Pulmonary Flashcards
Primary function of the respiratory system
gas exchange
ventilation
movement of air between the atomosphere and the respiratory portion of the lungs.
Inspiration and expiration
perfusion
flow of blood through the lungs
diffusion
transfer of gases between the air filled spaces in the lungs and the blood
Muccociliary blanket
mucus produced by the epithelial cells in the conducting airways
conducting airways
through which air moves as it passes between the atmosphere and lungs
Respiratory tissues of the lungs
where gas exchange takes place
Inspiration
innnervated by the diaphragm. phrenic nerve roots from c4. people who lose function require mechanical ventilation
accessory muscles to inspiration
scalene and sternocleidomastoid muscles. scale -first two ribs. sternocleidomastoid: raise the sternum to increase the rise of the chest
Lobes of the lungs
3 in the right, 2 in the left.
Hyaline cartilage in the bronchi
surrounds the lumina of the bronchi, and replace the c shaped cartilage rings. two layers of smooth layers of muscles spiraling in opposite directions.
The cartilage gradually decreases as there is an increase in smooth muscle and elastic tissue. by the time the bronchioles are reahced, there is no cartilage present.
Bronchiospasms
narrowing of the bronchioles and impairs airflow
tidal volume
volume of air inspired of exhaled with each breath.
Inspiratory reserve volume
max amt of air that can be inspired
Expiratory reserve volume
max that can be exhaled
Residual volume
always remains in the lungs, approx 1200 ml
Forced vital capacity
full inspiration to total lung capacity followed by forceful maximal expiration
Maximum voluntary ventilation
volume of air a person can move in and out of the lungs during max effort lasting for 12-15 seconds
Forced expiratory vital capacity
full inspiration, forceful max expiration
forced expiratory volume
expiratory volume achieved in a given time period
forced inspiratory vital flow
resp response during rapid max inspiration
FEV1.0
FEV that can be exhaled in 1 second. used to diagnose obstructive lung disorders
Factors affecting alveolar capillary gas exchange
surface area available, thickness of the alveolar-capillary membrane, partial pressure of alveolar gases, solubility and molecular weight of the gas
Oxygen Dissociation curve
Right
rightward shift means that a higher PO2 is required to achieve similar level of hemoglobin saturation compared to the baseline. dec affinity, inc temp, inc 2,3 DPA, inc Pco2, dec pH
Oxygen Dissociation Curve LEft
less po2 can achieve a higher hemoglobin saturation compared to the baseline. a higher affinity for oxygen. dec temp, dec pco2, dec 2,3 DPA, inc pH.
Chemoreceptors: Central and Peripheral
Central: extremely sensitive to pco2, an increase in pco2 inc ventilation and peaks within a minute
Peripheral: carotid and aortic bodies. little control over ventilation until po2 drops below 60. hypoxia is main drive for ventilation
Pacemaker center
pneumotaxic center, apneustic center
CO2 Narcosis
people with chronically elevated levels of PCO2 no longer have a response to the stimulus for increased ventilation, but rely on stimuls of decrease in PO2 levels.
Dyspnea
subjective. shortness of breath.
observed in: primary lung diseases (pneumonia, asthma, emphysema), heart disease (pulmonary congestion), neuromuscular disorders (myasthenia gravis and muscular dystrophy)
Lower Respiratory infections mortality
most deadly communicable disease. tb is the most.
Viruses and respiratory infections
most frequent cause, range from self limited cold to life threatening pneumonia
Factors affecting signs and symptoms of respiratory tract
function of the structure involved, severity of the infectious process, persons age and general health status.
Transmission of the common cold
direct mucus membrane contact by fingers picking up the virus from contaminated surfaces and carrying it to the nasal membranes and the eyes
Acue bacterial rhinosinusitis
symptoms that worsen after 5-7 days or persist beyond 10 days, or symptoms that are out of proportion of those usually associated with a viral upper resp tract infection
Sinus films
do not differentiate between bacterial from viral
Rhinosinusitis: the need for medical attention
facial swelling over the involved sinus, abnormal extraocular movements, protrusion of the eyeball, periorbital edema, or changes int he mental status may indicate indtracranial complications
Influenza Viruses
type A: most common type. can infect multipe species. either Hemaglutanin and neuraminidase.
Antigenic Shift
major genetic rearrangement in either antigen, may lead to epidemic or pancdemic
antigenic drift
population mostly protected by cross reacting antibodies
influenza
more contaigous than bacterial resp infections. inhalation of droplet nuclei. people become infectious 1 day before symtoms, and remain infectious through approx 1 week after illness onset.
Influenza infections
uncomplicated upper resp infection, viral pneumonia, and resp viral infection followed by a bacterial infeciton.
Reyes Syndrome
fatty liver with encephalitis. rare complication of influenza in young children who have been given aspirin
Pneumonia
caused by infectious agents and noninfectious agents aspirated into lungs
Classification of pneumonia
according to source of infection, immune status of the host, according to organism, anatomic location
Atypical pneumonia
caused by viral and mycoplasma infections that involve the alveolar septum and the interstitium of the lung. variety of agents. M. pneumoniae, and mycoplasm infections
lobar pneumonia
consolidation of a part or all of a lung lobe
bronchopneumonia
patchy consolidation involving more than 1 lobe
community pneumona
infections from organisms found in the community. bacterial or viral. S. pneumoniae
hospital acquired pneumonia
second most common cause of HAI, mortality of 30-50%. most are bacterial. many have antibiotic resistance
Tuberculosis
macrophage directed attack, has an outer waxy capsule that makes it more resistant, can persist in old necrotic and calcified lesions and remain capable of reinstating growth. strict aerobes. upper lobe or upper parts of the lower lobes of the lung
Primary TB
form of the disease that develops in previously unexposed and unsensitized people.
TB cell mediated immunity
sesults in the development of gray white circumscribed granulomatous lesion, Ghon focus, that contains tb modified macrophages and immune cells
Ghon Complex
combination of the primary lung lesion and lymph node granulomas
PPD
hypersensitivity. Type IV. cell mediated.
Quantiferon TB gold test is used to detect active and latent TB by measuring interferon y , which is part of the cell mediatedimmune response to TB
Goals of TB treatment
eliminate the tubercle from the infected person while avoiding emergence of significant drug resistance. treatment often needs multiple drugs for long periods of time.
Small cell lung cancers
highly malignant, tend to infiltrate widely, disseminate early in their course, rarely resectable. brain metastases are particularly common and may provide first evidence. associated with several types of paraneoplastic syndrome
non small cell lung cancer
squamos cell carcinomas, adenocarcinoma, and large cell.
Clinical manifestations of lung cancers:
:paraneoplastic manifestations: endocrine, neurologic and connective tissue.
all type has the ability to synthesize bioactive products and produce paraneoplastic syndromes. may result of hormonal production.
Most common sites of metastases: brain, bone and liver
for staging and treatment: divided into small and nonsmall, almost all small have metastasized at the time of diagnosis.
repiratory distress syndrome
most common causes of resp disease in premies. lack of surfactant. dysfunction and no diffusion. right after birth. higher in preterm male infants, white infants, infants of diabetic mothers.
Bronchopulmonary dysplasia
chronic lung disease that develops in premies who were trated with long term mechanical ventilation. present if dependent after gestation. fibrotic process of the lungs does not get better.
surfactant deficiency
lungs collapse between breaths. infants have to work harder. noncompliant areas become still. hyaline membrane forms inside the alvoli as protein and fibrin rich fluids are pulled into the alveolar space .
Central cyanosis is a prominent sign.
Bronchiolitis
Sx of viral upper resp infection. lower resp tract symptoms including persistent cough, tachypnea, and increased work of breathing later follow
Hypoxemia
reduction in arterial blood o2 levels which is considered a pa02 less than 95.
inadequate o2 in the air, disease of resp system. dysfuntion of the neuro system, alterations in circultory function
hemoglobin saturation with po2 of 60
90%
mild hypoxemia
metabolic acidosis, inc hr, peripheral vasoconstriction, diaphoresis, inc in blood pressure, slight impairment of mental performance
Chronic hypoxemia
insidious in onset and attributed to other causes. inc ventilation, pulmonary vasoconstriction, inc production of red blood cells, cyanosis. people with anemia are less likely to exhibit cyanosis.
Hypercapnia
increase in the carbon dioxide content of the arterial blood.
four Factors contribute to:
alteration in carbon dioxide production, disturbance in the gas exchange function of the lungs, abnormalities in function of the chest wall and respiratory muscles, and changes in neural control of respiration
Pleura: outer parietal layer
lines pulmonary cavities and adheres to the thoracic wall.
Pleura: inner visceral pleura
covers the lung and is adherent to all its surfaces. continous with the parietal pleura at the hilum of the lungs. thin layer of fluid separates the two
Causes of disorders of lung inflations
compression of the lung by an accumulation of fluid in the intrapleural space, complete collapse of an entire lung, collapse of a segment of the lung
Pleural effusion
abnormal collection of fluid in the pleural cavity.
hydrothorax: srous fluid.
can be uni or bilateral. hydro is usually CHF.
Parapneumonic effusions: common. largely bacterial infections. empyema. infection in the pleural cavity.
Hemothorax: blood in the pleural cavity
Pneumothorax
presence of air in the pleural space. causes partial or complete collapse of the affected lung.
Spontaneous pneumo
air filled blister of the lung surface ruptures.
hypothesized. primary: healthy people. Secondary: underlying lung disease (emphysema)
Traumatic Pneumo
caused by penetrating or nonpenetrating injuries.
Tension Pneumo
occurs when the intrapleural pressure exceeds atmospheric pressure. impairs resp and cardiac function.
lifethreatening, shift in the mediastinum to the opposite side of the chest, dec in venous return and reduced CO.
Atelectasis
incomplete expansion of a lung or portion of a lung
Primary: present at birth.
Secondary: later in life.
complete obstruction of an airway is followed by the absorption of air from the dependent alveoli and collapse of that portion of the lung
Pleuritis
pleuisy. inflammation of the pain.
Parasympathetic nervous system
airway constriction, increased glandular secretion. bronchoconstrictor. vagal control
Sympathetic
Beta adrenergic receptors. broncodilator. airway relaxation, blood vessel constriction, and inhibition of glandular secretion
Asthma
chronic disorder of the airways that causes episodes of airway obstruction, bronchila hyperresponsiveness, and airway inflammation.
wheezing, breathlessness, chest tightness, and a cough that is often worse at night.
common denominator is an exaggerated hyperresponsiveness to a variety of stimuli.
Treatment of asthma
first line in treatment is inflmmatory controller drug that would include inhaled corticosteroids. Quick relief medicaitons such as short acting beta two adrenergic agonists relax bronchila smooth muscle and provide promt relief of symtpoms.
COPD
chronic and recurrent obstruction of airflow in the pulmonary airways. most common cause is smoking. chornic cough, sputum production, dyspnea, and a history of exposures of risk factors
Causes of COPD
chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis
Emphysema
enlargement of air spaces and destruction of lung tissue. smoking, barrel chest, dec breath sounds, normal blood gases cor pulmonale only in advanced cases. pink puffer.
chronic obstructive bronchitis
increased mucus production, obstruction of small airways, and a chronic productive cough. smoking, barrel chest, SOB, rhonchi, sputum. clinical diagnosis requires a history of chronic productive cough for at least 3 consecutive months in at least 2 consecutive years
Cor pulmonale
right sided heart failure with peripheral edema.
venous congestion, peripheral edema, SOB, and a productive cough
Bronchiectasis
permanent dilation of the bronchi and bronchioles, secondary to persisting infection or obstruction
Cystic Fibrosis
autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, GI, and reproductive tracts. caused by mutations in a single gene.
Cystic Fibrosis manifestations
accumulation of viscid mucus in the bronchi, impaired muccociliary clearance, and lung infection. pancreatic function is often abnormal. malabsorption and malnutrition. sweat test for chloride.
Diffuse interstitial lung diseases
diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the insterstitium or inter alveolar septa of the lung. stiff and noncompliant. restrictive lung disorders.
occupational lung diseases
require comprehensive personal and family hsitory, with emphasis on exposure. primary treatment is removing the agent, suppressing the inflammatory response, and preventing progression of the disease, and supportive therapy
Pulmonary embolism
blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow. may consist of a thrombus air that has been introduced, fat in a large fracture, or amniotic fluid that enters maternal circulation
Manifestations of pulmonary embolism
: depends on the size and location of the obstruction. chest pain, dyspnea, and inc RR most frequenct signs
d-Dimer testing
measurement of plasma d-dimer, a degreatation product of coagulation factors that have been activated as the result of thromboembolic event.
Helical CT angiography requires adinistation of an intravenous radiocontrast medium. sensitive for the detection of emboli in the proximal pulmonary arteries.
Pulmonary hypertension
elevation of pressure within the pulmonary circulation, may be acute or chronic. can be due to changes in the arterial wall, or it may occur as a secondary condition.
Defined as persistent elevation in pulmonary artery pressure with normal left V pressures differentiating it from left sided heart failure.
ARDS
injury and increased permeability of the alveolar capillary membrane allow fluid, protein, cellular debris, platelets, and blood cells to move out of the vascular compartment and enter the interstitium and alveoli.
Causes: aspiration, trauma, sepsis, pancreatitis, metabolic events.
Rapid onset of resp distress within 12-18 hours of initiating event an increase in RR, and signs of R failure. marked hypoxemia occurs
assisted ventilation using high concentrations of oxygen my be required to correct
respiratory failure
failure in gas exchange due to either heart or lung failure or both.
Acute failure is manifested by varying degrees of hypozemia and hypercapnia. resp fialure conventionally defined by an arterial po2 less than 50 mm or an arterial pco2 50 or more, or both
Treatment of respiratory failure
establish an airway, bronchodialtors, antibiotics, adequate o2, supportive measures, ensure adeuqate o2 of vital organs, usually by mechanical ventilation
