Obstructive Lung Disease Flashcards
How does one acquire Cystic Fibrosis?
It is inherited genetic disorder
On which chromosome is the gene for Cystic Fibrosis located?
Chromosome 7
What type of mucous is associated with Cystic fibrosis?
Where does it come from?
What does it clog?
- Tenacious mucous
- Exocrine glands
- It clogs the bronchi
Define Tenacious mucous
Really, really thick mucous
What do exocrine glands do?
Exocrine glands secrete oil, sweat, enzymes, etc.
What organs does cystic fibrosis have an affect on?
Primary effects seen in lungs and pancreas
What does mucous do in the lungs of cystic fibrosis patients?
Mucous obstructs airflow in bronchioles and small bronchi causing permanent damage to bronchial walls.
Bronchiectasis is a disorder which can be caused by cystic fibrosis, what is it?
Bronchiectasis is a long-term condition where the bronchi of the lungs become abnormally widened/swollen
This leads to damage and opens the doors for infections.
What infections are common in cystic fibrosis patients? (name the pathogens)
Pseudomonas aeruginosa and Staphylococcus aureus
How does cystic fibrosis affect the GI tract specifically in newborns?
It causes Meconium ileus (intestinal obstruction)
Meconium is the earliest form of stool a mammal can have, in newborns it is thicker and stickier, it usually gets stuck in the ilium.
How does cystic fibrosis affect the GI tract? (3)
Hint: think about ducts
- Blockage of pancreatic ducts
- Obstruction of bile ducts
- Salivary glands may be affected
How does cystic fibrosis affect the reproductive tract of males?
It can cause obstruction of vas deferens.
How does cystic fibrosis affect the reproductive tract of females?
It can cause obstruction of cervix.
How does cystic fibrosis affect sweat glands?
What does that mean?
What does that lead to?
Sweat has a high sodium chloride content.
This means there is an electrolyte imbalance.
This could lead to dehydration.
Taking into consideration all of the aforementioned effects cystic fibrosis has on different organs, what would be the 4 general clinical manifestations?
- Salty skin
- Signs of malabsorption
- Chronic cough and frequent respiratory infections
- Failure to meet normal growth milestones
What is the clinical manifestation that specifically occurs in newborns?
Meconium ileus
Regarding the clinical manifestation: signs of malabsorption, what are those signs?
- Steatorrhea
- Abdominal distention (inflamed or swollen stomach)
Define Steatorrhea
Fatty stool
What is the life expectancy of a patient with cystic fibrosis?
Mid to late 30s
What diagnostic tests are preformed to diagnose cystic fibrosis? (6)
- Genetic Testing
- Sweat test
- Stool Test
- Radiography
- Pulmonary function test
- Blood gas analysis
What is the treatment for cystic fibrosis?
There is only symptomatic treatment. It is an interdisciplinary approach. - Replacement therapy - Well-balanced diet - Chest physiotherapy
What is replacement therapy?
Involves ingesting digestive enzymes
“replacing what’s lacking”
How common is lung cancer in the USA?
It is the 3rd most common caner in the US
T/F
Lung cancer can be primary and secondary metastatic.
True!
Why is secondary metastatic disease common?
It is common due to the venous return and lymphatic system bring tumor cells from many distant sites
What is the main cause of lung cancer?
Smoking, about 90% of cases are related
Where does broncogenic carcinoma start? What cells does it arise from?
It begins in the lungs.
It arises from bronchial epithelium.
Is bronogenic carcinoma malignant or benign?
Is it primary or secondary?
How common is it?
It is malignant.
It is the most common type of primary malignant lung tumor
Name the 4 lung cancer subtypes
- Squamous cell carcinoma
- Adenocarcinomas/ branchalveolar cell carcinoma
- Small (oat) cell carcinoma
- Large cell carcinoma
Where does squamous cell carcinoma usually develop?
It usually develops from the epithelial lining of a bronchus near the hilum
Where are adenocarcinomas from, what type of tissue?
Glandular tissue
Where are both adenocarcinomas and bronchoalveolar carcinomas found?
They are both found in the periphery of the lungs
Why are adenocarcinomas and bronchoalveolar carcinomas difficult to diagnose early?
Because they are less symptomatic
Where do you find small (oat) cell carcinomas?
Near a major bronchus, near the center of the lung
Are small (oat) carcinomas benign?
No, they are invasive and tend to metastasize early.
Where do you find large cell carcinomas?
They are found in the periphery of the lung
Large cell carcinoma’s cells are (undifferentiated/differentiated) cells which grow (and metastasize/cause a benign tumor) rapidly.
- Undifferentiated
- And metastasize
What is the first change that occurs in lung cancer?
First, metaplasia occurs, secondary to smoking or chronic irritation
Is the first change of lung cancer reversible?
Yes, metaplasia is reversible if the irritant is removed.
What is the second change that occurs with lung cancer, after the metaplasia?
As time progresses, normal epithelial lining begins to die off.
What are the cells called that begin to die off if the irritant isn’t removed after metaplasia occurs in lung cancer?
Ciliated pseudo-stratified epithelial cells
In lung cancer, after the ciliated pseudo-stratified cells die off, what happens?
Dysplasia or carcinoma in situ then develop
Define “in situ”
locally or on site
How does a lung tumor effect the airflow into a bronchus? What does this cause? (2)
It obstructs the airflow. This causes abnormal breath sounds and dyspnea
What is going on around a lung tumor? What does this cause? (3)
Inflammation and bleeding occurs surrounding the tumor.
This causes: cough, hemoptysis, and secondary infection
Define hemoptysis
Coughing up blood
An effect of lung cancer is fluid filling up in the lungs, what fluids fills the lungs (2) what is the proper name for those disorders?
Pleural effusion (Water) and hemothorax (blood)
An effect of lung cancer is air escaping into the area outside of the lung, what is that called? What does it lead to?
- Pneumothorax - air goes into the area around the lungs
- Lung collapse
An effect of lung cancer is paraneoplastic syndrome. What is that, what doesn’t it follow? Give examples
Paraneoplastic syndrome occurs when tumor cells secrete hormones or hormone-like substances
Such as: estrogen and ACTH
This doesn’t adhere to negative feedback.
What is the etiology of lung cancer? (2)
- Cigarette smoking
2. Occupational exposure
Does cigarette smoke only affect the person smoking?
No, second-hand smoke has been implicated in a number of cases
What substances can someone be exposed to during work that could cause lung cancer?
- Silica
- Vinyl chloride
- Asbestos
What are the early signs of lung cancer that involve cough? (2)
- Persistent productive cough
2. Hemoptysis
Can early signs of lung cancer be detected?
Yes, on radiograph
Can the early signs of lung cancer hurt?
Yes, chest pain and this pain could radiate to the shoulder
What parts of the chest and upper respiratory tract are involved in the early signs of lung cancer? (2)
What early symptoms/signs affect the throat? (2)
- Lungs
- Pleural involvement is possible
- Hoarse throat
- Dysphagia
One of the early signs of lung cancer is atelectasis, what is that?
Lack of air in parts of lung
Are there any head or facial symptoms of lung cancer?
Headache and Facial edema
Define Dysphagia
Difficulty swallowing
What are the 3 systemic signs of lung cancer?
- Weight loss
- Anemia
- Fatigue
What is paraneoplastic syndrome indicated by? (think broadly)
Signs of endocrine disorder
Related to the specific hormone that is secreted
What are 2 signs of metastasis?
i.e. where are the pain, deficits
- Bone Pain
- Cognitive and motor deficits
* spots on brain will be visible*
What 4 diagnostic tests are done for lung cancer?
- Specialized helical CT scans and MRI
- Chest radiography
- Bronchoscopy
- Biopsy and mediastino-scopy for lymph’s
What surgery is performed to treat lung cancer?
Surgical resection or lobectomy
Is any radiological treatment done for lung cancer?
Yes, Chemotherapy and radiation
What is photodynamic therapy?
A treatment that uses a drug called a photosensitizer or photosensitizing agent and a particular light.
These drugs when exposed to light produce a form of oxygen that kills nearby cells.
Approximately 24-72 hours after injection normal cells have “disposed” of the drug but cancer cells will hold on to it.
The tumor is then exposed to light and the active form of oxygen is produced and destroys the nearby cancer cells.
What is aspiration?
Passage of food, fluid, emesis, and other foreign material into trachea and lungs
What is emesis
vomit
What age category is aspiration common in?
young children and individuals who eat or drink while lying down
What does aspiration predispose someone to?
Pneumonia
If the aspirate is a solid object, what does it cause?
Obstruction
If the aspirate is an irritating liquid, what does it cause?
Inflammation and swelling
A potential complication of aspiration is aspiration pneumonia, what is impaired when aspiration pneumonia is acquired?
Gas diffusion due to inflammation
If microbes are aspirated they could cause ___
Pulmonary abscess
If following aspiration, widespread inflammation develops this is called ____
Respiratory distress syndrome
What systemic complication could happen after aspiration of solvents?
The solvents are absorbed into the blood
There are 13 clinical manifestations of aspiration.
2 occur with dyspnea
- Choking
2. Coughing
There are 13 clinical manifestations of aspiration.
5 occur in individuals with severe respiratory distress
- Tachypnea
- Nasal flaring
- Chest retractions
- Hypoxia
- Respiratory arrest
There are 13 clinical manifestations of aspiration.
2 describe how the heart reacts
- Tachycardia
2. Cardiac arrest
There are 13 clinical manifestations of aspiration.
1 is characteristic of liquid aspiration
Wheezing
There are 13 clinical manifestations of aspiration.
1 is characteristic of total obstruction
Loss of voice
There are 13 clinical manifestations of aspiration.
2 are characteristic of upper airway obstruction
- Stridor
2. Hoarseness
Define Chest retractions
Muscles between lungs are pulled in
What is obstructive sleep apnea the result of?
Pharyngeal tissue collapse during sleep
What does obstructive sleep apnea lead to?
Repeated and momentary cessation of breathing
In sleep apnea, which sex is affected more?
Men are more affected than women
In sleep apnea, what are the two most common predisposing factors?
- Age
2. Obesity
What 2 tools are used for treatments of obstructive sleep apnea?
- Continuous positive airway pressure pump (CPAP)
2. Oral appliances that reduce collapse of pharyngeal tissue
Define Asthma
Periodic episodes of SEVERE BUT REVERSIBLE bronchial obstruction in persons with Type 1 hypersensitivity or hyper-responsive airways
What could repeated asthma attacks cause?
Permanent damage
When can onset of asthma occur? Adulthood or childhood?
Both
Are there predisposing factors of asthma?
Family history and allergic conditions
Define extrinsic asthma
Acute episodes triggered by a Type I hypersensitivity reaction to an inhaled antigen
Is there a familial link to extrinsic asthma?
Yes, often it is a familial history of allergic conditions (hay fever, allergic rhinitis)
Which age group is extrinsic asthma common in?
Children
Which age group is intrinsic asthma common in?
Onset during adulthood
What is intrinsic asthma?
Hyper-responsive tissue in airway initiates attack
What stimulates intrinsic asthma? (6)
- Respiratory infections
- Stress
- Exposure to cold
- Inhalation of irritants
- Exercise
- Drugs
What are the 3 physiological changes of bronchi and bronchioles due to asthma?
- Inflammation of the mucosa with edema
- Bronchoconstriction
- Increased secretion of thick mucus in the airways
Do the changes that occur due to asthma cause total obstruction?
Yes as well as partial obstruction
There are many clinical manifestations of asthma, which involve the heart?
- Tachycardia
- Pulsus paradoxus
What sound does a patient produce when they are having an asthmatic episode?
Wheezing
How does a patient describe their chest when they are having asthmatic issues?
Tight feeling in chest “bricks”
When one seeing a patient having an asthma attack, how would they describe the patients breathing?
What is the result of the breathing issues?
Marked dyspnea
Rapid, labored breathing
Hypoxia is the result
During an asthmatic episode a patient will be coughing, describe the cough?
It is productive, the expulsion is thick or sticky
Define pulsus paradoxus
When the pulse drops during aspiration
What clinical manifestation of asthma is caused by hyperventilation?
Respiratory alkalosis
What clinical manifestation of asthma is caused by air trapping?
Respiratory acidosis
Asthmatic patients sometimes go through respiratory failure, what is this indicated by?
- Decreasing responsiveness
- Cyanosis
Define cyanosis
Turning blue
How does an asthmatic patient reach severe respiratory distress?
Hypoventilation leads to hypoxemia and respiratory acidosis
Together this is characterized as severe respiratory distress
Define Status asthmaticus
Persistent severe attack of asthma
How do patients with status asthmaticus respond to usual therapy?
What could this lead to? (3)
This is categorized as a _ _.
They do not, respond to usual therapy at all.
May be fatal because of severe hypoxia and acidosis.
This is categorized as a medical emergency
What are the general measures for asthma treatment? (5)
- Skin tests for allergic reactions
- Avoidance of triggering factors
- Good ventilation in the environment
- Swimming and walking
- Use of maintenance inhalers or drugs
What are the measures for acute attacks? (3)
- Controlled breathing techniques
- Inhalers: Bronchodialators
- Glucocorticoids
What measures are taken when a patient is in status asthmaticus? (1)
Hospital care if no response to bronchodilator
Why would a leukotriene receptor antagonist be used as a prophylactic treatment for asthma patients?
Is it effective for acute attacks
Because asthmatics produce too much of it. By blocking the receptor, you block the inflammatory responses in the presence of stimuli.
It is not effective for acute attacks
Cromolyn sodium is a prophylactic medicine for asthma patients.
How often is it used?
Who is it useful for?
Does it help during an acute attack?
Used daily
Useful for athletes and sports enthusiasts
No value during an acute attack
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
COPD is a group of chronic respiratory disorders including (2):
- Emphysema
2. Chronic Bronchitis
Are the changes caused by COPD reversible?
No, they are irreversible.
COPD causes progressive damage to lungs
How does COPD affect a patients livelihood?
COPD is debilitating. It may affect a persons ability to work
What cardiovascular issue could COPD lead to?
Cor pulmonale: right sided heart failure
T/F
Respiratory failure may occur due to COPD
True
What part of the lungs does emphysema affect? What does it do to those parts?
It causes destruction of alveolar walls and septae.
Leads to large, permanently inflated alveolar air sacs
Do patients with emphysema have difficulty breathing in or out?
They have difficulty breathing out
How is emphysema classified?
By specific location of changes
What are the 4 contributing factors of emphysema?
- Genetic deficiency
- Genetic tendency
- Cigarette smoking
- Pathogenic bacteria
In emphysema patients, the breakdown of the alveolar cells results in (5):
- Loss of surface area for gas exchange
- Loss of pulmonary capillaries
- Loss of elastic fibers
- Altered ventilation-perfusion ratio
- Decreased support for other structures
The fibrosis that occurs in emphysema patients affects the airways by ___, affects the walls by ___, and causes interference with ___.
The fibrosis that occurs in emphysema patients affects the airways by [narrowing them], affects the walls by [weakening them], and causes interference with [passive expiratory airflow].
As the disease of emphysema progresses, the difficulty with expiration increases.
- Why does it become more difficult? (3)
- What physiological sign is characteristic of progressive emphysema?
- What sign is visible on radiographs?
- Air trapping, increased residual volume, overinflation of the lungs
- Barrel chest
- Flattened diaphragm
Define barrel chest.
Fixation of ribs in a respiratory position, increased anterior-posterior diameter of thorax.
In advanced emphysema, what happens to the alveoli?
What is the result of this?
The adjacent damaged alveoli coalesce.
This forms large air spaces
In advanced emphysema, pneumothorax occurs, what is that?
Pneumothorax occurs when the pleural membrane surrounding large blebs ruptures.
Another way to define it is: the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.
In advanced emphysema, one experiences high levels of what?
What is that called?
High levels of CO2
Hypercapnia
In advanced emphysema, one experiences low levels of what?
What is that called?
This becomes the driving force for ___.
Oxygen
Hypoxia
Respiration
In advanced emphysema, what does a patient frequently suffer from?
Frequent infections
What cardiovascular side effects may develop in the late stages of emphysema?
- Pulmonary hypertension
- Cor pulmonale
What are the 4 clinical manifestations of emphysema?
- Dyspnea: occurring on the first exertion
- Hyperventilation with prolong expiratory phase –> Development of barrel chest
- Anorexia and fatigue –> weight loss
- Clubbed fingers
What diagnostic tests are performed for emphysema? (2)
- Chest radiography
2. Pulmonary function test
Can emphysema be treated?
No, therapies are strictly supportive.
As a treatment for emphysema, patients are told to avoid __.
Respiratory irritants
As a treatment for emphysema, immunizations against ___ and ___ are given.
- Influenza
2. Pneumonia
As a treatment for emphysema, patients begin __ rehab. Where they learn ___.
Pulmonary rehab
Appropriate breathing techniques
As a treatment for emphysema, patients must ingest ___ ___ and ___. This improves ___ ___ and ___ ___ ___.
As a treatment for emphysema, patients must ingest ADEQUATE NUTRITION and HYDRATION. This improves ENERGY LEVELS and RESISTENCE TO INFECTION.
To treatment for emphysema as the condition progresses, patients as prescribed (3)
- Bronchodilators
- Antibiotics
- Oxygen therapy
What surgery do some patients go through as a treatment for emphysema?
Lung reduction surgery
What is the diagnostic criteria for chronic bronchitis?
Inflammation, obstruction, repeated infection, chronic coughing twice for 3m or longer in two years
People with chronic bronchitis have a history of __ or __ or __.
Cigarette smoking
Living in an urban area
Living in an industrial area
How does the mucosa of the bronchi react to chronic bronchitis?
The mucosa is inflamed and swollen
During chronic bronchitis, how do the mucous glands react?
They go through hypertrophy and hyperplasia
Define mucous gland hypertrophy
growth of the mucous gland
Define hyperplasia
increase in number of cells
During chronic bronchitis, what happens to the bronchial wall?
It undergoes fibrosis and it thickens
What are the oxygen levels of a patient with chronic bronchitis like?
They are low
What are the cardiovascular effects of chronic bronchitis? (3)
- Pulmonary hypertension
- Cor pulmonale
- Polycythemia
How is a patients breathing described when they have chronic bronchitis?
They have severe dyspnea
How does a patient with chronic bronchitis feel?
Very fatigued
What is the most common cause of chronic bronchitis?
Cigarette smoking
What type of cough would a patient with chronic bronchitis have?
A constant, productive cough.
How is the breathing of a patient with chronic bronchitis?
They have tachypnea and shortness of breath
What type of secretions do patients with chronic bronchitis have?
How often is it expelled?
Frequent, thick, and purulent secretions
What sound does one hear when listening to the lungs of a patient with chronic bronchitis?
Rhonchi (a snoring sound)
What time of day are the cough and rhonchi worse for a patient with chronic bronchitis?
They are most severe in the morning
Due to airway obstruction, patients with chronic bronchitis often have these 3 things.
- Hypoxia
- Cyanosis
- Hypercapnia
Can chronic bronchitis be treated completely?
No, there are only supportive therapies available
What supportive treatment for chronic bronchitis involves the patient stopping current habits?
The cessations of smoking and reduction of exposure to irritants
What is given prophylactically to patients with chronic bronchitis to prevent infection?
Vaccination
What is prescribed to patients with chronic bronchitis? (4)
- Expectorants
- Bronchodilators
- Low-flow oxygen
- Nutritional supplements
What therapy is recommended for patients with chronic bronchitis?
What is usually included in this therapy?
Appropriate chest therapy including postural drainage and percussion
Is bronchiectasis a primary or secondary condition?
Secondary
What is the main pathophysiology of bronchiectasis?
What is the shape?
Irreversible abnormal dilation of medium sized bronchi
May be saccular or elongated
What does bronchiectasis arise from?
Recurrent inflammation and infection
What does bronchiectasis lead to? (3)
- Obstruction of airways
- Weakening of muscles
- Weakening of elastic fibers of bronchial walls
What is usually the infecting organisms of bronchiectasis? (4)
- Streptococci
- Staphylococci
- Pneumococci
- H. influenzae
What are the systemic clinical manifestations of bronchiectasis? (3)
- Weight loss
- Fatigue
- Anemia
Describe the cough of a patient with bronchiectasis.
Chronic cough
Hemoptysis
Dyspnea
Describe the sputum of a patient with bronchiectasis.
Copious amounts of purulent, red, foul-smelling sputum
If listened to, a patient with bronchiectasis has one of these 2 chest sounds.
- Rales
2. Rhonchi
Describe the breath of a patient with bronchiectasis.
Foul-smelling
Is bronchiectasis fixable?
Yes.
What are the 4 treatments for bronchiectasis.
- Antibiotics
- Bronchodilators
- Chest physiotherapy
- Treatment of primary condition
