Pulmonary Pathologies Flashcards
What are some CVR pathologies where the airways are affected?
- Asthma
- COPD
What are some CVR pathologies where lung tissue is affected?
- Pulmonary fibrosis
- Sarcoidosis
What are some CVR pathologies where lung circulation is affected?
- Pulmonary embolism
- Pulmonary hypertension
What are some examples of obstructive lung diseases?
- COPD
- Bronchitis
What are some examples of restrictive lung diseases?
- Sarcoidosis
- Interstitial lung disease
What are the different classifications of lung disease?
- Tissue or vessel affected
- Obstructive or restrictive lung disease
- Acute
- Chronic
- Occupational
What are (5) cardinal signs of respiratory disease?
- Cough
- Sputum
- Dyspnoea (breathlessness)
- Wheeze
- Chest pain
What is Chronic Obstructive Pulmonary Disease (COPD)?
- A common preventable & treatable disease
- Characterised by persistent air flow limitation
- Usually progressive (spans 20-50 years)
- Associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
What does ‘COPD’ stand for?
Chronic Obstructive Pulmonary Disease
What (3) things is COPD an umbrella term for?
- Chronic Bronchitis
- Emphysema
- Chronic Severe Asthma
What are some typical co-morbidities for COPD?
- Ischaemic heart disease
- Cardiac failure
- Osteoporosis
- Diabetes metabolic syndrome
- Nomocytic anaemia
- Depression
What are the causes of COPD?
- Smoking
- Industrial pollutants
- Mining
- Bacteria infection
- Viral infection
- Wood, fire, biomass fuels
- Vehicle exhaust pollution
What is emphysema?
Permanent enlargement of the alveoli
- Destruction of alveolar walls
- Lungs lose their elasticity
- Walls of terminal bronchioles and alveoli are destroyed by inflammation
- Airway collapse
- Air trapping
- Enlarged alveoli sacs-dead space
Describe air trapping in emphysema.
- Bronchioles open on inspiration but
collapse on expiration - Air trapped within alveoli
- Hyperinflation-barrel chest
- Diaphragm flattens
- Ventilation capacity decreased
What are the accessory muscles of inspiration?
- Sternocleidomastoid
- Scalene (anterior, middle and posterior)
- Serratus anterior
- Serratus posterior
- Pectoralis major
- Pectoralis minor
- Trapezius
- Latissimus dorsi
What are the accessory muscles of expiration?
- Abdominals
- Rectus abdominis
- External oblique
- Internal oblique
- Transversus abdominis
Why are accessory muscles of respiration special?
- Composed of fatigue resistant muscle fibres (Type 1)
- Controlled by both voluntary + involuntary mechanisms
What does the excessive use of accessory muscles mean for patient’s with emphysema?
- Tire easily
- Lots of energy use
Describe a barrel chest.
- Enlarged chest
- Rounded cross section
- Fixed horizontal position of ribs
How does emphysema affect the heart?
- Alveolar walls disintegrate
- Increases resistanceinpulmonary circulation
- Right ventriclehas to work
harder - Enlarged right ventricle
- Cor pulmonale
What is Cor pumonale?
a condition that causes the right side of the heart to enlarge and fail.
(also known as pulmonary heart disease)
What is Cor pulmonale caused by?
long term high pressure in the pulmonary arteries of the lungs and right ventricle of the heart.
What are some symptoms of Cor pulmonale?
- Shortness of breath (SOB)
- Syncope
- Tachycardia
- Chest pain
- Foot and ankle swelling
- Cyanosis
What does emphysema co-exit with?
Chronic bronchitis
What is bronchitis?
an inflammation of the lining of the bronchial tubes
What is chronic bronchitis?
a cough that occurs every day with sputum production that lasts for at least 3 months, 2 years in a row.
What is a major cause of chronic bronchitis?
- Cigarette smoking
- Bronchial irritants
(usually inhaled repeatedly by the affected person)
Describe chronic bronchitis.
- The lining of the bronchial tubes repeatedly becomes irritated and inflamed, which can damage the airways and cause a build up of sticky mucus, making it difficult for air to move through the lungs.
- This leads to breathing difficulties that gradually get worse.
- The inflammation can also damage the cilia
- When the cilia don’t work properly, the airways often become a breeding ground for bacterial and viral infections.
-Infections typically trigger the initial irritation and swelling that lead to acute bronchitis.
What are symptoms of COPD?
- Cough
- Dyspnoea-difficult or laboured breathing
- Excessive sputum production
- Chest tightness or wheeze
- Oedema
- Heart failure
- Recurrent chest infections
- Hyperinflated lungs
- Fatigue
- Chest pain/discomfort
What does long-term exposure to smoke do to cilia?
Cilia beat slower
What is Alpha 1 anti-trypsin deficiency?
- A rare, inherited condition, which can cause lung and liver problems
- Lack a protective enzyme inhibitor (alpha-1-antitrypsin)
- More vulnerable to the effects of inhaling smoke or other toxic materials like dust, fumes or chemicals.
More likely to develop chronic obstructive pulmonary disease (COPD).
Why would spirometry be performed?
- At diagnosis
- To reconsider the diagnosis, for people who show an exceptionally good response to treatment
- To monitor disease progression
What should be done to diagnose COPD?
- Spirometry
- Chest x-ray
- Full blood count to identify anaemia or polycthaemia
- BMI
- Sputum culture
- Home peak flow measurements (to exclude asthma if doubt remains)
- Electrocardiogram (ECG)
- Echocardiogram
- CT thorax
- Serum alpha-1 antitrypsin
What is the BODE index (prognosis)?
B MI
Airflow O bstruction
D yspnoea
E xercise capacity
Why does airflow obstruction occur?
due to a combination of damage to the airways and also to lung parenchyma (e.g. alveoli)
(damage is the result of chronic inflammation that differs to that seen in asthma)
What is dyspnoea?
Awareness of breathing & increased effort (gasping)
- Worse during exacerbations
- Presents insidiously on exertion, becomes progressive + persistent
Describe a wheeze?
- Audible wheeze may arise at laryngeal level
- Inspiratory and expiratory wheezes can be present
- Chest tightness often follows exertion
What does Cor Pulmoale cause?
alteration in the structure & function of the right ventricle
What is peripheral oedema caused by?
the expansion of interstitial tissue
What is exacerbation of COPD?
an acute worsening of respiratory symptoms that result in additional therapy
What is mild exacerbation of COPD?
treated with short acting bronchodilators (SABD) only
What is moderate exacerbation of COPD?
treated with SABDs plus antibiotics and/or oral corticosteroids
What is severe exacerbation of COPD?
Patient requires hospitalisation or visits to the emergency department.
- Severe exacerbations may also be associated with acute respiratory failure
What are some symptoms of exacerbated COPD?
- Dyspnoea
- Fatigue
- Cold symptoms
- Sputum colour changes
- Sputum volume changes
- Cough
What are some causes of exacerbation?
- Viral (especially rhinovirus)
- Bacterial infections
- Environmental pollution
What are the symptoms of non-infective exacerbation of COPD?
- Increased dyspnoea
- Upper airway symptoms (e.g.:, colds and sore throats)
- Increased wheeze and chest tightness
- Fatigue and reduced ex tolerance
- Marked respiratory distress with dyspnoea + tachypnoea
- Possibly acute confusion, increased cyanosis, peripheral oedema
- Respiratory failure
What are the symptoms of infective exacerbation of COPD?
- Increased cough
- Increased sputum purulence (change in colour and viscocity)
- Increased sputum volume
- Pyrexia (fever)
- Increased dyspnoea
- Upper airway symptoms (e.g.:, colds and sore throats)
- Increased wheeze and chest tightness
- Fatigue and reduced ex tolerance
- Marked respiratory distress with dyspnoea + tachypnoea
- Possibly acute confusion, increased cyanosis, peripheral oedema
- Respiratory failure
Describe the process of exacerbation.
- Exposure to trigger (viral, bacterial or environmental) causes worsening airway inflammation
- Increased inflammation = increased airway oedema and mucus hypersecretion
(Also have worsening: airway obstruction, dynamic hyperinflation, dyspnoea , cough) - Increased work of breathing (WOB)
What are the long-term effects of exacerbation?
- Structural lung damage (contributed by inflammatory cascade that occurs during acute exacerbation)
- Rapid decline in lung function
- Sustained reduction in health related quality of life (QOL)
- increased risk of future exacerbation
What conditions cause mucoid to be opalescent or white?
- Chronic bronchitis (without infection)
- Asthma
What conditions cause mucopurulent to be slightly discoloured, but not frank pus?
- Bronchiectasis
- Cystic fibrosis
- Pneumonia
What condition causes purulent to be thick, viscous and yellow/dark green - brown/rusty/redcurrant jelly coloured?
Haemophilus
What condition causes purulent to be thick, viscous and dark green/ brown coloured?
Pseumococcus
What conditions cause purulent to be thick, viscous and rusty coloured?
- Pseumococcus
- Mycoplasma
What condition causes purulent to be thick, viscous and redcurrant jelly coloured?
Klebsiella
What condition causes frothy pink or white sputum?
Pulmonary oedema
What conditions cause haemoptysis to be ranging from blood specks to frank blood, old blood (dark brown)?
- Infection (tuberculosis, bronchiectasis)
- Infarction
- Carcinoma
- Vasculitis
- Trauma
- Coagulation disorders
- Cardiac disease
What conditions cause sputum to be black specks in mucoid secretions?
- Smoke inhalation (fires, tobacco, heroin)
- Coal dust
What are obstructive disorders characterised by?
reduction in airflow
What are restrictive disorders characterised by?
a reduction in lung volume
What are some examples of obstructive disorders?
- COPD
- Asthma
- Bronchiectasis
What are some examples of restrictive disorders?
- Interstitial lung disease
- Scoliosis
- Neuromuscular cause
- Marked obesity
What happens to the different lung volumes in obstructive lung disorders?
Decreased:
- Vital Capacity
- Inspiratory Reserve Volume
- Expiratory Reserve Volume
Increased:
- Residual Volume
- Functional Residual Capacity
- Total Lung Capacity
What happens to the different lung volumes in restrictive lung disorders?
Decreased:
- Vital Capacity
- Residual Volume
- Functional Residual Volume
- Tidal Volume
- Total Lung Capacity
What are some respiratory tract infections?
- UTRI (e.g.: colds, laryngitis, sinusitis, tonsilitis)
- LTRI (e.g.: bronchitis, bronchiolitis, pneumonia)
- Covid 19
- Influenza
What is atelectasis?
an area of lung tissue collapse
What are the causes of atelectasis?
- Airway obstruction (foreign body, sputum etc)
- Loss of volume postoperatively (due to reduced surfactant)
- Compression (due to tumor/effusion)
- Conditions (like pneumonia)
What is Consolidation?
Increase in density in lung tissue as air in respiratory bronchioles and alveoli is replaced by exudate, sputum, pus, blood, etc.
What is pulmonary oedema?
Accumulation of fluid in the interstitial spaces between capillaries and alveoli
How much interstitial fluid does it take before alveolar membranes rupture and fluid enters the alveoli (even in mild pulmonary oedema)?
100ml
What are the signs & symptoms (S&S) of pulmonary oedema?
- Significant hypoxemia
- Tachypnea
- Respiratory distress
- Diffuse crackles/wheeze
- Pink frothy sputum
How is treatment done for pulmonary oedema?
Treatment depends on cause but includes:
- Reversal/treatment of cause
- Oxygenation
- CPAP
- Diuretics
- Vasodilators
- Nitrates
What are the causes of pulmonary oedema?
- Increased pulmonary capillary hydrostatic pressure (e.g. LVF, hypervolemia (e.g. excess IV fluid))
- Increased capillary permeability (e.g. pneumonia, oxygen toxicity, sepsis)
- Decreased plasma oncotic pressure e.g hemodilution (e.g. excess IV fluid), some renal diseases
- Lymphatic insufficiency (e.g. pulmonary fibrosis, compression by tumours)
What is pneumothorax?
Accumulation of air in the pleural space
Why does pneumothorax occur?
- Traumatic (e.g. penetrating chest wall injury)
- Spontaneous
- Due to underlying lung disease
How is pneumothorax managed?
Conservatively or with a chest drain/pleurodesis/pleurectomy (depending on size + patient presentation)
How can tension pneumothorax occur?
when air enters the pleural space but can’t exit
What does tension pneumothorax cause?
- Mediastinal shift
- Significant pulmonary & cardiovascular compromise
What is pleural effusion?
Accumulation of fluid in the pleural space.
(Altered balance between pleural fluid production and reabsorption)
What are some examples of causes of pleural effusion?
- Pneumonia
- Heart failure
- Malignancy
What are some symptoms of pleural effusion?
- Breathlessness
- Chest pain
What are some managements for pleural effusion?
- Reversing cause
- Thoracentesis
What is empyema?
pus in the pleural space
What are the (3) types of pleural effusion?
- Haemothorax (blood)
- Pyothorax (pus)
- Pneumothorax (air)
What is a pulmonary embolism & what does it cause?
a thrombus from a deep vein in the body (usually legs) travels and causes occlusion in pulmonary vasculature
What are some symptoms of pulmonary embolism?
- Dyspnoea
- Chest pain
- Hypoxia
How can pulmonary embolisms be managed?
- Anticoagulants
- Thrombolysis
- IVC filter insertion
- Thrombectomy
What % of DVTs embolise into pulmonary vasculature?
51%
