Lung B 34, vascular origin diseases and atelectasis

Question 1

Types of atelectasis and their basic causes

Answer 1

Compression - by mass-malignancy, air-PTX, or fluid-hydrothorax or effusion

Contraction - fibrosis

Resorption - bronchiole obstruction, mucinous or aspirating foreign body

(CCR)

Question 2

What are the diseases of vascular origin for the lung (3)

Answer 2

Embolism
Hemorrhage
Infarction

Question 3

What are the Acquired risk factors for venous thrombus development?

Answer 3

Prolonged inactivity

Surgery, especially involving bones
Large fractures

Severe Burns

Congestive heart failure

Atrial fib

Previous MIs

Estrogen based birth control

Disseminated cancers

SLE associated AntiPhospholipid syndrome

Heparin induced thrombocytopenia

Malignancy

Myeloproliferative disorders

Question 4

What are the congenital hypercoagulability states?

Answer 4

Factor V resistant to APC degradation Leiden mutation
Or, acquired protein C resistance.

Antithrombin, Protein S, Protein C deficiencies,

Dysfibrinogenemia,

Excessive prothrombin levels from non-coding mutation

Hyperhomocysteinemia

High factor 8, 9, or 11 levels

Question 5

What are the pathologic/physiologic consequences of pulmonary embolism?

Answer 5

Increased pulmonary pressure, demand on Right ventricle, Acute Cor Pulmonale and right heart failure

Ischemia of obstructed lung tissue IF the bronchial circulation is insufficient or compromised (from heart failure, lung disease, lots of atherosclerosis in elderly).

Lung infarcts are Hemorrhagic and cause subsequent coagulative necrosis and fibrotic scarring.

Hypoxia, caused by multiple things:

1) atalectesis of the ischemic tissue and ventilation perfusion mismatch. (cell dysfunction and surfactant loss, and reduced ventilation due to pain)
2) Right-to-left shunting in people with patent foramen ovale (as high as 30%)
3) Decreased cardiac output and widening of the difference in arterial-venous oxygenation saturation.

Question 6

What is the clinical presentation of Pulm embolism?

Answer 6

Most are asymptomatic, because they are small enough.
They are removed by fibrinolysis by the blood, and bronchial circulation and ventilation supplies the lung tissue until circulation is restored

if more than 60% of the pulmonary arteries are occluded (by one or multiple emboli), sudden death
acute cor pulmonale right sided heart failure, or cardiogenic shock

symptoms in between:
Dyspnea 
Chest pain
Hydrothorax
Hemoptysis

Question 7

Treatments for pulmonary embolism:

Answer 7

Urgent treatment:
Thrombolytics
Clot disruption via catheter
Surgergical removal of clot

Sub emergency treatment:
Anticoagulants, heparin warfarin
Compression leggings to prevent venous pooling
Isometric bed exercises for bedridden patients