PC 604 test 4 Flashcards
Decreased compliance of the lungs
or RESTRICTIVE DISORDERS OF THE LUNG cause..
dyspnea, increased respiratory rate and decreased tidal volume
Pulmonary function tests FOR RESTRICTIVE DISORDERS OF THE LUNG
decreased forced vital capacity
Restrictive pulmonary disorders affect
alveolocapillary membrane and causes decreased diffusion of O2 from alveoli to blood
Acute (adult) Respiratory Distress Syndrome (ARDS) IS…
Acute lung inflammation and diffuse alveolocapillary injury
CAUSES OF Acute (adult) Respiratory Distress Syndrome (ARDS)
Causes – severe trauma, sepsis, fat emboli, shock, pancreatitis, pneumonia, DIC.etc.
CLINICAL MANIFESTATIONS OF Acute (adult) Respiratory Distress Syndrome (ARDS)
• Marked dyspnea, rapid shallow breathing, inspiratory crackles, respiratory alkalosis (because of rapid breathing), decreased lung compliance, hypoxemia that is unresponsive to O2 therapy, diffuse alveolar infiltrates on xray without cardiac disease,
•
PATHOPHYSIOLOGY OF Acute (adult) Respiratory Distress Syndrome (ARDS)
MASSIVE PULMONARY INFLAMMATION THAT INJURES THE ALVEOLI/CAPILLARY MEMBRANE AND PRODUCES PULMONARY EDEMA
EXAMPLES OF RESTRICTIVE DISORDERS OF THE LUNG
PULMONARY FIBROSIS
INHALATION DISORDERS
ACUTE REPIRATORY DISTRESS SYNDROME
• Much more frequently seen in primary care
Obstructive Pulmonary Disorders
• Airway obstruction occurs that is worse on expiration
Obstructive Pulmonary Disorders
EXAMPLES OF OBSTRUCTIVE PULMONARY DISORDERS
asthma, chronic bronchitis, emphysema
• All cause dyspnea and wheezing, increased work of breathing, ventilation\perfusion mismatch and decreased forced expiratory volume
Obstructive Pulmonary Disorders
• Primary cause: Smoking!
Obstructive Pulmonary Disorders
• HOW MANY DEATHS FROM COPD IN 2005
• Chronic obstructive lung disease was the underlying cause of 1 in 20 deaths in the United States in 2005
COPD DEATHS MORE PREVELANT AMONG MEN OR WOMEN?
• Death rates from COPD decreased among men but increased among women, keeping the death rate from COPD about the same overall.
MORE PREVELANT AMONG WHAT RACE?
COPD
• COPD deaths are higher among Whites than Blacks or people of other races.
MOST IMPORTANT CAUSE OF COPD..
• Smoking is the most important cause of COPD.
WHAT IS SHUNTING IN Acute (adult) Respiratory Distress Syndrome (ARDS
• Mismatching of the ventilation to perfusion ratio
EXPLAIN SHUNTING IN Acute (adult) Respiratory Distress Syndrome (ARDS
- Specifically in ARDS we see an inadequate ventilation of well perfused areas of lung
- Blood supply is undisturbed but the alveoli are inflamed and we get this shunting because of the alveolar function compromise
- We see hypoxemia
• Remember the increased volume of the left ventricle means there is a backflow to the lungs THIS IS CALLED//
PULMONARY EDEMA
LEFT IS LUNG
• THERE IS Excess water in the lungs, the water escapes the capillary and goes into the alveoli IN WHAT DISORDER?
PULMONARY EDEMA
WHAT IS THE Most common cause OF heart failure, particularly left heart failure
PULMONARY EDEMA
occurs in many lung disorders
AND Occurs in ARDS
PULMONARY EDEMA
WHAT ARE SIGNS AND SYMPTOMS OF PULMONARY EDEMA
PULMONARY EDEMA
o Inspiratory crackles
o Lungs dull to percussion because there’s increased fluid inside
o Those with severe pulmonary edema would have a pink frothy sputum
o Hypoxemia
o Hypoventilation
PULMONARY EDEMA IS SEEN IN
LEFT SIDED HEART FAILURE AND ARDS
PULMONARY EDEMA
A PNEUMOTHORAX IS
Presence or air in the pleural space caused by an opening in the pleura or chest wall.
WHEN THERE IS AN OPENING IN THE PLEURA OR CHEST WALL
This destroys the negative pressure that helps the lung recoil after expiration. So the lung collapses
WHAT CAN CAUSE OPENINGS IN THE PLEURA?
Spontaneous – bleb
Secondary – trauma
Open
Tension – rupture is one-way valve – air in – collapsing lung and eventually compromising the other lung
WHAT ABOUT THE BLEB?
- When the pleura has opened
- The lung can have a bleb and the lung tissue where the bleb is opens spontaneously because the wall is a little thinner than the rest of the lung
- So we have an area where air is getting into the pleural space but there is no disturbance in the pleura or the chest wall.
- Every breath will bring more air into the space
- Important to get chest tubes in to get the bleb area repaired or give it a chance to heal
WHAT CAUSES A TENSION PNEUMO THORAX?
- rupture occurs and the air inside keeps filling the pleural space causing a severe collapse and eventually it will affect the other lung as well
- So every breath in more air goes into the pleura space and cause more collapse so eventually this will compromise both lungs
- is one-way valve – air in – collapsing lung and eventually compromising the other lung
Inflammatory disorder of airways – reversible
WHAT IS ASTHMA?
wHAT AGE GROUPS ARE AFFECTED BY ASTHMA
OCCURS IN ALL AGES
HOW MANY GENES HAVE BEEN FOUND TO PLAY A ROLE IS ASTHMA
• Have identified over 20 genes that play a role in asthma either in susceptibility or pathogenesis of asthma
WHAT ARE THE RISK FACTORS FOR ASTHMA
family history, allergen exposure, urban living, air pollution, cigarette smoke, recurrent URI from viruses, other atopic disorders IgE mediated
CAN ASTHMA OCCUR DUE TO LACK OF EXPOSURE TO INFECTIOUS AGENTS?
YES! • Somehow this affects the immune system in such a way that a child that is too clean, that is never allowed to make mud pies, or play in the dirt or play in the sand, is much more susceptible to asthma
CLINICAL MANIFESTATIONS OF ASTHMA
- Between asthma attacks patient is totally asymptomatic
- During an attack theres chest constriction, expiratory wheezing, dyspnea, non-productive cough, prolonged expiration, tachycardia and tachypnea
- The bronchospasm can become very severe and if it is not reversible we have a condition called status asthmaticus if it’s not reversed
• Hypersecretion of mucous and chronic productive cough for at least 3 months of each year X 2 years straight (to be able to diagnose it)
Chronic bronchitis
What is the primary cause of chronic bronchitis.
Smoking
Dring chronic bronchitis airways are inflammed with
infiltration of neutrophils , macrophages, and lymphocyte into the bronchial walls
The • The inflammation of asthma
leads to hyper responsiveness of the airways
• If we trace the inflammation of asthma
we see that exposure to an allergen will lead to mast cell degranulation and this will lead to a release of inflammatory mediators practically histamine, interleukins, prostaglandins, leukotryines and nitric oxide
When inflammatory mediators are released in asthma what results?
then vasodilation, and an increase in capillary permeability results
In asthma eosinophils do what/
• Eosinophils release toxic chemicals that increase the inflammation and the tissue damage
When inflammation begins in the tissue
the bronchial smooth muscle will spasm and there will be vascular congestion, edema, thickened mucous, and impaired ciliary function
What are cilia?
• Now cilia are little extensions off of the cell membrane that move ad this movement moves away trash and mucous and debris that may gather in the lung
• We also see the increased bronchial __________ in asthma.
hyperresponsiveness
Chronic Bronchitis is
Hyper-secretion of mucous and chronic productive cough for at least 3 months of each year X 2 years
•******* Primary cause of bronchitis is
know this card for the test
• Primary cause is cigarette smoking
The pathophysiology of Bronchitis is
• Airway inflammation with infiltration of neutrophils , macrophages, and lymphocyte into the bronchial walls
Later in Bronchitis we see
bronchial edema, increase in mucous cells, and the production of a thick tenacious mucous and with this very poor ciliary action with an increase in susceptibility to infection
• The air trapping that happens in chronic bronchitis is due to this
hypersecretion of mucous as opposed to asthma where it is more about inflammation
PRODUCTIVE COUGH
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: CLASSIC SIGN
In Emphysema: LATE IN THE COURSE
DYSPNEA
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: LATE IN THE COURSE
In Emphysema COMMON
WHEEZING
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis:INTERMITTENT
In Emphysema MINIMAL
HISTORY OF SMOKING
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON
In Emphysema COMMON
BARREL CHEST
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: OCCASIONALLY
In Emphysema COMMON
PROLONGED EXPIRATION
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: ALWAYS PRESENT
In Emphysema ALWAYS PRESENT
CYANOSIS
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON
In Emphysema UNCOMMON
CHRONIC HYPOVENTILATION
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis:COMMON
In Emphysema LATE IN THE COURSE
POLYCYTHEMIA
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON
In Emphysema LATE IN THE COURSE
CORPULMONALE
Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON
In Emphysema LATE IN THE COURSE
• Don’t get me wrong, there is still inflammation in chronic bronchitis but the primary mechanism of air trapping in chronic bronchitis is
the hyper-secretion of mucous
chronic bronchitis is associated with these symptoms
Bronchial edema
increase in mucous cells
production of a thick tenacious mucous
poor cilliary action with an increase in susceptibility to infection.
In emphysema air is trapped within the
alveoli
The patient with emphysema cannot move air out of the lungs because of
ballooning of the alveoli
T/F We do not see fibrosis in emphysema?
True.
Primary cause of emphysema is
smoking
Besides smoking, name 2 other possible causes of emphysema
air pollution, childhood upper respiratory infections
Primary emphysema is an inherited disorder that is
autosomal RESSIVE
PRIMARY EMPHYSEMA IS VERY RARE!
YES, IT IS!
primary EMPHYSEMA IS A DEFICIENCY OF
• Deficiency of the alpha 1 antripson
HOW DOES CIGARETTE SMOKING CAUSE EMPHYSEMA
Cigarette smoking
Inhibits anti protease
Inflammation of the lung due to aspiration of stomach juices
PNEUMONITIS
Pneumonitis inflammation of
BRONCHIAL TREE
WHAT “ACTION” IS LOST IN PNEUMONITIS
CILIARY
IF GASTRIC JUICES ENTER THE ALVEOLI WHAT CAN OCCUR
HEMORRHAGIC PNEUMONITIS
IN PNEUMONITIS, LUNGS BECOME
STIFF ADND LOOSE SURFACTANT PRODUCTION
IS PNEUMONITIS LIFE THREATENING?
YES!!
Infection of the lower respiratory tract – 6th leading cause of death in U.S.
PNEUMONIA
SEVERE TYPE OF PNEUMONIA IS CAUSED BY
STREPTOCOCCAL PNEUMONIAE
STREPTOCOCCAL PNEUMONIAE IS CONSIDERED
COMMUNITY AQUIRED
RISK FACTORS FOR STREPTOCOCCAL PNEUMONIAE ARE
ADVANCED AGE IMMUNOCOMPROMISED ALCOHOLISM SMOKING DEBILITATING EVENTS
WALKING PNEUMONIA IS CAUSED BY
MICOPLASM PNEUMONIA
NAME 3 ROUTES FOR INFECTION WITH PNEUMONIA
INHALED
INFECTION IN THE OROPHARYNX
FROM BLOOD BORNE PATHOGEN
CLINICAL MANIFESTATIONS OF PNEUMONIA
AN UPPER RESPIRATORY INFECTION
FEVER CHILLS PRODUCTIVE COUGH
RUST COLORED OR BLOODY SPUTUM
WHAT WILL YOU AUSCULTATE IN THE LUNGS WITH THE PNEUMONIA PATIENT?
INSPIRATORY CRACKLES
AN INFECTED LUNG IS DULL TO PERCUSSION
YES MAAM, IT SURE IS!
THERE IS NO TACTILE FERMENTUS, IS THERE?
YES! YES! THERE IS TACTILE FERMENTUS IN THE INFECTED LUNG.
WHAT BACTERIA CAUSES TUBERCULOSIS?
Infection with mycobacterium tuberculosis
TUBERCULOSIS
OCCURS IN THE LUNGS IN THE US
in other conutries, tuberculosis can appear in other parts of the body due to
unpastuerized milk
How is tuberculosis spread
airborne, droplet. Usually lodges in the upper part of the lung
What happens when the tuberculine bacteria enters the lungs
• Mild pneumonitis and the bacilli will migrate to the lymph nodes where lymphocytes attack them and initiate an immune response and a cell-mediated response involving macrophages and neutrophils will engulf and isolate the bacilli stopping the spread
Tuberculosis may produce a tubercule or
granulomatous lesion. The tissue within the lesion may die.
What causes scar tissue within the lung from tuberculosis
encasiation causes the scar tissue
Once the bacilli is isolated, the disease process
STOPS
CELL MEDIATION HAS CONTAINED THE EXPOSURE.
TB may be dormant for a lifetime and occur in response to
decreased immunity or if exposed to more active disease
– Active Tuberculosis (Pulmonary that has been around a while) shows symptoms of
• Fatigue, wt loss, lethargy, anorexia, a low grade fever particularly in the evening, cough, that is productive of purulent sputum, night sweats and anxiety (not over night type of reaction, this has been around awhile)
• Tuberculosis infection rate has declined in the United States to
4.8 cases per 100,000 population
• Hispanics, blacks, and Asians had TB rates
7.3 (Hispanics), 8.3 (blacks), and 19.6 (Asians) times higher than whites in the United States in 2005.
• The seven states with the highest incidence of tuberculosis are
California, Florida, Georgia, Illinois, New Jersey, New York and Texas.
Acute bronchitis is
• Acute infection or inflammation – usually viral of airways and bronchi – self limiting
Acute bronchitis begins with a
cold that “goes to the chest.”
Clinical manifestations of acute bronchitis
cough,chest pain related to cough
Pulmonary embolism
occlusion of the pulmonary vascular bed with an embolism.
pulmonary embolism usually originates from
veins of the legs and pelvis
pulmonary embolism may be from
blood clots, amniotic fluid, fat from longbone fracture
Does an embolism always infarct the lung?
Not always
clinical manifestations of DVT
usually non-specific. chest pain, dyspnea, tachypnea, anxiety
**check history for DVT
Corpulmonale is
right sided heart failure
volume backflow of corpulmonale is to the
periphery
paroxysmal nocturnal dypnea
PND is a symptom of
lung disease or heart failure
