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Pathophysiology Flashcards

1
Q

First changes to lung

A

destruction of the alveoli

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2
Q

Breathing movements Air in

A
  • Ribcage moves up and out
  • Diaphragm contracts and moves down
  • Lung expands, pressure decreases as air comes in
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3
Q

Compliance

A
  • Ability of lunge tissue to expand with ventilation
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4
Q

Hypoxemia

A
  • Low blood oxygen level
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5
Q

Hypercapnea

A
  • High blood carbon dioxide level
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6
Q

Diffusion

A
  • Ability of gas to cross alveolar capillary membrane
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7
Q

PFT’s

A
  • Pulmonary Function Tests
  • Measurement of volume and air flow in and out of the lung
  • Deep Breath in, and exhale as fast as you can
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8
Q

Tidal Volume

A
  • Amount of air in and out each breath under normal resting conditions
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9
Q

Inspiratory reserve volume (IRV)

A
  • Air forcefully inhaled after a normal tidal breathing
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10
Q

Expiratory reserve volume (ERV)

A
  • Air forcefully exhaled after a normal tidal breathing
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11
Q

Residual Volume (RV)

A
  • Air left in the lung after a forceful exhalation
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12
Q

Total lung capacity

A
  • Maximum amount of air contained in the lungs after a maximum inspiratory effort
  • TV + IRV + ERV +RV
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13
Q

Vital capacity (VC)

A
  • Maximum amount of air that can be expired after a maximum inspiratory effort
  • TV + IRV + ERV (Should be 80% of TLC)
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14
Q

Inspiratory Capacity (IC)

A
  • Maximum amount of air that can be inspired after a normal expiration
  • TV + IRV
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15
Q

Functional Residual capacity (FRC)

A
  • Volume of air remaining in the lungs after a normal tidal volume expiration
  • ERV + RV
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16
Q

Causes of Hypoxia

A
  • Hypoventilation
  • Diffusion impairment
  • Shunt
  • Ventilation - Perfusion Inequality
  • Altitude or reduction in PO2
  • May present without symptoms of dyspnea
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17
Q

Causes of Hypoxia: Hypoventilation

A
  • Increased blood CO2 level
  • Decreased blood O2 level
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18
Q

Causes of Hypoxia: Diffusion Impairment

A
  • Gas exchange at the alveolar-capillary border
  • Blood and Gas reaching target areas but not able to cross barrier
  • Impairment created by increased collagen / tissue at this barrier (Pulmonary fibrosis)
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19
Q

Causes of Hypoxia: Shunt

A
  • Pulmonary blood flow is altered and bypasses aerated areas of the lungs
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20
Q

Causes of Hypoxia: Ventilation - Perfusion Inequality

A
  • unequal ration between blood and air
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21
Q

Causes of Hypoxia: Altitude or Reduction in PO2

A
  • PaO2 is reduced with a decrease in PO2
  • Higher altitude destinations
  • Airplane travel
22
Q

Additional Causes of Hypoxia

A
  • Decreased hematocrit
  • Decreased Hgb
  • SpO2 reading remains normal
23
Q

Normal hematocrit level

A

Women: 38 - 46%
Men: 42 - 54%

24
Q

Normal Hgb level

A

Women: 12-16 gm/dL
Men: 14 - 18 gm/dL

25
What causes Dyspnea
- Hypoxia - Chronic and acute illness - Anxiety (Hyperventilation) - Exercise / exertion - Deconditioning
26
Difference between Obstructive and Restrictive
- Total lung capacity increased for Obstructive Pulmonary Disease
27
Chronic Obstructive Pulmonary Disease (COPD)
- Airflow limitation on expiration - not fully reversible - Chronic respiratory symptoms, structural pulmonary abnormalities, lung function impairment - 3rd Leading Cause of Death Worldwide - COPD related to smoking is associated with more severe emphysema
28
COPD exacerbation
- an increase in dyspnea, cough, or sputum purulence with or without symptoms of upper respiratory infection
29
Asthma: Inflammation to Bronchoconstriction
1. Irritation (Trigger) 2. T cell release 3. Mast cell release 4. Antibodies 5. Inflammation 6. Airway constriction
30
Emphysema
- Abnormally expanded air spaces - Destruction of the walls of the involved air spaces - Impaired expiratory airflow
31
Emphysema: Pathophysiology
- Inflammatory cells reduce the effect of Alpha 1 antitrypsin and increase the effect of proteolytic enzymes - Proteolytic enzymes leads to erosion of the alveolar septa / lung parenchyma - Decrease in Radial traction - Hyperinflation
32
Centriacinar
- Emphysema - Bronchioles destroyed with sparing of alveoli
33
Panacinar
- Both Bronchioles and alveoli are destroyed
34
Paraseptal
- Along periphery at septum
35
Alpha 1 Antitrypsin Deficiency Emphysema
- A Genetically linked type of Emphysema - 5-13% of all emphysema is a1ATD - Develops between 30 - 40 years of age
36
a1 AT normal & Deficiency
- Normal: 104 - 276 mg/dL - Deficiency: less than 50 mg/dL
37
Emphysema: Patient Presentation
- Irreversible enlargement of terminal bronchioles - Flattened diaphragm / Increased A-P diameter - 1:4 Insp & Exp ratio
38
4 characteristics of Emphysema
- Hyperinflation - Trapped Air - Prolonged Expiratoration - Decreased elastic Recoil
39
FVC
- Forced (Functional) vital capacity - Maximum amount of air that can be expired forcefully
40
FEV1
- Forced expiratory volume / time - Amount expired over given time interval - 1st second
41
Chronic Bronchitis
- Wet cough - Excess mucous production - 3 consecutive moths of a productive cough for two consecutive years - Primary cause is tobacco smoke
42
Bronchiectasis
- Permanent abnormal dilation or widening of one or more large bronchi - Large quantities purulent sputum and permanently dilated airways - Bronchial wall thickened by and inflammatory infiltrate of lymphocytes and macrophages - Purulent sputum
43
Clinical Findings of Bronchiectasis
- Respiratory failure / RH failure - Hypoxia → Pulmonary HTN → Right Heart failure - Osteoporosis and Muscle Atrophy - Chronic infections
44
GOLD Classification
- using FEV1 to classify COPD Severity
45
mMRC
COPD Dyspnea Scale
46
CAT
- COPD Assessment Test - Threshold score of 10 for severity
47
GOLD ABE Assessment Tool
48
Cystic Fibrosis
- Genetic - Blocked chloride channels → higher levels of NaCl on the skin and lack of NaCl in the lungs - Excessive production of thick and purulent mucus in the lung - No sodium chloride → no water → thicker mucus
49
Cystic fibrosis: Presentation
- Thin - Osteoporosis - Malabsorption - Muscle weakness - GERD - Reflux - GI obstruction - Recurrent pneumonia → airway destruction → bronchiectasis and pneumothoracis - Chronic Hypoxia (digital clubbing)
50
COPOD Patients are at Increased Risk for
- Osteoporosis
51
Risk Factors in patients with COPD
- Tobacco use - Sedentary lifestyle - Family history of osteoporosis - Advanced Age - Poor nutrition - Chronic use of drugs known to reduce bone mass
52
COPD Patients are at Increased Risk for Myopathy
- Decreased activity secondary to DOE - Side effects of steroids - Effects both Type I and Type II muscle fibers

Pulm (7 decks)

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