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*Patho > Pulm Patho > Flashcards

Pulm Patho Flashcards

1
Q

What type lung dz is pulm edema?

A

acute intrinsic restrictive lung dz

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2
Q

What causes pulmonary edema?

A
  1. valvular dysfxn, CAD, LVF causing LAP –> inc pulm hydrostatic pressure –> pulm edema
  2. inflammation/injured capillary endothelium –> inc cap permability –> proteins, etc leak into lungs –> pulm edema
  3. blocked lymph vessels –> interstitial accumulation –> pulm edema
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3
Q

What does a CXR look like w/ pulm edema?

A

bilat symm opacities

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4
Q

What is ARDS? (acute intrinsic)

A
  • acute resp distress syndrome - DIFFUSE pulm endothelial injury –> inc cap permeability w/ atelectasis
  • occurs w/ sepsis
  • first sign of MODS
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5
Q

What is the patho of ARDS?

A

acute insult (PNA, asp, smoke) –> inflammatory response –> inflamm mediators activate complement causing:

  1. damaged type 2 pneumos (dec surfactant) = atelectasis and dec compliance and inc surface tension (need PEEP to open up)
  2. disrupts alv-cap membrane (edema) = dec diffusion/shunting
  3. pulm HTN
  4. pulm fibrosis
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6
Q

What is aspiration pneumonitis?

A

gastric acid secretions damage type 2 pneumos and pulm capillary endothelium –> inc cap permeability w/ atelectasis
(similar to ARDS)

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7
Q

What are sx of asp pneumonitis?

A
  • hypoxia
  • tachypnea
  • bronchospasm
  • pulm vasoconstriction –> pulm HTN
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8
Q

How does asp pneumonitis show on CXR?

A
  • usually RLL

- changes occur 6-12 hrs later

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9
Q

How do you try asp pneumonitis?

A
  • INC FIO2!!
  • PEEP (d/t atelectasis)
  • B2 agonist for bronchospasm
  • lavage? improve suctioning vs spreading aspirate
  • fiberoptic bronch for solid material aspiration
  • antbx/steroid? controversial
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10
Q

Describe cardiogenic pulm edema.

A

-caused by LVF –> inc pulm vascular hydro pressure (outside)

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11
Q

S/S of cardiogenic pulm edema.

A

SNS activation -

  1. extreme dyspnea
  2. tachypnea
  3. tachycardia
  4. HTN
  5. diaphoresis
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12
Q

Describe neurogenic pulm edema and sx.

A

similar to cardiogenic pulm edema
-min to hrs after acute brain injury (MEDULLA)
-massive SNS discharge =
general vasoconstriction –> inc pulm vascular hydro pressure

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13
Q

How do you try neurogenic pulm edema?

A
  • supportive
  • control ICP, inc FiO2, PPV, PEEP, etc
  • NO diuretics
  • resolves in a few days
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14
Q

Describe drug-induced pulm edema.

A
  • cocaine - inc permeability
  • heroin - pulm vasoconstriction and/or MI causing pulm edema
  • treatment is supportive
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15
Q

Describe high altitude pulm edema

A
  • intense hypoxic pulm constriction after 48-96 hrs (2500-5000 m altitude)
  • inc pulm vasc pressure –> inc permeability –> pulm edema
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16
Q

How do you treat high altitude pulm edema?

A
  • supplemental O2
  • descent from altitude
  • inhaled nitric oxide
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17
Q

Describe re-expansion pulm edema.

A
  • evacuating PTX or pleural effusion causes inc cap permeability
  • more common if >1L air/fluid w/ >24 hr collapse, w/ rapid re-expansion
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18
Q

How do you treat re-expansion pulm edema.

A
  • supportive

- NO diuretics

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19
Q

Describe causes of neg pressure pulm edema.

A

post-ext laryngospasm, hiccups, OSA, epiglottitis, tumors, obesity

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20
Q

How does neg pressure pulm edema occur?

A
  • inc negative intrapleural pressure against a closed glottis/upper a/w resulting in
  • dec interstitial hydro pressure
  • inc VR
  • inc after load on LV
  • inc SNS = HTN, pooling
  • hypoxemia
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21
Q

What are sx and try of neg pressure pulm edema?

A
  • tachypnea
  • cough
  • failure to maintain sat >95%
  • lasts 12-24 hrs
  • trx w/ supplemental O2, maintain a/w, mech vent PRN
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22
Q

When is a tension PTX more likely to occur?

A
  • rib fracture
  • barotrauma
  • medical ER
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23
Q

What are s/s of PTX?

A
  • acute dyspnea
  • ipsilateral chest pain
  • dec PaO2, inc PCO2
  • hypotension/tachycardia (pulm capillaries are compressed –> hypoxic shunting and dec CO)
  • dec chest wal mvmt
  • dec/dim BS in affected lung
  • hyperresonant percussion (hollow)
24
Q

How do you trx PTX?

A
  • idiopathic - aspiration or CT
  • tension - small bore catheter into 2nd IC
  • inc FiO2 (improves rate of air resorption by pleura 4x)
25
Q

Name the diff disorders that disrupt the pleural space.

A
  • PTX = air
  • pleural effusion = fluid which can be:
    1. hemothorax = blood
    2. chylothorax = lymph/lipid
    3. hydrothorax = serous
    4. empyema = pus
26
Q

What is acute mediastinitis?

A

-perf esophagus w/ bacterial contamination

27
Q

What is pneumomediastinum? Causes?

A
  • air in mediastinum

- d/t trachs, alveolar rupture, cocaine, idiopathic

28
Q

What are sx of pneumomediastinum?

A
  • retrosternal chest pain
  • dyspnea
  • sudden inc WOB, cough, emesis
29
Q

What is the possible extent of pneumomediastinum?

A
  • SQ emphysema from arms to and to neck

- can cause PTX in pleural space

30
Q

How do you treat peumomediastinum?

A
  • O2
  • supportive
  • occasional surgical decompressio
31
Q

What are bronchogenic cysts? Why are they concerning?

A
  • air/fluid filled cysts in lungs or mediastinum

- can cause life threatening a/w obstruction

32
Q

How do you trx pleural effusions? What pts commonly have pl eff?

A
  • thoracentesis

- common w/ CHF pts

33
Q

What is concerning about mediastinal tumors?

A
  • a/w obstruction
  • SVC outlet syndrome
  • dec lung volumes
  • PA/cardiac compression
34
Q

Virchow’s triad

A
  1. hypercoagulability
  2. venous stasis
  3. endothelial injury
35
Q

What does a PE cause?

A
  • hypoxic vasoconstriction
  • dec surfactant
  • pulm edema
  • atelectasis
36
Q

What are sx of PE? What does it cause?

A
  • tachypnea
  • dyspnea
  • chest pain
  • inc dead space
  • V/Q mismatch
  • dec PaO2
  • pulm HTN/infarct
  • dec CO
  • hypotension
  • shock
37
Q

What is considered pulm HTN?

A

PAP 5-10 mmHg > normal

or > 20 mmHg

38
Q

What endothelial dysfunction causes pulm HTN?

A

-too much vasoconstrictors
(endothelin, thromboxane)
-not enough vasodilators
(nitric oxide, prostacyclin)

39
Q

What is a chronic intrinsic restrictive lung dz?

A

pulm fibrosis

40
Q

What tends to occur w/ pulm fibrosis disorders?

A
  • pulm HTN
  • cor pumonale (RHD 2nd to pulm dz)
  • PTX w/ advanced dz
  • dyspnea (rapid/shallow) d/t dec diffusion/compliance
41
Q

What is sarcoidosis?

A

-systematic granulomatous (inflammatory nodules) d/o in t lymph nodes or lungs

42
Q

How is sarcoidosis dx? What do you need to monitor?

A

mediastinoscopy

*watch for hypocalcemia

43
Q

What trx are sarcoidosis pts usually on?

A

-steroids

44
Q

How do you dose sarcoidosis pts for surgery?

A
  • minor surgery = double their dose
  • mod surgery = hydrocortisone 25/75/50 mg IV
  • major surgery = 50/100/100 mg IV
45
Q

What are examples of pneumoconiosis?

inhalant d/o

A
  • silicosis
  • asbestosis
  • coal worker’s pneumoconiosis (black lung)
46
Q

What are examples of hypersensitivity pneumonitis? (inhalant d/o)

A
  • bird fancier’s lung
  • farmer’s lung
  • ingesting mold/spores/fungi/protein (living things)
47
Q

What is the path of chronic intrinsic restrictive lung dz?

A
  • lung injury (inhalant, toxin, etc)
  • macrophages activated (granulomas)
  • neutrophils activated + proteases -> damage type 1 pneumos
  • fibroblasts overproduced -> hypertrophy/plasia of type 2 pneumos
  • all leading to fibrosis
48
Q

What are chronic EXTRINSIC restrictive lung dz effects?

A
  • inc WOB
  • dec volumes/inc a/w resistance
  • abnormal chest mechanics
  • thoracic deformities = cause RV dysfxn d/t chronic compression of pulm vessels
  • impaired cough
49
Q

What pulm effects does obesity have?

chronic extrinsic restrictive dz

A
  • dec FRC
  • V/Q mismatch
  • supine worsens these things
50
Q

Name some costovertebral deformities.

A
  1. kyphosis - “hump” = ant flexion of vertebrae

2. scoliosis - “s” = lateral curve/rotation of vertebrae

51
Q

Describe pulm effects r/t scoliotic angle

A

60 degree - dyspnea w/ exercise
90 degree - alv hypoventilation, dec PaO2, erythrocytosis, pulm HTN, cor pulmonale
110 degree - VC <45%, reap failure

52
Q

What anesthetic precautions do you take with scoliotic pts?

A

-CNS depressents worsen hypoventilation/PNA

53
Q

What is pectus excavatum?

pectus carinatum?

A
  • sternal inward concave

- sternal outward protrusion

54
Q

Describe flail chest.

A
  • unstable thoracic cage d/t rib fracture or dehiscenced sternotomy
  • moves in on inspiration - dec lung volume
  • moves out on expiration - inc lung volume
  • results in inc PCO2 and dec PaO2 (hypoventilation)
  • PPV required until stabilized
55
Q

Regarding NM d/o and chronic extrinsic restrictive dz, what is useful to measure impact of NM disease on pulm function?

A

vital capacity

*Patho (6 decks)

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