Pulm Patho Flashcards
What type lung dz is pulm edema?
acute intrinsic restrictive lung dz
What causes pulmonary edema?
- valvular dysfxn, CAD, LVF causing LAP –> inc pulm hydrostatic pressure –> pulm edema
- inflammation/injured capillary endothelium –> inc cap permability –> proteins, etc leak into lungs –> pulm edema
- blocked lymph vessels –> interstitial accumulation –> pulm edema
What does a CXR look like w/ pulm edema?
bilat symm opacities
What is ARDS? (acute intrinsic)
- acute resp distress syndrome - DIFFUSE pulm endothelial injury –> inc cap permeability w/ atelectasis
- occurs w/ sepsis
- first sign of MODS
What is the patho of ARDS?
acute insult (PNA, asp, smoke) –> inflammatory response –> inflamm mediators activate complement causing:
- damaged type 2 pneumos (dec surfactant) = atelectasis and dec compliance and inc surface tension (need PEEP to open up)
- disrupts alv-cap membrane (edema) = dec diffusion/shunting
- pulm HTN
- pulm fibrosis
What is aspiration pneumonitis?
gastric acid secretions damage type 2 pneumos and pulm capillary endothelium –> inc cap permeability w/ atelectasis
(similar to ARDS)
What are sx of asp pneumonitis?
- hypoxia
- tachypnea
- bronchospasm
- pulm vasoconstriction –> pulm HTN
How does asp pneumonitis show on CXR?
- usually RLL
- changes occur 6-12 hrs later
How do you try asp pneumonitis?
- 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
Describe cardiogenic pulm edema.
-caused by LVF –> inc pulm vascular hydro pressure (outside)
S/S of cardiogenic pulm edema.
SNS activation -
- extreme dyspnea
- tachypnea
- tachycardia
- HTN
- diaphoresis
Describe neurogenic pulm edema and sx.
similar to cardiogenic pulm edema
-min to hrs after acute brain injury (MEDULLA)
-massive SNS discharge =
general vasoconstriction –> inc pulm vascular hydro pressure
How do you try neurogenic pulm edema?
- supportive
- control ICP, inc FiO2, PPV, PEEP, etc
- NO diuretics
- resolves in a few days
Describe drug-induced pulm edema.
- cocaine - inc permeability
- heroin - pulm vasoconstriction and/or MI causing pulm edema
- treatment is supportive
Describe high altitude pulm edema
- intense hypoxic pulm constriction after 48-96 hrs (2500-5000 m altitude)
- inc pulm vasc pressure –> inc permeability –> pulm edema
How do you treat high altitude pulm edema?
- supplemental O2
- descent from altitude
- inhaled nitric oxide
Describe re-expansion pulm edema.
- evacuating PTX or pleural effusion causes inc cap permeability
- more common if >1L air/fluid w/ >24 hr collapse, w/ rapid re-expansion
How do you treat re-expansion pulm edema.
- supportive
- NO diuretics
Describe causes of neg pressure pulm edema.
post-ext laryngospasm, hiccups, OSA, epiglottitis, tumors, obesity
How does neg pressure pulm edema occur?
- 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
What are sx and try of neg pressure pulm edema?
- tachypnea
- cough
- failure to maintain sat >95%
- lasts 12-24 hrs
- trx w/ supplemental O2, maintain a/w, mech vent PRN
When is a tension PTX more likely to occur?
- rib fracture
- barotrauma
- medical ER
What are s/s of PTX?
- 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)
How do you trx PTX?
- idiopathic - aspiration or CT
- tension - small bore catheter into 2nd IC
- inc FiO2 (improves rate of air resorption by pleura 4x)
Name the diff disorders that disrupt the pleural space.
- PTX = air
- pleural effusion = fluid which can be:
1. hemothorax = blood
2. chylothorax = lymph/lipid
3. hydrothorax = serous
4. empyema = pus
What is acute mediastinitis?
-perf esophagus w/ bacterial contamination
What is pneumomediastinum? Causes?
- air in mediastinum
- d/t trachs, alveolar rupture, cocaine, idiopathic
What are sx of pneumomediastinum?
- retrosternal chest pain
- dyspnea
- sudden inc WOB, cough, emesis
What is the possible extent of pneumomediastinum?
- SQ emphysema from arms to and to neck
- can cause PTX in pleural space
How do you treat peumomediastinum?
- O2
- supportive
- occasional surgical decompressio
What are bronchogenic cysts? Why are they concerning?
- air/fluid filled cysts in lungs or mediastinum
- can cause life threatening a/w obstruction
How do you trx pleural effusions? What pts commonly have pl eff?
- thoracentesis
- common w/ CHF pts
What is concerning about mediastinal tumors?
- a/w obstruction
- SVC outlet syndrome
- dec lung volumes
- PA/cardiac compression
Virchow’s triad
- hypercoagulability
- venous stasis
- endothelial injury
What does a PE cause?
- hypoxic vasoconstriction
- dec surfactant
- pulm edema
- atelectasis
What are sx of PE? What does it cause?
- tachypnea
- dyspnea
- chest pain
- inc dead space
- V/Q mismatch
- dec PaO2
- pulm HTN/infarct
- dec CO
- hypotension
- shock
What is considered pulm HTN?
PAP 5-10 mmHg > normal
or > 20 mmHg
What endothelial dysfunction causes pulm HTN?
-too much vasoconstrictors
(endothelin, thromboxane)
-not enough vasodilators
(nitric oxide, prostacyclin)
What is a chronic intrinsic restrictive lung dz?
pulm fibrosis
What tends to occur w/ pulm fibrosis disorders?
- pulm HTN
- cor pumonale (RHD 2nd to pulm dz)
- PTX w/ advanced dz
- dyspnea (rapid/shallow) d/t dec diffusion/compliance
What is sarcoidosis?
-systematic granulomatous (inflammatory nodules) d/o in t lymph nodes or lungs
How is sarcoidosis dx? What do you need to monitor?
mediastinoscopy
*watch for hypocalcemia
What trx are sarcoidosis pts usually on?
-steroids
How do you dose sarcoidosis pts for surgery?
- minor surgery = double their dose
- mod surgery = hydrocortisone 25/75/50 mg IV
- major surgery = 50/100/100 mg IV
What are examples of pneumoconiosis?
inhalant d/o
- silicosis
- asbestosis
- coal worker’s pneumoconiosis (black lung)
What are examples of hypersensitivity pneumonitis? (inhalant d/o)
- bird fancier’s lung
- farmer’s lung
- ingesting mold/spores/fungi/protein (living things)
What is the path of chronic intrinsic restrictive lung dz?
- 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
What are chronic EXTRINSIC restrictive lung dz effects?
- 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
What pulm effects does obesity have?
chronic extrinsic restrictive dz
- dec FRC
- V/Q mismatch
- supine worsens these things
Name some costovertebral deformities.
- kyphosis - “hump” = ant flexion of vertebrae
2. scoliosis - “s” = lateral curve/rotation of vertebrae
Describe pulm effects r/t scoliotic angle
60 degree - dyspnea w/ exercise
90 degree - alv hypoventilation, dec PaO2, erythrocytosis, pulm HTN, cor pulmonale
110 degree - VC <45%, reap failure
What anesthetic precautions do you take with scoliotic pts?
-CNS depressents worsen hypoventilation/PNA
What is pectus excavatum?
pectus carinatum?
- sternal inward concave
- sternal outward protrusion
Describe flail chest.
- 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
Regarding NM d/o and chronic extrinsic restrictive dz, what is useful to measure impact of NM disease on pulm function?
vital capacity
