Pulmonary Pathology: Restrictive Lung Disease Flashcards
cardiovascular causes of restrictive lung dysfunction
- pulmonary edema
- pulmonary emboli
Neuromuscular Causes of restrictive lung dysfunction
- SCI
- ALS
- Polio
- Guillain-Barre Syndrome
- Myasthenia Gravis
- Tetanus
- Duchenne’s Muscular Dystrophy
Connective Tissue Causes of restrictive lung dysfunction
- RA
- SLE
- Polio
Nutritional and Metabolic Causes of restrictive lung dysfunction
- Obesity
- DM
Traumatic Causes of restrictive lung dysfunction
- crush injuries
- penetrating wounds
- thermal trauma
Immunologic Causes of restrictive lung dysfunction
- Goodpasture’s syndrome
- Wegener’s Granulomatosis
Therapeutic Causes of restrictive lung dysfunction
- surgical therapy
- lung transplant
- drug therapy
- radiation therapy
Hospital-Acquired Pneumonia
- infection of lower respiratory tract beginning 72 hours + after hospitalization
- most common cause: pseudomonas aeruginosa
- Risk factors: tubes in throat, dysphagia, lung injury, diabetes, chronic cardiopulm disease, infection, smoker
Thoracic Cage Changes Due to:
- kyphoscoliosis
- ankylosing spondylitis
Common restrictive primary problems
- decreased compliance
- decreased lung volume & capacity
- increased WOB
Cor Pulmonale
R ventricular hypertrophy
Limited diaphragm displacement due to:
- obesity
- ascites
Alveolar compression caused by
-pleural effusion
Decreased compliance due to:
- stiffening of lung parenchyma
- alveolar compression
- thoracic changes
- limited diaphragm displacement
Restrictive
-trouble getting air in
Lung parenchyma stiffening from:
- interstitial fibrosis
- sarcoidosis
- scleroderma
Common restrictive symptoms
- dyspnea
- dry, nonproductive cough
- wasted, emaciated appearance
Common Restrictive Signs
- tachypnea
- vent-perf mismatching
- decr breath sounds
- decr lung volume and capacity
- cor pulmonale
Common restrictive diseases
- RDS
- BOOP
- Pneumonia
- ARDS
- Idiopathic Pulmonary Fibrosis
ARDS
Pathophysiology
-exact mechanism unknown
-damage to capillary & alveolar endothelial cells–>
-incr permeability–>
-fluid & protein leave capillaries to interstitial fluid & alveoli–>
-decr lung vol & capacity & compliance–>
-Incr PVR–>
-R to L shunt–>
decr vent-perf matching–>
-alveolar fibrosis and los of capillaries
ARDS
Etiology
- trauma
- shock
- blood transfusion
- pneumonia
- metabolic
- drugs
- inhaled toxins
- aspiration
ARDS
Prognosis
80% survival rate
ARDS
Treatment
- treat cause
- maintain gas exchange (vent)
- supportive (nutrition, electrolytes, fluid)
- Prevent complications
- positioning
- prone
BOOP
Bronchiolitis obliterans w/ organizing pneumonia
aka. bronchiolitis fibrosa obliterans, follicular bronchiolitis, bronchiolitis w/ diffuse interstitial pneumonia
BOOP
Pathophysiology
- necrosis of epithelium in affected bronchioles–>
- accum fluid/debri–>
- pulm edema with obstruction of small airways–>
- atelectasis from collapsed airways–>
- inflamation–>
- fibrosis of bronchial tree and alveoli
BOOP
Etiology
- result of having something else
- fibrotic lung disease of smaller airways
- can cause restrictive or obstructive lung diseases
- children: viral infection
- adults: viral, bacterial, mycobacterial infections, toxic fumes, connective tissue diseases (RA), graft vs host reactions
BOOP
Treatment
- Kids: supportive (O2, hydration, postural drainage, suctioning)
- Adults: supportive (O2, hydration, corticosteroids
IPF
Idiopathic Pulmonary Fibrosis
Idiopathic Pulmonary Fibrosis
Pathophysiology
- localized inflammatory changes (alveolitis) progressing to scarring and fibrosis
- alveoli irregular in size/shape
- capillaries destroyed
Idiopathic Pulmonary Fibrosis
Etiology
- unknown
- immunnologically mediated response to acute injury or infection
Idiopathic Pulmonary Fibrosis
Treatment
- corticosteroids
- cytotoxic meds
- supportive (O2, vent)
- lung transplant
Types of Pneumonia
- community-acquired
- hospital acquired (nosocomial)
Community Acquired Pneumonia
- most can be tracked to cause (bacterial mostly)
- streptococcus pneumoniae (pneumococcus) most common
Pneumonia
Pathophysiology
- agent enters through inhalation/aspiration
- bacterial/viral
Pneumonia
Etiology
- 5th leading cause of death in US
- inflm of lung parenchyma from exposure to microbes
-(bacteria, mycoplasms, viruses, protozoa, psittacosis agents)
Bacterial Pneumonia
–1st response to infection is edema then polymorphonuclear leukocytes (phagocytosis) and deposits of fibrin
Bacterial Pneumonia
Treatment
- antibiotics
- supplemental O2 as needed
- pulm hygiene
- hydration
- nutrition
Viral Pneumonia
- 1st localizes in epithelial cells and destroys cilia and mucosal surfaces
- may proceed to alveoli–>edema, hemorrhage, hyaline membrane formation or ARDS
Viral Pneumonia
Treatment
- supportive
- few antivirals available
RDS
Pathophysiology
- absence/inadequate surfactant
- abnormal alveolar and epithelial & endothelial permeability
- pulmonary HTN
RDS
Etiology
(hyaline membrane disease)
- gestation <36 weeks (no surfactant)
- more in males
- delivered by c-section
- mother has diabetes (insulin delays surfactant production)
- born with PDA
RDS
Prognosis
- progressively worse for 2-4 days then improves
- potential for BPD
RDS
Treatment
- mechanical vent (–>BPD)
- supplemental O2
- CPAP
- Surfactant replacement
- medications (sedation, pain relief)
