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Pathophysiology > Module 4: Disorders of Pulmonary System > Flashcards

Module 4: Disorders of Pulmonary System Flashcards

1
Q

Define hypercapnia

A

Increased PaCO2 in arterial blood defined as > 45 mmHg

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2
Q

What causes hypercapnia?

A
  1. Hypoventilation of the alveoli
  2. Suppressions of respiration centers
    - -> DRG and VRG
  3. Large airway obstructions (tumors or sleep apnea)
  4. Damage to alveoli (emphysema)
  5. Respiratory acidosis

** Anything that impairs the nervous system or mechanical work of breathing

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3
Q

Respiratory Acidosis

A

any condition which lungs can’t effectively remove all CO2 from blood

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4
Q

Tissue Hypoxia

A

Decreased O2 in any tissue that could be caused by any number of causes, some of which include hypoxemia or ischemia

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5
Q

Hypoxemia

A

Decreased PaO2 in arterial blood

Defined as < 60 mmHg in arterial blood

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6
Q

What are the 5 major causes of hypoxemia?

A
  1. Decreased PO2 of inspired air
    - -> either from altitude or suffocation
  2. Hypoventilation
    - -> meds that depress resp. centers (DRG & VRG)
  3. Diffusion abnormality of alveolocapillary membrane
    - -> emphysema, fibrosis, or edema

4 and 5. Altered V/Q perfusion ratio (low or high V/Q)
–> MC cause!

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7
Q

What causes low V/Q?

A

Pulmonary “right to left shunting”

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8
Q

What is “right to left shunting”?

A

When blood travels from right heart to left without receiving O2…so poor O2 returns to left side of heart

Blood may pass through alveoli that are damaged/filled with fluid/debris

BOTTOM LINE:
Blood can get there, but lung tissue can’t deliver O2

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9
Q

Examples of right to left shunting

A 
Asthma
Chronic bronchitis
Pneumonia
ARDS
Respiratory distress syndrom of infants
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10
Q

What causes high V/Q?

A

Inadequate blood flow in area of well ventilated lung

BOTTOM LINE:
lung tissue can deliver O2 but blood can’t get there

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11
Q

Name an example that causes high V/Q

A

pulmonary embolism

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12
Q

Describe the difference between low V/Q and high V/Q hypoxemia

A

Low V/Q means that the blood can get there but the lung tissue can’t deliver O2

High V/Q means that the lung tissue CAN deliver O2 but blood can’t get there

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13
Q

Aspiration

A

Entry of fluid or solids into trachea and lungs

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14
Q

What are risk factors for aspiration?

A

Neurological conditions
Medicines
Decreased level of consciousness

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15
Q

Pulmonary edema

A

Excess fluid in lungs

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16
Q

What is the most common cause of pulmonary edema?

A

heart disease (increased left sided pressures)

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17
Q

What are the 4 types of Atelectasis?

A
  1. Compressive Atelectasis
  2. Absorptive Atelectasis
  3. Surfactant Impairment
  4. Post-operative Atelectasis
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18
Q

Compressive Atelectasis

A

external pressure compresses lung

Caused by:

  • Tumor
  • Fluid or air in pleural space
  • Abdominal distention
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19
Q

Absorptive Atelectasis

A

Air from blocked or hypoventilated alveoli gets absorbed into system

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20
Q

Surfactant Impairment

A

Lack of surfactant results in increased surface tension which makes lung prone to collapse

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21
Q

Post-Operative atelectasis

A

Most common form of atelectasis

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22
Q

How to prevent post-op atelectasis?

A
  • Post surgical deep breathing exercise
  • Patient positioning
  • Early ambulation
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23
Q

Do surfactant impairment and post-op atelectasis cause compressive or absorptive atelectasis?

A

Absorptive Atelectasis

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24
Q

Pneumothorax

A

Air accumulation within pleural cavity (pleural space)

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25
Q

Three “types” of pneumothorax:

A
  1. Open pneumothorax
  2. Tension pneumothorax
  3. Spontaneous pneumothorax
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26
Q

Open Pneumothorax

A

Air enters pleural cavity during inspiration and exits during expiration

This causes air pressure in pleural space to = barometric air pressure

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27
Q

Tension Pneumothorax

A

Air enters pleural cavity during inspiration but DOES NOT EXIT during expiration

This gradual buildup of air pressure collapses lung and compresses or displaces other structures (heart, vessels, etc)

EMERGENCY condition

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28
Q

Spontaneous Pneumothorax

A

An UNEXPECTED rupture of pleura common in 20-40 yo males

Air escapes from lung into pleural space and it may or may not develop into tension penumothorax

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29
Q

What is pleural effusion?

A

Fluid in pleural space

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30
Q

What can pleural effusion cause?

A

compressive atelectasis

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31
Q

5 causes of pleural effusion:

A
  1. Transudate
  2. Exudates
  3. Pus
  4. Blood
  5. Lymph fluid
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32
Q

What is the difference between pleural effusion and pulmonary edema?

A

Pleural effusion has fluid in pleural space and pulmonary edema has fluid in lung tissue itself

Pleural effusion contains dull or decreased breath sounds while pulmonary edema has crackles, rales sounds

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33
Q

Name the 4 main Pulmonary Disorders:

A
  1. ARDS
  2. Obstructive pulmonary disease
  3. Restrictive pulmonary diseases
  4. Pulmonary embolism
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34
Q

ARDS (acute respiratory distress syndrome)

A

Respiratory failure due to acute inflammation and alveolar damage

35
Q

What is the most common cause of ARDS?

A

Infection or multiple trauma

36
Q

Describe Phase I of ARDS

A
  • Initial injury to lung (damages alveolar & vascular endothelium)
  • MASSIVE INFLAMMATORY RESPONSE
  • Surfactant is inactivated
  • Alveoli collapse d/t less compliance and filling of inflammatory fluid
37
Q

Describe Phase II of ARDS

A
  • Hyaline membrane forms into fibrous mass coating alveoli and bronchioles
38
Q

Describe Phase III of ARDS

A
  • End result is respiratory failure

- Inflammatory mediators can cause secondary inflammation and damage other organs which can cause death

39
Q

Obstructive Pulmonary Disease

A

Airway obstruction that is worse with expiration

Can get air in but can’t breath out = wheezing

40
Q

What are the 3 most common obstructive pulmonary diseases?

A
  1. Chronic bronchitis
  2. Emphysema
  3. Asthma
41
Q

Name 6 common clinical characteristics of obstructive pulmonary disease

A
  1. Dyspnea - perceived difficulty breathing
  2. SOB or pain
  3. Increased WOB
  4. Wheezing
  5. Decreased FEV1/FEV ( b/c blood can get there but lungs can’t deliver O2
42
Q

What co-existing conditions are referred to as COPD (chronic obstructive pulmonary disease)

A

Chronic bronchitis

Emphysema

43
Q

What is the primary cause of COPD?

A

Smoking

44
Q

Describe the pathophysiology of chronic bronchitis

A

The bronchial tubes are narrowed

Excess mucous production which decreases airways and increases risk of infection and inflammation

45
Q

Describe the alveolar ventilation and V/Q ratio in Chronic Bronchitis

A

Decreased alveolar ventilation

Low V/Q

46
Q

Hypoxemia and Hypercapnia occur in ______.

A

Chronic Bronchitis

47
Q

What is car pulmonale and what is it a result of?

A

Car pulmonale: a change in structure and function of the right ventricle of the heart as a result of pulmonary hypertension

Pulmonary hypertension can stem from polycythemia, or increased amounts of RBCs

48
Q

Signs and symptoms of chronic bronchitis

A
  1. Productive and persistent couch; “smokers cough”
  2. Recurrent pulmonary infections
  3. Reduced flow rates (dec. FEV1/FVC) - prolonged expiration
  4. Static lung volumes (decreased FVC and Increased RV)
49
Q

Treatments of Chronic Bronchitis

A
  1. Expectorants
  2. Bronchodilators
  3. Physical Therapy
  4. Antibiotics and steroids
  5. Low flow O2 for severe hypoxemia
50
Q

What is the challenge with giving low flow O2 to patients with chronic bronchitis?

A

The potential adverse effect is respiratory depression because the peripheral receptors that are sensitive to O2 take over and depress ventilation.

The challenge is to provide low flow O2 w/o increasing PaO2 above 60 mmHg

51
Q

Emphysema

A

pathological accumulation of air in the lungs

Enlargement of gas exchange airways (acini)

52
Q

What are the 2 forms of emphysema?

A
  1. Centriacinar (centrilobar)

2. Panacinar (panlobular)

53
Q

Centriaacinar Emphysema

A

Destruction of the bronchioles and alveolar ducts
Alveolar sac remains intact

This is more common in chronic smoker

54
Q

Panacinar Emphysema

A

Destruction of entire acinus (bronchiole, alveolar duct, and alveoli)

This is more common in elderly

55
Q

Describe how smoking causes emphysema (the pathophysiology)

A

Proteases and free radicals destroy elastin in lungs.

Smoking inhibits a protease inhibitor (alpha1-antitrypsin)

This promotes release of elastase, which is an enzyme that destroys elastic tissue in lung

**Smoking also favors recruitment of WBC’s

56
Q

What two things are uncommonly seen in a pt. with Emphysema?

A

Coughing and wheezing

57
Q

What are some “clinical pearls” of Emphysema?

A

Barrel chest (chronic expansion)

Classic sit and lean forward with arms extended breathing position

58
Q

What is the end stage of emphysema?

A

SAME AS CHRONIC BRONCHITIS

Pulmonary HTN and cor pulmonale

59
Q

Treatment for acute emphysema:

A
  1. O2 therapy (positive pressure or mechanical ventilation)
  2. Bronchodilators
  3. Corticosteroids and antibiotics
60
Q

Treatment for chronic emphysema:

A
  1. QUIT SMOKING
  2. Pulmonary rehab and pt. education
  3. O2 therapy if necessary
  4. Beta agonist or anticholinergic meds
61
Q

Asthma

A

Reversible obstructive lung disease caused by increased reaction of airways to various stimuli (hypersensitive)

62
Q

What are the 3 things that result from inflammation and epithelial damage that occurs in asthma?

A
  1. Bronchial smooth muscle spasm
  2. Mucus production (impairs cilia function)
  3. Vascular Congestion
63
Q

What triggers exercise induced asthma?

A

Dry, cold air

Classic Fall weather

64
Q

What are 4 characteristics of Restrictive Pulmonary Conditions?

A
  1. Short shallow breathing patterns
  2. Flow rates: increased or no change (FEV1/FVC (>90%))
  3. Static Volumes: Decreased FVC, RV and TLC
  4. DOE progress to dyspnea at rest
65
Q

Sarcoidosis

A

Inflammation that produces tiny lumps of cells in various organs throughout the body

66
Q

What are the 4 Restrictive-Parenchymal Conditions?

A
  1. Sarcoidosis
  2. Idiopathic pulmonary fibrosis
  3. Pneumoconiosis
  4. Drug- or radiation-induced interstitial lung disease
67
Q

What are the 7 Restrictive-Extraparenchymal Conditions?

A
  1. Myasthenia gravis
  2. Guillain-Barre syndrome
  3. Muscular dystrophies
  4. Cervical spine injury
  5. Kyphoscoliosis
  6. Obesity
  7. Ankylosing spondylitis
68
Q

Pulmonary Fibrosis

A

Excessive fibrosis proliferation in lung

69
Q

What are 3 causes of pulmonary fibrosis?

A
  1. Secondary complication from disease (TB, ARDS)
  2. Inhalation of environmental hazards (pneumoconiosis)
  3. Idiopathic pulmonary fibrosis
70
Q

Why is their excessive fibrosis proliferation in pulmonary fibrosis?

A

Chronic inflammation.

Alveoli are invaded by fibroblasts

71
Q

Pneumoconiosis

A

Lung pathology due to inhalation of inorganic environmental hazards (often long term exposure)

72
Q

What are some common pathologies of pneumoconiosis?

A
  1. Silica (common in mining)
  2. Asbestos
  3. “Coal miner lung” (coal, silica, and quartz)
73
Q

Tuberculosis (TB)

A

Infection from mycobacterium tuberculosis

74
Q

How is TB transmitted?

A

Through airborne particles/droplets

–> VERY contagious

75
Q

What is the pathology of TB?

A

Inflammatory process secondary to bacteria

Immune response leads to formation of granulomatous lesions known as tubercle

Tissue within tubercle becomes necrotic

Scar tissue surrounds tubercle

Remains dormant unless disrupted or if immune system is comprimised
–> HIV greatest risk to reactivate TB

76
Q

A positive PPD (purified protein derivative) means…

A

Pt either had disease or was vaccinated

77
Q

What do chest films show in pts with TB?

A

Calcifications

Nodes observed in upper lobes

78
Q

Pulmonary Embolism

A

Occlusion of pulmonary vascular/capillary supply

79
Q

What is the V/Q ratio of pulmonary embolism?

A

Lung CAN deliver O2 but blood can’t get there so…

High V/Q ratio

80
Q

What is the most common cause of pulmonary embolism?

A

Most common via DVT - Deep Vein Thrombosis

81
Q

What are risk factors for a pulmonary embolism caused by venous stasis?

A
  • immobility (post surgery, long travel)
  • Pregnancy
  • Congestive heart failure
82
Q

What are risk factors for a pulmonary embolism caused by hypercoagulation?

A

Genetics

OCPs

Malignancy

83
Q

What are risk factors for a pulmonary embolism caused by damage to endothelium of blood vessels?

A

Trauma or surgical

CVA (stroke)

Pathophysiology (12 decks)

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