Parenchymal and Pulmonary Vascular diseases Flashcards
List some parenchymal lung diseases
- Pulmonary edema
- ARDS
- Atelectasis
- Pneumothorax
- Lung Cancer
what causes pulmonary edemas?
these occur when pulmonary vasculature fills with fluid that leaks into the interstitial spaces or the vasculature becoomes very leaky allowing fluid to escape into the interstitial space
fluid then moves into the alveolar spaces decreasing the space available for gas exchange
pulmonary edema can develop as a result of what 4 things?
- fluid overload
- decreased albumin
- lymphatic obstruction
- increased capillary permeability (tissue injury or excessive immune response)
what is the effect of pulmonary edema on respiration?
reduced gas exchange
what is ARDS?
Acute Respiratory Distress Syndrome
a conditiont that causes fluid to leak into your lungs, limiting movement of air into the alveoli (hypoxemia)
characterized by widespread inflammation in the lungs
what are some complications to ARDS?
- Atelectasis
- pneumothorax
- widespread organ damage or failure
- kidney failure
- cardiogenic shock
- long term
- scarred lungs
- ICU aquired muscle weakness
what is the mortality rate of ppl who develop ARDS?
40-60%
what is Atelectasis?
the collapse of normally expanded and aerated lung tissue at any structural level (parenchyma, alveoli, pleura, chest wall, bronchi)
how is atelectasis categorized?
obstructive-absorptive
non-obstructive
compressive
what is the primary cause of obstructive-absorptive atelectasis?
obstruction of the bronchus serving the affected area
- communication between the alveoli and the trachea is obstructed
- air in the alveoli is not replaced
- air diffuses into the blood
- alveoli collapse
what is non-obstructive atelectasis?
interference with the natural forces that drive lung expansion
- hypoventilation assocaited w/decreased pulmonary motion
- failure to breath deeply postoperatively b/c of pain leading to muscle guarding and splinting
- oversedation, coma, immobility
- loss of surfactant
what is compressive atelectasis?
caused by pneumothorax, hemothorax, fluid in the pleural cavity
abdominal distension occurs
what are the implications of compressive atelectasis for a PT?
- frequent gentle position changes, deep breathing, coughing, ambulation sooner rather than later
- these interventions promote ciliary clearance, mucus clearance, enhance lung expansion, permit collateral ventilation of the alveoli (Kohn pores)
what is Pneumothorax?
abnormal collection of air in the pleural space
typically unilateral
can only occur/develop if air is allowed to enter the pleural through damage to chest wall or lung itself
what are the 2 main types of lung cancer?
- small cell lung cancer (SCLC)
- Non-small lung cancer (NSCLC)
what is SCLC?
cells become so dense that there is almost no cytoplasm present and the cells are compressed into an ovid mass
tends to be located centrally, most often near the hilum of the lung
lymphatic and distant metastases are usually present at the time of dx
very aggressive
what is NSCLC?
accounts for ~85% of all lung cancers
spread of the primary cancer to other locations (involves blood and lymph)
metastases: brain, bone and liver
carcinomas of the kidney, breast, pancreas, colon, and uterus are likely to metastasize to the lung
describe the clinical manifestation of lung cancer
- cough, sputum production and dyspnea
- anorexia, fatigue, weakness, and weight loss
- recurring bronchitis or pneumonia; productive cough with hemoptysis; wheezing; poorly defined persistent chest pain
- difficulty swallowing
- cardiac, and esophageal compression
how are lung cancers treated?
- Surgically
- not usually an option for SCLC b/c of location
- radiation
- chemotherapy
how are cancers staged?
I-IV
the larger the number the more severe the disease
list some disorders of pulmonary vasculature
pulmonary HTN
pulmonary embolism
what is pulmonary HTN
high BP in the pulmonary arteries
characterized by diffuse narrowing of the pulmonary arteries caused by hypertrophy of smooth muscle in the vessel walls and formation of fibrous lesions in and around the vessels
5-10 above normal (15-18 is normal)
What are some underlying causes of pulmonary HTN?
- congestive heart failure
- blood clots in lung
- HIV
- drug abuse (cocaine or meth)
- liver disease (ex cirrhosis)
- CT autoimmune diseases (SLE, scleroderma, RA, etc)
- lung diseases like emphysema, chronic bronchitis, or pulmonary fibrosis
- congenital heart diseases
how is pulmonary HTN treated?
depends on the cause:
- R sided HF → treatment of this failure
- hypoxia due to chronic lung disease → provide O2 and treat underlying disease
- sleep apnea → CPAP devices
- Autoimmune diseases → management of the disease
how is pulmonary HTN diagnosed?
difficult most of the time
pulmonary function tests:
- oximetry
- V/Q scan
- blood tests (CBC, HIV, ANA tests)
- exercise capacity tests
- R heart catheterization to get pressure readings
list risk factors for pulmonary embolism
- prolonged immobility
- hypercoagulability
- meds
- smoking
- polycythemia
- cancer
- surgery
- damage to walls of veins
what are the 3 classifications for pulmonary embolism?
low risk PE
intermediate risk PE
High risk PE
describe low risk PE
- normotensive
- no RV dysfunction
- normal biomarkers
describe intermediate risk PE
- normotensive
- RV dysfunction/RV dilation
- BNP > 90 pg/ml
- pro-BNP > 500 pg/ml
- Myocardial necrosis
- Trop I > 0.4 ng/ml
- Trop T > 0.1 ng/ml
describe high risk PE
- hypotensive
- SBP < 90 for >15 min
- shock
- Pulselessness
- Profound bradycardia
- HR < 40
list some s/s of pulmonary embolism
- SOB that may occur suddenly
- sudden, sharp chest pain that may become worse w/deep breathing or coughing
- rapid HR and breathing
- sweating
- anxiety
- coughing up blood or pink, foamy mucus
- fainting
patients who present with what symptoms are at risk for sudden death?
- hypotension
- syncope
- bradycardia
- inability to maintain adequate oxygenation
T/F: patients who present with end organ damage but are hemodynamically stable can be considered low risk
FALSE
intermediate risk
why are lungs a hard organ to harvest for transplantation?
at the time of death there is a catecholamine storm leading to disruption of the pulmonary capillary beds leading to edema and difficulty perfusing and ventilating the organ
death caused by trauma often injuries the lungs
