obstructive lung disease Flashcards
What allows for the passage of air between the alveoli to share to air
pores of Kohn
What is atelectasis
alveolar collapse
What is atelectasis associated with
compression
decreased surfactant
obstruction
What can cause compression of the alveoli
external force from pneumo, plural effusion, abdominal distention
What is occurring in obstruction of the alveoli
hypoventilation of the alveoli
-absorption of air that is left in alveoli with no new air coming in b/c of obstruction
Why does decreased surfactant cause atelectasis
the reduction or production / alteration in the makeup causes the tension to not be maintained
What is decreased surfactant associated with
premature births
aspiration
ARDS
anesthesia
ventilation
Which cells create surfactant
type 2 alveolar epithelial cells
What makes up surfactant
phospholipids, proteins, ions
What allows water retention for recoil in the alveoli
layer of fluid
What is obstructive lung disease
disease state in which it is difficult for the patient to get air out of the lung
What may cause obstructions for the lungs
mechanical
increased resistance
airway closure
What can cause mechanical obstruction of airways
FB
Tumor
What causes increased resistance in the lungs
thickening associated with inflammatory changes
chronic bronchitis
What can cause airway closure in obstructive lung disease
asthma
emphysema
What is the biggest difference between asthma and COPD
COPD is irreversible
What is FEV1 and FVC in obstructive lung disease
decreased FEV1
lowered FEV1/FVC ratio
What is restrictive lug disease
disease state in which it is difficult for the patient to get air IN to the lung
What may cause restrictive lung disease
stiffening of the lungs
stiff chest wall
Muscular weakness or resp. muscle
What can cause the stiffening of the lungs
interstitial lung disease
What can cause a stiff chest wall
kyphosis
ankylosing spondylitits
obesity
What can cause muscular weakness of respiratory muscle
neurologic / neuromuscular disease
What type of lung disease Is COPD
chronic obstructive
What is often included with COPD
Emphysema and chronic bronchitis
What is emphysema
progressive destruction of alveolar membranes and dilatation of distal airways
*bronchioles collapse more readily
What is emphysema m/c associated with
smoking
What is occurring in the body during emphysema
macrophages try to protect alveoli and engulf forge in substance
inflammatory activation with cytokine release
increase WBC recruitment -> WBC release protease
Causes breakdown of CT surrounding alveoli
What helps maintain alveolar shape
elastin
What occurs when there is elastin breakdown in the alveoli
Airway will collapse and will trap inhaled air
Decrease alveolar surface area & decreased gas exchange
What tissue layers make up bronchioles
epithelial (goblet cells & cilia)
Smooth muscle layer
Connective tissue layer
What appearance will alveoli have in emphysema
honeycomb appearance
What is the progression of emphysema
inflammation & exposure to toxins = growth factor activation = fibrous tissue deposition = irreversible damage
What is a bleb
a small coalition of alveoli with loss of elastin because of a pneumo on the outer edge of the lung
**generally in upper lobe
What is a Bulla
Air filled space of 1cm of diameter that has developed because of emphysematous destruction of lung parenchyma
What are some complications of emphysema
hypoxemia
hypercapnia
pneumothorax
What are some of the presentations of emphysema
Prolonged expiratory phase
accessory breathing
barrel shaped chest
decreased FEV1/FVC ration
What causes chronic bronchitis
obstructive airflow secondary to thick mucus
What is chronic bronchitis often associated with
smoking
What is the job of goblet cells
modified epithelial cells to produce mucin to lubricate airways
What occurs in the body with chronic bronchitis
irritation (smoking) will cause irritation = ciliary damage = over production of mucus = goblet cells will up regulate in size
What occurs in the airway when glandular cells (goblet) become unregulated and increase in size
thickening of the airway
What is the major problem with having damaged cilia
unable to get rid of excess mucus
What are complications of chronic bronchitis
pneumonia distal to obstruction
hypoxemia
hypercapnia
VQ mismatch
What are the types of COPD
Chronic bronchitis
emphysema
What is bronchiectasis
Abnormal dilatation of bronchi which makes airways more readily collapsable
what is bronchiectasis most commonly due to
cystic fibrosis
aspiration
immunodeficiency
connective tissue disease
How does bronchiectasis present
productive cough with purulent, foul smelling sputum
hemoptysis
What is asthma
Obstructive disease pattern associated with airways being hyperactive
reversible
When do airways constrict with asthma
airways constrict secondary to inhalation of noxious stimuli
What are common triggers for asthma
allergens
cold
exercise
illness
pets
increased emotional stress/anxiety
What is the process during asthma attack
Trigger= dendritic cell activation= activate T cells = release interleukins = activate B cells & eosinophils = activate mast cells= degranulation = histamine production
What do eosinophils release
protease which causes cellular destruction
What occurs after the immediate asthma response
ciliary damage, decreased mucus expulsion = mucus plugging
If asthma is left untreated, what can occur
irreversible airway remodeling associated with fibrosis and smooth muscle hypertrophy
What can happen to intrathoracic pressure in asthmatics
can increase to the point they have pulsus paradoxus
What occurs during an asthma exacerbation
increased lung volumes
muscular fatigue
respiratory failure
How do asthmatics present during exacerbations
wheezing
tight chest
hyper expansion
cough
VQ mismatch
prolonged expiration
What is cystic fibrosis
autosomal recessive resulting in mutation of cystic fibrosis transmembrane conductance regulator (CFTR)
What chromosome does CF effect
7
When is CF diagnosed
generally before 6 months old
Where is CF found
epithelial cells of airways
bile ducts
pancrease
sweat glands
sinuses
vas defrens
What are pulmonary manifestations in cystic fibrosis
mucus plugs
inflammatory reaction
increased risk of infection
recurrent infections
What are complications of cystic fibrosis
peripheral bullae
pneumothorax
hemoptysis
cor pulmonale
What are the common presentations of cystic fibrosis
neonate difficulty passing meconium
Foul smelling stool
failure to thrive
cough
infection
SOB
What is the typical cause of death in CF patients
respiratory failure
