obstructive lung disease Flashcards
what is the gas exchange unit within the lungs
alveloi
what is atelectasis
alveolar collapse
very common in patients who are immobilized
what is atelectasis associated with
compression: external force
Obstruction: hypoventilation
decreased surfactant: may be reduction of production or alternation in makeup of surfactant
what creates surfactant
type 2 alvelolar epithelial cells
mix of phospholipids, proteins, ions
what does surfactant do to the surface tension
keeps surface tension lower
creates water tension for recoil
what is the presentation of atelectasis
typically asymptomatic
may have SOB, cough, fever, elevated WBC
what are obstructive lung diseases
disease state in which it is difficult for the patient to get air OUT of the lung
what can cause obstructive lung disease
mechanical obstruction: FB, tumor, mucus plug
increased resistance: thickening associated with inflam changes, chronic bronchitis
airway closure : asthma/emphysema
what is lowered with obstructive patterns
Decreased FEV1
FEV1/FVC ratio
what is FEV1
forced expiratory volume in 1 second
what is restrictive lung disease
disease state in which it is difficult for the patient to get air IN to the lung
what can restrictive lung disease be associated with
stiffening of the lungs
stiff chest wall
muscular weakness of respiratory musculature
What is emphysema
progressive destruction of alveolar membranes and dilation of the distal airways
what is emphysema associated with
most commonly associated with smoking (inhaled pollutant)
less commonly associated with alpha-1 antitrypsin deficiency
what occurs with emphysema
macrophages try to protect alveoli and engulf foreign substance (pollutant)
inflammatory activation with cytokine release
increased WBC recruitment
WBC release proteases
break down the connective tissue surrounding alveoli
what are the layers of the cronchioles
epithelial lining: contains goblet-cells and cilia
smooth muscle layer
connective tissue
what presents with a honeycombing appearance
emphysema - large airspace
is emphysema reversible or irreversible
irreversible damage
what are complications of emphysema
hypoxemia, hypercapnia
pneumothorax
what is the presentation of emphysema
dyspnea
prolonged expiratory phase
accessory breathing
wheezing
barrel shaped chest
dyspnea
decreased FEV1/FVC ratio
what is a bleb vs bulla
bleb- small
bulla - large
what is chronic bronchitis
obstructive airflow secondary to thick mucus - not as much structural, more mucus plugging
associated with smoking
what occurs during chronic bronchitis
exposure (smoking) will cause irritation/inflammation
cellular damage, ciliary damage
over production of mucus
goblet cells will unregulated/increase the number and size, thickening in the airway
what is air trapping
decreased air out during expiration compared to air in during inspiration
what is a mucus plug
increased mucus with chronic bronchitis can lead to a mucus plug which further reduces the passage of air
what is the presentation of chronic bronchitis
dyspnea - worse with exertion
decreased FEV1/FVC ratio
flare will lead to decreased alveolar lumen
what are complications of chronic bronchitis
pneumonia distal to obstruction
hypoxemia
hypercapnia
VQ mismatch
What is bronchiectasis
considered a chronic obstructive pulmonary disease but not COPD
abnormal dilation of the bronchi
dilated airways more readily collapse
chronic inflammatory state will cause increased mucus production/stasis
what is the most common cause of bronchiectasis
cystic fibrosis
aspiration
immunodeficiencies
connective tissue diseases
what is the presentation of bronchiectasis
productive cough - foul smelling sputum, purulent
hemoptysis
what is the atopic triad
atopic dermatitis (eczema)
allergic rhinitis (Hay fever)
asthma
what are common triggers for asthma
allergens
cold
exercise
illness
pets
increased emotional stress/anxiety
what is the process of asthma
trigger - leads to activation of dendritic cells
activated T cells
releases interleukins
activated B cells and eosinophils
activation of mast cells
degranulation -> histamine production
what occurs during asthma exacerbation
patient will have increased lung volumes (like emphysema)
muscular fatigue
respiratory failure
intrathoracic pressure can increase to the point patient has pulsus paradoxus
what are complications of asthma
chronic complications associated with repetitive cellular damage - fibrosis
what is cystic fibrosis
autosomal recessive abnormality resulting in mutation of CF transmembrane conductance regulator (CFTR protein)
what is CFTR
chronic transportation protein on the exocrine glands
found in epithelial cells of the airways, bile ducts, pancreas, sweat glands, sinuses, vas deferens
what is the pulmonary manifestations of CF
mucus plugs
inflammatory reaction
increased risk of infection
recurrent infections - chronic inflammatory changes - COPD/Bronchiectasis
what are complications of CF
peripheral bullae
pneumothorax
hemoptysis
cor pulmonale
what is the presentation of CF
neonatal difficulty with passage of meconium
foul smelling stool
failure to thrive
cough
infections
SOB
what is the typical cause of death in patient with CF
respiratory failure
what occurs with CF alternation
change in water concentration/movement
thickening of secretions (dehydration)
