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Pulm > Pathophysiology > Flashcards

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
Q

What causes Dyspnea

A
  • Hypoxia
  • Chronic and acute illness
  • Anxiety (Hyperventilation)
  • Exercise / exertion
  • Deconditioning
26
Q

Difference between Obstructive and Restrictive

A
  • Total lung capacity increased for Obstructive Pulmonary Disease
27
Q

Chronic Obstructive Pulmonary Disease (COPD)

A
  • 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
Q

COPD exacerbation

A
  • an increase in dyspnea, cough, or sputum purulence with or without symptoms of upper respiratory infection
29
Q

Asthma: Inflammation to Bronchoconstriction

A
  1. Irritation (Trigger)
  2. T cell release
  3. Mast cell release
  4. Antibodies
  5. Inflammation
  6. Airway constriction
30
Q

Emphysema

A
  • Abnormally expanded air spaces
  • Destruction of the walls of the involved air spaces
  • Impaired expiratory airflow
31
Q

Emphysema: Pathophysiology

A
  • 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
Q

Centriacinar

A
  • Emphysema
  • Bronchioles destroyed with sparing of alveoli
33
Q

Panacinar

A
  • Both Bronchioles and alveoli are destroyed
34
Q

Paraseptal

A
  • Along periphery at septum
35
Q

Alpha 1 Antitrypsin Deficiency Emphysema

A
  • A Genetically linked type of Emphysema
  • 5-13% of all emphysema is a1ATD
  • Develops between 30 - 40 years of age
36
Q

a1 AT normal & Deficiency

A
  • Normal: 104 - 276 mg/dL
  • Deficiency: less than 50 mg/dL
37
Q

Emphysema: Patient Presentation

A
  • Irreversible enlargement of terminal bronchioles
  • Flattened diaphragm / Increased A-P diameter
  • 1:4 Insp & Exp ratio
38
Q

4 characteristics of Emphysema

A
  • Hyperinflation
  • Trapped Air
  • Prolonged Expiratoration
  • Decreased elastic Recoil
39
Q

FVC

A
  • Forced (Functional) vital capacity
  • Maximum amount of air that can be expired forcefully
40
Q

FEV1

A
  • Forced expiratory volume / time
  • Amount expired over given time interval - 1st second
41
Q

Chronic Bronchitis

A
  • Wet cough
  • Excess mucous production
  • 3 consecutive moths of a productive cough for two consecutive years
  • Primary cause is tobacco smoke
42
Q

Bronchiectasis

A
  • 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
Q

Clinical Findings of Bronchiectasis

A
  • Respiratory failure / RH failure
  • Hypoxia → Pulmonary HTN → Right Heart failure
  • Osteoporosis and Muscle Atrophy
  • Chronic infections
44
Q

GOLD Classification

A
  • using FEV1 to classify COPD Severity
45
Q

mMRC

A

COPD Dyspnea Scale

46
Q

CAT

A
  • COPD Assessment Test
  • Threshold score of 10 for severity
47
Q

GOLD ABE Assessment Tool

A
48
Q

Cystic Fibrosis

A
  • 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
Q

Cystic fibrosis: Presentation

A
  • Thin
  • Osteoporosis - Malabsorption
  • Muscle weakness
  • GERD - Reflux
  • GI obstruction
  • Recurrent pneumonia → airway destruction → bronchiectasis and pneumothoracis
  • Chronic Hypoxia (digital clubbing)
50
Q

COPOD Patients are at Increased Risk for

A
  • Osteoporosis
51
Q

Risk Factors in patients with COPD

A
  • Tobacco use
  • Sedentary lifestyle
  • Family history of osteoporosis
  • Advanced Age
  • Poor nutrition
  • Chronic use of drugs known to reduce bone mass
52
Q

COPD Patients are at Increased Risk for Myopathy

A
  • 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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