Pathologies Flashcards
What is the definition of Chronic Obstructive Pulmonary Disease?
Group of lung conditions that includes both emphysema and chronic bronchitis
What is emphysema?
Pink Puffers
Primarily affects the alveoli and the small distal airways
What is chronic bronchitis?
Blue Bloaters
Primarily affects the bronchi and bronchioles
What does research suggest the prevalence of COPD is strongly related to?
Smoking
Air pollution
Occupation
Patients with susceptible genetic backgrounds
What is the pathophysiology of emphysema?
Inflammatory response leads to elastin fibre breakdown and breakdown of alveolar walls, leads to loss of elastic alveoli recoil = impairing ventilation and leads to air trapping
This increases end expiratory volume causing hyperinflation (O2 and CO2 still trapped in the alveoli at then end of expiration)
The reduced ventilation and loss of gas exchange surface area lead to matched V/Q deficit = hypoxaemia and hypercapnia
What is the pathophysiology of chronic bronchitis?
Inflammatory changes leading to mucociliary dysfunction and increase goblet cell function and numbers = excessive mucus production
Bronchoconstriction of the bronchi and bronchioles
Airway obstruction (bronchoconstricition & excessive mucus production) = Wheezing usually during expiration
Alveolar hypoxia due to imapaired flow of O2 through smaller airways = V/Q mismatch causing hypoxaemia and hypercapnia
In chronic bronchitis, what happens due to V/Q mismatch?
Body makes more haemoglobin due to hypoxaemia (Polycythemia)
Hypercapnia = blood becomes acidic
Polycythemia and acidic blood = cynosis (blue colour)
How does Right sided heart failure occur in patients with chronic bronchitis?
Alveolar hypoxaemia = constriction of pulmonary vessels to shunt blood flow to healthier alveoli
Pulmonary vasconstriction = increase in pulmonary vascular pressure (pulmonary hypertension)
Pulmonary hypertension causes back-flow of blood to the Right side of the heart and cause Right sided heart failure
What are the main problems that affects physiotherapy intervention in COPD patients?
Sputum retention
Increased work of breathing
What are the 2 types of asthma? And which is most common?
Atopic and non-atopic
Most common = Atopic
What is the definition of asthma?
Hyperactive airways that respond to various stimuli by widespread inflammation and airway narrowing
What is Atopic asthma?
Extrinsic triggered by the environment
Inflammation mediated by SYSTEMIC IgE production
What is Non-atopic asthma?
Intrinsic
Inflammation caused not by exposure to allorgen
Inflammation mediated by LOCAL IgE production
What is the pathophysiology of asthma?
Lumen in asthmatic bronchiole is narrower
Increases in mucus production and increase in goblet cells
Increase in eosinophils in mucus and tissue (highly inflammatory)
Increase mast cell numbers in lamina propria (release histamine)
Increase neutrophils and t helper cells (both highly inflammatory)
Increase in smooth muscle cell size (hypertrophy)
What is the 3 characteristics of asthma?
- Airflow obstruction
- Bronchiole hyperresponsiveness
- Inflammation
What are the symptoms of asthma?
Shortness of breath
Wheeze
Chest tightness
Dry cough
Explain the role of IgE antibodies in asthma
IgE antibodies bind to mast cells and release lots of histamine
Histamine causes bronchoconstriction by stimulating smooth muscle
Explain the role of T-Helper cells in asthma
T-Helper 2 cells not usually found in normal lungs
In asthmatic lungs, T-Helper 2 cells promote inflammation by increasing antibody production
What are the main problems that affects physiotherapy intervention in asthmatic patients?
Increased work of breathing
Sputum retention in severe cases
What is the definition of pneumonia?
Inflammation of the lungs caused by microbes
The infection brings water into lung tissue
What are the 3 main causative agents for pneumonia? And the most common?
Viruses, bacteria and fungi
Viruses e.g. staph aureus and strep pneumonia
What are the symptoms of pneumonia?
Malaise
Confusion
Tachycardia
Rigor (sudden feeling of cold/shivering and rise in temperature/sweating)
Productive cough
What is the pathophysiology of pneumonia?
Causative agents enter the lungs to the alvoeli and causes an immune response
Macrophages secret cytokines which cause vasodilation and increased vascular permeability
This causes fluid to pass into alveolar space leading to consolidation
Also see bronchoconstriction and increased mucus
What is lobar pneumonia?
Consolidation of a lobe
Starts distally and spreads throughout
What is broncho pneumonia?
Affects areas throughout the lung (bronchi and alveoli)
Begins proximally and moves distally
What are the 6 catagories of pneumonia
- Community acquired pneumonia
- Hospital acquired pneumonia
- Ventilator associated pneumonia
- Broncho pneumonia
- Atypical or Interstitial pneumonia
- Lobar pneumonia
What is Community acquired pneumonia?
Most common, patient becomes unwell outside a healthcare setting
What is Hospital acquired pneumonia?
Patient becomes unwell in a hospital setting
More serious = Patient has weakened immune system and more resistant viruses e.g. MRSA
What is Ventilator associated pneumonia?
Patient unable to cough so microbes move to lungs from airway
What is Atypical or Interstitial pneumonia?
Infection of interstitium that surrounds alveoli
What are the main problems that affects physiotherapy intervention in pneumonia patients?
Sputum retention
Loss of lung volume
What would a chest examination show on a patient with pneumonia?
Reduced chest expansion
Impaired resonance during percussion
Bronchial breath sounds
Vocal resonance during auscultation
What is the definition of cystic fibrosis?
Most common lung disease in young adults and children
Systemic dieases that affects the respiratory tract, gastrointestinal tract, reproductive organs and liver and pancreas
Explain the pathophysiology of cystic fibrosis
Mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene
This gene regulates movement of chloride and sodium ions across epithelial cell membranes
The chloride channels do not work and chloride cannot be secreted across the epithelium to moisten the lung
As chloride ions are -ve and sodium ions are +ve they stay together and sodium is also not secreted across the epithelium
Water follows sodium = reduced water across the epithelium = mucus hyperviscosity
Hyperviscous mucus leads to impaired mucocillary clearance, pancreatic insufficiency and intestinal malabsorption
What does impaired mucocillary clearance in cystic fibrosis lead to?
Inflammation (neutrophils and interleukins)
Neutrophil breakdown releases massive amounts of proteases that destroy the local host defences, induce oxidative stress, increase viscosity of endobrachial secretions, worsen mucociliary clearance and promote lung tissue destruction, mucus obstruction and infection
Impaired mucociliary clearance causes build-up of pathogens and debris in the airways that cannot be expectorated leading to further infection
This leads to further scaring of the epithelial tissue leading to greater damage and further impairment of mucocillary escalator
What triggers recurrent cystic fibrosis exacerbations and what does this cause?
Triggered by acute bacterial infections
Promotes progressive loss of lung tissue architecture with bronchiectasis
What is the most common bacteria that colonises airways in CF?
Pseudomonas aeruginosa
What are the most prominent symptoms in CF?
Cough
Tachypnoea
Wheezing due to recurrent chronic bronchopulmonary infections
Lung hyperinflation starts early in the course of the disease
What are the main problems that affects physiotherapy intervention in CF patients?
Sputum retention
Increase work of breathing
What is the definition of bronchiectasis?
Permanent abnormal dilation of 1 or more bronchi with excessive mucus production
What is bronchiectasis a common feature of?
Cystic fibrosis
Patients can get non-CF bronchiectasis
What is the main cause of bronchiectasis?
Damage to the airways due to severe lower respiratory tract infections e.g. pneumonia
Also associated as a secondary manifestation of primary lung disease e.g. COPD and asthma
What is the pathophysiology of bronchiectasis?
The inflammatory processes linked to acute and chronic lung infection damage the epithelial cells
Bacteria can enter and remain in the airways and colonise mucus
Bacteria stimulates many inflammatory response which further inhibit epithelial cell function, damages the elastic and muscular tissue of the bronchial walls and increases mucus production
Loss of elastic and muscular tissue in the airway walls = dilation of bronchi
Viscous cycle occurs where clearance of sputum from the dilated bronchi is impaired and secretions become chronically infected
This produces a persistent inflammatory response which results in progressive destructive lung disorder
Hyper secretion of mucus
What is the clinical features of bronchiectasis?
Chronic cough
A lot of sputum
Dyspnoea
Wheezing
Chest pain
What are the main problems that affects physiotherapy intervention in bronchiectasis patients?
Sputum retention
Increase work of breathing
What is a restrictive disease?
Difficulty fully expanding the lungs (AIR IN)
Affects the respiratory zone
FEV1/FVC ratio is >70%
What is an obstructive disease?
Difficulty fully exhaling air from lungs (AIR OUT)
Affects the conductive zone
FEV1/FVC ratio is <70%
What type of disease is COPD?
Obstructive
What type of disease is asthma?
Obstructive
What type of disease is pneumonia?
Restrictive
What type of disease is Cystic Fibrosis?
Obstructive
What type of disease is bronchiectasis?
Obstructive
