lungs Flashcards
toxic gases, organic dusts, inorganic dusts
pulmonary fibrosis
rheumatologic diseaase
pulmonary fibrosis
chronic inflammation, alveolar epithelialization, mylofibroblast proliferation
pulmonary fibrosis
MC idiopathic lung disorder, men over 60, survive 2-4yrs
idiopathic pulmonary fibrosis
PE diffuse inspiratory crackles
idiopathic pulmonary fibrosis, pulmonary edema, vial pneumonia
damage airway epithelium, cilia, alveoli
toxic gases
burning of eyes, nose, throat
toxic gases
inhaled inorganic dust particles
pneumoniciosis
MC silicosis, asbestosis, coal worker/black lung
Pneumoconiosis
Pneumoconiosis cough
productive
proinflammatory cytokines released, inflammation, scarring of alveolocapillary membrane, and pulmonary fibrosis
Pneumoconiosis
organic dust particles
Hypersensitivity pneumonitis/ extrinsic allergic alveolitis
type 3 hypersens, IgG, granuloma
Hypersensitivity pneumonitis/ extrinsic allergic alveolitis
Granulomatous disorders
CT disorders
Goodpasture’s syndrome
Systemic disorders affecting airways, lungs, and lung parenchyma
Excess water in the lungs from capillary hydrostatic pressure (from heart failure), oncotic pressure, and permeability (from injury) so pts have dyspnea, orthopnea, hypoxemia, and inc work of breathing
Pulmonary edema
MCC is left sided heart disease
Pulmonary edema
PE- inspiratory crackles, dullness to percussion at lung bases, and ventricular dilation (S3 gallop)
Pulmonary edema
MC predisposing factors- genetics, sepsis, and multiple traumas
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
exudative phase, proliferative phase, then fibrotic phase
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
predisposing factors: heart disease, ARDS, inhalation of toxic gases
pulmonary edema
rare but life threatening complication that can occur after relief of upper airway obstruction
postobstructive pulmonary edema; neg press pulmonary edema
dyspnea, wheezing, low VQ, dec FEV1
Obstructive pulmonary disease
Mucous plug
asthma, bronchiectasis, COPD
IRREVERSIBLE if left untreated
asthma
bronchospasm is not reversible by usual trmt
Status asthmaticus-
3rd leading cause of death in the US
COPD
6th leading cause of death in the world
COPD
Risk factors: tobacco, dust and chemicals, indoor air pollution, anything that affects lung growth during gestation and childhood
COPD
Mucous plugs narrow airways so air trapping and hyperinflation occur
copd
chronic bronchitis type of cough
productive
polycythemia
chronic bronchitis
Gas exchange airways are permanently enlarged and alveolar walls are destroyed WITHOUT fibrosis so we lose elastic recoil
Emphysema
Barrel chest & pts lean forward to increase lung capacity
emphysema
MCC smoking emphysema
sec
centriacinar, panacinar
emphysema
Elastin breakdown, imbalance of protease and antiprotease, oxidative stress, apoptosis of lungs structural cells
emphysema
MCC short term disability in the US
Respiratory tract infections
6th leading cause of death in the US
pneumonia
Different microorganisms causes this pneumonia
CAP
Seasonal, mild, self limiting infection of LRT
Viral pneumonia
Viral pneumonia type of cough
productive
PE= crackles, inc tactile fremitus (vibratory tremors on chest palpation), egophony (inc voice resonance on auscultation)
Viral pneumonia
Virus destroys epithelial cells, invades goblet cells, destroys bronchial epithelium, prevents mucous from being cleared, bronchial walls become red and WBC come in
Viral pneumonia
Leading cause of death worldwide from a curable infectious disease
tb
night sweats
tb
caseous necrosis
tb
Must use at least 4 drugs for 18 months; check at 6 months to see if it’s working
tb
MCC aspiration
Abscess and cavitation
Abscess and cavitation cough type
productive
chronic PRODUCTIVE cough with foul smelling and purulent sputum
Bronchiectasis, Abscess and cavitation
Acute infection or inflammation of airways/bronchi usually after a viral illness
Acute bronchitis
Acute bronchitis cough type
nonproductive
Has similar sx to pneumonia, but no pulmonary consolidation and chest infiltrates… chest x ray is normal
Acute bronchitis
Virchow’s triad: venous stasis, venous endothelial damage, hypercoagulability
pe
high vq
pe
Workload of right ventricle is increased so right ventricular hypertrophy occurs
PAH
First induction: chest radiography shows enlarged pulmonary arteries on R heart border or R ventricular hypertrophy on ECG
PAH
Hoarseness
Laryngeal cancer
2-3% of all cancers in the US
Laryngeal cancer
MCC of cancer death in the US
Lung cancer/bronchogenic carcinomas
MCC of cancer death in the US
Lung cancer/bronchogenic carcinomas
85% of all lung cancers
Non small cell lung cancer
Squamous cell carcinoma
nonproductive cough or hemoptysis
Adenocarcinomas-
tumors from glands; asymptomatic OR pleuritic chest pain and SOB
Non small cell lung cancer types
squamous cell, adenocarcinoma, large cell
chemo and radiation are not helpful so palliative care is best option
Large cell carcinomas/ undifferentiated
MC and WORST prognosis cancer
Small cell carcinoma/Oat cell carcinoma
1st manifestation: paraneoplastic syndrome- t cells attack body’s own CNS
Small cell carcinoma/Oat cell carcinoma
Rare and are NOT related to smoking
Bronchial carcinoid tumors
Asymptomatic; we can cure these if they have not spread
Bronchial carcinoid tumors
Associated with asbestos
May take 20-40 years to appear
Mesothelialomas
TNM classification system of CA
T: extent of primary tumor
N: nodal involvement
M: extent of metastasis
MC pain caused by pulm disease
pleural pain
chest wall pain-
from costochondritis- inflammation of costochondral junction; reproducable
hypercapnia due to _______ ventilation of alveoli
hypo
easily overlooked as normal breathing and ventilation may appear normal
hypercapnia
how can we inc hypoventilatio of alveoli
inc rate and depth of breathing
MCC hypoxemia
vq mismatch
normal vq
0.8-0.9
would we die 1st from hypoxemia or hypercapnia
hypoxemia
MV=
TV*RR
maintain arterial CO2 at
40 mmHg
MC post op problems: atelectasis, pneumonia, pulmonary edema, PE
acute resp failure
MCC of hospital admission from hypercapnia and hypoventilation
Respiratory difficulty
hypo or hypoerventilaion in flail chest
hypo
PE= No or decreased breath sounds and hyperresonance to percussion on affected side
tension pneumothorax
PE= decreased breath sounds and dullness to percussion
empyema
Caused by Staph aureus, E. coli, Anaerobic bacteria, Klebsiella pneumonia (think SEAK) so we want to treat with antimicrobial meds
empyema
PEEP
aspiration
fever and leukovytosis, sydpnea, cough
atelectasis
deep breathing
atelectasis
high resolution CT
Bronchiectasis, idiopathic pulm fibrisos
MC in children, but can also occur in adults with chronic bronchitis or viral infection from inhaling toxic gases
bronchiolitis
bronchiolitis cough
nonproductive
MC after lung transplant
Bronchiolitis obliterans
dec perfusion at the alveolocapillary membrane
pulm fibrosis
Injury to pulmonary capillary endothelium, inc capillary permeability, inflammation, surfactant inactivation, edema, atelectasis
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
prolonged exposure to high conc of supplpemental O2
oxygen toxicity
reduce inspired O2 conc to less than 60 %
oxygen toxicity
life threatening complication that can oocur after relief of upper airway obstruction
POPE postobstructive pulm edema; negative pressure pulm edema
Acute lung inflammation and alveolocapillary injury
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
poor resp with O2 supplementaion
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
resp alkalosis, metabolic acidosis, resp acidosis
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
early detection is key
Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) or noncardiogenic pulmonary edema
MC: asthma, chronic bronchitis, emphysema, COPD
Obstructive pulmonary disease