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module 11 restrictive lung disease Flashcards

1
Q

restrictive PFT

A 
decreased inspiration amount
FEV1: gets out less then normal 
- 2.5L
FVC: less out in total 
- 3.0L
FEV1/FVC: 83%
- normal
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2
Q

restrictive lung diseases caused by

A

alterations in

  • lung parenchyma
  • pleura
  • chest wall
  • neuromuscular funtion
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3
Q

restrictive lung disease presenting s/s

A

more effort to expand lungs during inspiration
inc. respiratory rate; rapid, shallow
dec. tidal volume
dyspnea

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4
Q

characteristics of restrictive disorders

A

dec. vital capacity
dec. total lung capacity
dec. function residual capacity
dec. residual volume
- greater dec. in lung vol. the greater the severity of disease

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5
Q

restrictive disorders ABG

A

dec. PaO2
normal or dec. PaCO2
inc. pH

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6
Q

overview of restrictive lung disorders

A 
parenchyma
- diffuse interstitial lung disease
- sarcoidosis
- pneumonitis
- occupational lung disease
atelectatic disorders
- ARDS
- IRDS
infection/inflammatoin
plueral space
- PTX
- effusion 
neuromuscular disorders
chest wall deformities
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7
Q

diffuse interstitial lung disease

A 
restrictive lung disorder
 also called pulmonary fibrosis 
3 pathological patterns
- inflammation 
- fibrosis
- destruction 
Causes thickening of alveolar interstitum
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8
Q

diffuse interstitial lung disease pathogenesis (pulmonary fibrosis)

A

inj. to alveolar or capillary endothelial cells
- > infiltration of lymphocytes, macrophages, plasma cells
- > obliteration of capillaries, reorganization of lung parenchyma, irreversible fibrosis
- >thickened alveolar wall and interstitium
- > formation of large air filled sacs/cysts and dilated terminal and respiratory bronchioles

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9
Q

diffuse interstitial lung disease s/s

A 
progressive dyspnea 
irritating non productive cough
rapid, shallow breathing
clubbing of nail beds
bibasilar end-expiratory crackles
cyanosis: late
anorexia and wt. loss
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10
Q

inflammatory pattern of diffuse interstitial lung disease

A

triggering event

  • occupational, smoking, drugs, CT disease
  • > inflammatory response
  • > inj. to alveolar capillary basement membrane
  • > inc. permeability -> fluids and debris into alveoli
  • > fibroblastic proliferation -> deposition of collagen
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11
Q

fibrotic pattern of diffuse interstitial lung disease

A

inc. mesenchymal and fibroblasts in interstitium
thickened alveolar walls w/ inc. fibrous tissue
-> restriction, dec. compliance, inc. elastic recoil

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12
Q

destruction pattern of diffuse interstitial lung disease

A

loss of alveolar walls

xray: honeycomb lung

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13
Q

sarcoidosis

A

acute or chronic systemic disease of unknown cause
immunologic basis
- presence of CD4 T cells
activation of alveolar macrophage to unknown trigger
women in 20-30’s
- 1st degree relative w/ hx inc risk 5x
noncaseating granulomas: fibrotic surrounded by large histiocytes

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14
Q

sarcoidosis pathogenesis

A

development of multiple, uniform, noncaseating epithelioid granulomas: affect multiple organ systems
Abnormal T cell function

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15
Q

sarcoidosis s/s

A 
malaise
fatigue
wt loss
fever
chest discomfort
dyspnea
dry nonproductive cough
erythema nodosum (nodes on lower extremities)
macules
papules
hyperpigmentation
subQ nodules
hepatosplenomegaly
lymphadenopathy
iritis
uveitis
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16
Q

hypersensitivity pneumonitis

A

extrinsic allergic alveolitis
restrictive and occupational disease
>300 inhaled organic agents responsible for inflammatory proccess
- genetic predisposition
antigen combines with serum antibody in alveolar walls -> type 3 hypersensitivity reaction -> antigen- antibody complexes -> inflammation and lung tissue injury
leads to diffuse pulmonary fibrosis in upper lobes (hallmark)

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17
Q

hypersensitivity pneumonitis granulomatous inflammation

A

-> lung tissue injury
- thickening of alveolar walls
- formation of exudate in bronchiolar lumen
- infiltration of lymphocytes, plasma cells, and eosinophils
fibrotic lung changes occur in advanced cases

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18
Q

acute hypersensitivity pneumonitis s/s

A 
4-6 hours after exposure, resolves in 18-24 hours
chills
sweating
myalgia 
nausea
lethargy
HA
malaise
possible fever
dyspnea at rest
dry cough
inc. RR
chest discomfort
cyanosis (late)
crackles in bases
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19
Q

chronic hypersensitivity pneumonitis s/s

A 
progressive diffuse pulmonary fibrosis in upper lobes
cough
dyspnea
fatigue
cor pulmonale
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20
Q

pneumoconiosis: occupational lung diseases

A

parenchymal lung disease caused by inhalation of inorganic dust particles; greater the exposure, the worse the consequence

  • anthracosis: coal miners lung/ black lung
  • silicosis: silica inhalation
  • asbestosis: asbestos inhalation
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21
Q

pneumoconiosis pathogenesis

A

alveolar macrophages try to engulf and remove particles
macrophages secrete lysozymes to control foreign particle activity
-> damage to alveolar walls causing deposition of fibrous materials

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22
Q

pneumoconiosis s/s

A 
none in early stages 
physical s/s w/ impaired pulmonary circulation d/t inc. pulm vascular resistance or development of infection 
- productive cough
- dyspnea
- progressive fatigue
- clubbing of fingers
Late
- chronic hyposemia
- cor pulmonale
- respiratory failure
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23
Q

atelectatic disorders

A

atelectasis: collapse of lung tissue
compression
absorption
surfactant

24
Q

compression atelectasis

A

tumors
fluid
air in pleural space

25
absorption atelectasis
obstructed alveoli -> no intake of air into alveoli - tumor, mucus plugs, foreign body concentrated O2, replaces nitrogen content, or anesthetic agents -> too much O2 absorbed from alveoli -> collapse
26
surfactant impairment atelectatic
``` dec. production or inactivation of surfactant prematurity ARDS anesthesia mechancial ventialtion ```
27
ARDS: acute (adult) respiratory distress syndrome
characterized by damage to the alveolar capillary membrane -> wide spread protein alveolar infiltrates and dyspnea changes in alveolar diameter injury to pulmonary circulation disruptions in O2 transport and utilization associated with dec. in PaO2 refractory (does not respond) to O2 therapy
28
common findings with ARDS
``` severe hypoxemia r/t intrapulmonary shunting of blood dec. lung compliance dec. FRC diffuse, fluffy alveolar infiltrates noncardiogenic pulmonary edema ```
29
early ARDS s/s
``` hx of precipitating event -> low blood volume state 1-2 days before resp. failure sudden respiratory distress slight inc. HR dyspnea dec O2 shallow, rapid breathing ```
30
progressive ARDS s/s
inc. HR inc. RR hypoTN restlessness AMS frothy secretion crackles, ronchi retractions
31
late ARDS s/s
cyanosis
32
ARDS breakdown tissue trauma
alveolar capillary membrane injury - > tissue trauma - > inc. platelet aggregation -> release of proteases and kalikrein - > microemboli in pulm. vessels - > activated neutrophils: serotonin, bradykinin, histamin, thromboxan A2 -> free radicals - > pulmonary platelet trapping and coagulation activation - > inc. permeability of endothelium and epithelium - > inc. interstital and alveolar edema - > dec. alveolar and airway filling - > consquencses - dec. FRC - inc. intrapulmonary shunting - dec. lung compliance - inc. dead space - loss of hypoxic vasoconstriction - hyaline membrane formation
33
ARDS breakdown type 1 alveolar epithelial defects
alveolar capillary membrane injury - > type 1 alveolar defects - > dec. surface area, leaky capillary - > disrupted basement membrane - > disorganized collagen in the interstitium - > fluid accumulation in alveoli - > damage to type 2 pneumocytes and type 1 alveolar cells - > decreased surfactant - > alveolar collapse - > dec. alveolar and airway filling - > consequences
34
high FiO2 and ARDS
leads to damage to type 2 pneumocytes and type 1 alveolar cells inc. permeability of endothelium and epithelium - paralysis of ciliary action - atelectasis - pulmonary edema - alveolar cell hypertrophy - damage to mitochondria of type 2 cells
35
pneumonia
inflammatory reaction in alveoli and interstitium caused by infectious agent - aspiration of oropharyngeal secretions - inhalation of contaminants - contamination from systemic circulation
36
CAP pneumonia
community acquired - mild/moderate - severe
37
nosocomial pneumonia
medically acquired - ventilator: VAP - health care facility: HCAP (resting home) - hospital: HAP
38
pneumothorax
``` air in pleural space spontaneous primary: rupture of small blebs -> air in pleural space -- spontaneous -- tall, thin men, 20-40 w.out underlying disease factors -- smoking inc. risk Secondary: rupture of bleb or cyst -- r/t complication of preexisting pulmonary disease - asthma - emphysema - cystic fibrosis - infectious - interstitial lung disease ```
39
tension pneumothorax
build up of air under pressure in pleural space - traumatic orgin - penetrating or nonpenetrating injury - medical emergency - > lung collapse on same side - > forces mediastinum toward contralateral side - > dec. venous return and CO
40
pneumothorax s/s
inc. HR dec. or absent breath sounds hyperresonance sudden chest pain dyspnea Tension and large - severe inc. HR - hypoTN - tracheal shift - neck vein distention - hyperresonance - SubQ emphysema
41
pleural effusion
``` fluid in pleural space - transudate - exudate - empyema - hemothorax - chylothorax change in pleural capillary hydrostatic pressure, colloid oncotic pressure, or intrapleural pressure ```
42
transudative effusion
``` low protein and LDH - HF - cirrhosis - nephrotic syndrome - myxedema r/t inc. hydrostatic or dec. oncotic pressure ```
43
hemothorax effusion
blood and pleural fluid | - chest trauma
44
exudative effusion
``` high protein and LDH - malignancy - infection - sarcoidosis r/t inc. production of fluid d/t inc. permeability of pleural membrane or impaired lymphatic drainage ```
45
chylothorax effusion
traumatic leakage of lymph fluid - rheumatoid effusion - TB pleuritis
46
empyema effusion
r/t infection in pleural space
47
pleural effusion s/s
``` dyspnea pleuritic pain: sharp, worse with inspiration dry cough dec. chest wall movement no breath sounds dullness to percussion dec. tactile fremitus ```
48
neuromuscular disorders
diseases affecting the muscles of respiration or their nerve supply can lead to dyspnea and respiratory failure - poliomyelitis - ALS - mascular dystrophies - guillian-barre syndrome - myasthenia gravis
49
chest wall deformities
physically restrict expansion - kyphoscoliosis - ankylosing spondylosis - flail chest - obesity
50
kyphoscoliosis
bone deformity of chest wall resulting from posterior curvature (hump back) and scoliosis- lateral curvature -> compression of lung volume, atelectasis, hypoxemia
51
kyphoscoliosis s/s
dyspnea on exertion rapid, shallow breathing hypoxemia later on and eventually CO2 retention
52
Flail chest
multiple rib fx at 2 different sites -> unstable, free floating chest wall segment moves paradoxically; inward on inspiration, outward on expiration -> pulmonary contusion, dec. compliance, resp. failure
53
flail chest s/s
``` SOB pain on inspiration hypoTN cyanosis hypoxemia ```
54
obesity
dec. ventilatory drive inc. work of breathing inc. abd. size -> compression of chest cavity
55
obesity s/s
``` dec. alveolar ventialtion somnolence severe hyposemia polycythemia cor pulmonale SOB ```

Pathophysiology (80 decks)

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