Productive diseases Flashcards
What is bronchiectasis?
the permanent abnormal dilation in one or more of the lungs bronchi. Extra mucus is secreted and pools in the areas of the airways that are dilated making the person more prone to infection
In which gender is bronchiectasis more common in?
females
In what age population are 60% of bronchiectasis diagnoses made?
over 70s
What is the first stage of the pathophysiology cycle of bronchiectasis?
impaired mucocilliary clearance leads to the accumulation of secretions
What is the second stage of the pathophysiology cycle of bronchiectasis?
accumulation of secretions leads to infection by bacteria because it is a good environment for bacteria to grow
What is the third stage of the pathophysiology cycle of bronchiectasis?
infection by bacteria leads to increased mucus production, impaired cillary performance and an inflammatory response
What is the fourth stage of the pathophysiology cycle of bronchiectasis?
excessive inflammatory response causes tissue damage
What is the fifth stage of the pathophysiology cycle of bronchiectasis?
tissue damage eventually produces dilated bronchi including loss of cilliated epithelium and impaired mucocilliary clearance
Name some causes of bronchiectasis
idiopathic (arises spontaneously/unknown cause)
infection (usually in childhood)
immunodeficiency
cillary dysfunction
ABPA (allergic bronchopulmonary aspergillosis)
inflammatory conditions
aspiration/obstruction
Name some clinical features of bronchiectasis
Very wet and productive cough
chronic sputum production
dyspnoea
wheeze
chest pain
chronic sinusitis
nasal polyps
How can we diagnose bronchiectasis?
chest X ray
HRCT ( high resolution computed tomography)
bloods and sputum microbiology
pulmonary function tests
What is bronchiectasis characterised off of?
What the damage to the airways looks like
Name three types of bronchiectasis
Saccular/cystic (occurs in large bronchi that become large and balloon like)
cylindrical (involves medium sized bronchi which usually are symmetrically dilated)
varicose (constrictions and dilations deform bronchi)
Name some symptoms of acute exacerbation of bronchiectasis
change in sputum production
increased dyspnoea
increased cough
temperature > 38
increased wheezing
malaise, fatigue, lethargy or decreased exercise tolerance
reduced pulmonary function
x-ray changes consistent with a new pulmonary process
changes in chest sounds
How can we treat and manage bronchiectasis?
physiotherapy
IV/oral/nebulised antibiotics
bronchodilators
steroids
nasal sprays
flu and pneumococcal vaccinations
surgery
What is the prognosis for someone with bronchiectasis?
Unclear but related to lung function and presence of infection
What is pneumonia?
an inflammatory condition of the lung leading to abnormal alveolar filing with consolidation and exudation
What is the single largest infectious cause of death in children worldwide?
pneumonia
What are the 4 stages of pneumonia?
congestion
red hepatization
gray hepatization
resolution
In what time frame does congestion occur (pneumonia)?
First 24 hours
In what time frame does red hepatization occur (pneumonia)?
2-3 days
In what time frame does gray hepatization occur (pneumonia)?
4-6 days
In what time frame does resolution occur (pneumonia)?
> 6 days
Describe the first stage of pneumonia
congestion -> characterised by vascular engorgement, intra-alveolar fluid and numerous bacteria; the lung is heavy, boggy and red
Describe the second stage of pneumonia
red hepatization -> massive exudation develops with red blood cells, leukocytes and fibrin filling the alveolar spaces; the affected area appears red, firm and airless, with a liver like consistency
Describe the third stage of pneumonia
characterised by progressive disintegration of red blood cells and the persistence of fibrin exudate
Describe the fourth stage of pneumonia
Resolution -> the consolidated exudate within the alveolar spaces undergoes progressive digestion to produce debris that is later reabsorbed, ingested by macrophages or coughed up
Name some causes of pneumonia
bacteria
fungi
virus
parasites
chemical
aspiration
inhalation (smoke, burns)
What are the two anatomical classifications of pneumonia?
lobar pneumonia
bronchopneumonia
What are the four setting classifications of pneumonia?
community acquired pneumonia (CAP)
health care associated pneumonia (HCAP)
hospital acquired pneumonia (HAP)
ventilator associated pneumonia (VAP)
Name some common symptoms of pneumonia
Fever
Malaise
muscle ache/fatigue
coughing (productive and non productive)
Dyspnoea
pleuritic or chest pain
loss of appetite
rapid heartbeat
Name some less common symptoms of pneumonia
coughing up blood
fatigue
nausea/vomiting
diarrhoea
wheezing
confusion
Name some complications of pneumonia
lung abscess
pleural effusions
empyema (infection/pus between the pleural cavity)
septic shock
Name 5 findings that can lead to a medical diagnosis of pneumonia
temperature>37.8
HR>100 bpm
crackles
decreased breath sounds or bronchial breath sounds
absence of asthma
Describe the clinical prediction rule for pneumonia
5 findings = 84-91% probability
4 findings = 58-85%
3 findings = 35-51%
2 findings = 14-24%
1 finding = 5-9%
0 findings = 2-3%
Name some diagnostic tests for pneumonia
CXR
CT scan
Blood test
sputum culture
pleural fluid culture
bronchoscopy
What general management is used for pneumonia?
Antibiotics/anti-fungal medication
oxygen support
hydration - IV fluids
rest
analgesics
cough suppressant medication
fever reducing medication
prevention through vaccine programmes
What is cystic fibrosis?
an inherited autosomal recessive disease
What causes cystic fibrosis?
It is the result of a gene mutation - single gene defect on chromosome 7
What is chromosome 7 responsible for?
encoding the cystic fibrosis membrane conductance regulator, a transmembrane protein involved in ion transport called the cystic fibrosis transmembrane regulating (CFTR) protein
What does a defect on chromosome 7 lead to for cystic fibrosis?
It leads to a compromise in ion transport -> it impairs transport of chloride ions, and also affects the levels of sodium and water in the cell
What does cystic fibrosis affect?
It affects several organs causing ducts to become obstructed with mucus
(affects any organ that relies on the CFTR protein for ion transport)
What type of protein is CFTR?
channel protein
What does CFTR protein control?
the flow of water and chloride ions between membranes
What happens to the natural accumulation of mucus when the CFTR protein is altered?
Mucus is much thicker than it should be
What happens when the natural accumulation of mucus is thicker than it should be due to altered CFTR protein?
Thickness of mucus means it is stagnant, it blocks ducts and airways and is breading ground for infection which if repeated, damages structures and leaves scar formation
What does defect in CFTR protein result in, in terms of problems for patient?
respiratory disease
high sodium sweat
pancreatic insufficiency
biliary disease
infertility
cirrhosis of the liver
gastrointestinal disease
In which sex is infertility a problem for cystic fibrosis patients and why?
male CF patients are often infertile due to the absence of vas deferens which prevents the transport of sperm from testes to the urethra
What are three ways to diagnose cystic fibrosis?
Genetic testing
heal prick test
sweat test
What are some common lung symptoms of someone with cystic fibrosis?
persistent cough
coughing fits
wheezing
SOB
difficulties breathing
Name some common digestive system symptoms of people with cystic fibrosis
large smelly stools
malnutrition/poor weight gain/stunted growth
Name some general symptoms of cystic fibrosis (not lung or digestive system related)
diabetes
sinusitis
nasal polyps
arthritis
osteoporosis
infertility
liver failure
urinary incontinence
delayed puberty
kyphosis of the spine resulting in neck and back pain
Name some medications that can be used to treat cystic fibrosis
bronchodilators
hypertonic saline nebs
antibiotics
mucolytic
steroids
routine vaccines
digestive enzymes
What is treatment for cystic fibrosis dependent on?
The patients main symptoms/problems
Name some treatments for cystic fibrosis
medication
dietary advice
education
exercise
lung transplant
psychological support
physiotherapy
What physiotherapy techniques can be used for cystic fibrosis?
Postural drainage
percussion, vibs/shakes
ACBT
AD
Adjuncts
Mobilisation/exercise
Suction
What is the prognosis for cystic fibrosis?
no cure or prevention
lung complications are normally cause of death
