue Remaining kidney cannot maintain body internal environment Need renal replacement therapy

Nephrotic syndrome Partho? S/s?

A type of renal failure Partho: abnormal of glomerular capillaries Manifestation: proteinuria Hypoalbuminemia Hyperlipidemia(high serum cholesterol and low density lipid protein

Drug in genitourinary system

Urinary analgesic Analgesic to urinary tract mucosa Use when pain, burning, itchy sensation Diuretic Increase excretion of water and urinary output