Pulmonary Pathophys Flashcards
Which side of the lungs is a FB more likely to get stuck in?
Right
Where are Goblet cells and submucosal glands located in the respiratory tree?
Walls of trachea and bronchi. Not bronchioles.
What do neuroendocrine cells secrete in the respiratory tree?
Serotonin, Calcitonin
What are type 1 alveolar pneumocytes?
cover 95% of alveolar surface
What are type 2 alveolar pneumocytes?
they are rounded cells that secrete surfactin and cover 5% of alveolar surface. They give rise to type 1 cells.
What are Pores of Kohn?
connect alveoli to alveoli
Does hypoplasia lung defect usually affect 1 or both lungs?
both
What is agenesis?
congenital defect where 1 or 2 lobes are missing.
What is tracheal atresia?
condition of abnormally closed or absent trachea.
At which point is a tracheal/ bronchial stenosis a clinical manifestation?
When it is less than 50% of its size
What can happen with esophageal atresia and distal fistula?
Food/drink intake will induce vomiting
What can happen with no esoophageal atresia but “H” fistula”?
Fluid can pass from esophagus into trachea.
What is eupnic respirations
“normal” breathing. 8-16bpm, 400-800 tidal volume.
What are Kussmaul Respiration?
inc vent rate and tidal volume
Characteristics of restricted breathing?
small TV, rapid rate, rapid expiration
What are Cheyne Stokes Respiration?
Alternating periods of deep and shallow breathing.
Brainstem breathing pattern.
What could cause Kussmaul Respirations?
metabolic problem. DKA
What can hyperventilation cause?
hypocapnia= 1)tingling in fingers/lips 2)dec resp drive= fainting
What causes cyanosis?
saturated hemoglobin of 5gm or more
What are signs of central cyanosis?
blue buccal mucosa and lips
What are signs of peripheral cyanosis?
blue nail beds
What is clubbing associated with?
chronic hypoxia= inc vascular growth
What is important to consider about location of irritant receptors in the airway?
few receptors in distal bronchi and alveoli so it is possible for secretions to accumulate distally w/o cough.
what is the effectiveness of cough dependent on?
Inspiratory volume
what is chronic cough defined as?
persistent cough for > 3 weeks
What is typical with hemoptysis?
blood from airway
bright red
alkaline
mixed with frothy sputum
What is typical with hematemesis?
blood from GI tract
Dark
Acidic
Food particles may be present
What is type 1 resp failure?
hypoxia w/o hypercapnia
Pa02 less than or equal 50mmHg
What is type 2 resp failure?
hypoxia with hypercapnia
Pa02 less than or equal 50mmHg and PaC02 greater than or equal 50 with pH less than or equal 7.25
What is neonatal atelectasis?
incomplete expansion of the lungs
What is Acquired atelectasis?
collapse of previously inflated lung
Where does the mediastinum shift in Resorption atelectasis?
toward the affected side due to dec pressure
Where does the mediastinum shift in compression atelectasis?
away from the affected side.
What is bronchiectasis?
permanent dilation of bronchi and cronchioles
What causes bronchiectasis?
Caused by destruction of muscle & elastic tissue, resulting from or associated with chronic necrotizing infections.
What conditions can be associated with Bronchiectasis?
Congenital conditions: CF
Post-infectious conditions: TB, bact, virus
Bronchial obstruction: tumors, FB, mucus
Other conditions: RA, systemic Lupus, IBD
What is characteristic of lungs with Bronchiectasis?
Infection: Inflammation Necrosis Fibrosis Dilation of airways
What is Bronchiolitis?
Inflammatory obstruction of the small airways or bronchioles
What is Bronchiolitis obliterans?
fibrotic process occluding airways and causes permanent scarring of the lungs
Common after lung transplantation.
What are characteristics of Bronchiolitis?
Most commonly in children: Due to RSV
In adults: accompanies chronic bronchitis
Usually diffuse
What causes pulm edema with inc hydrostatic pressure and normal oncotic pressure?
Left Heart failure, Mitral stenosis
What causes Pulm edema with normal hydrostatic pressure and dec oncotic pressure?
nephrotic syndrome, liver Dz
What causes pulm edema with normal hydrostatic pressure and normal oncotic pressure?
Microvascular Injury…
- Infections
- Aspiration
- Drugs
- Radiation
What drug can cause pulm edema due to microvascular inj?
penicillin (after 10 days)
Which part of the lungs is most affected by pulm edema?
lower lobes
What are “heart failure cells?”
hemosiderin laden macrophages from pulm edema
What occurs in the lungs with pulm edema?
Hemosiderin laden macrophages abundant
Fibrosis
Thickening of alveolar walls results in lungs becoming firm and brown “brown induration”
What is the 2012 criteria for ARDS?
Respiratory symptoms must have started within one week of a known clinical insult
Bilateral opacities on chest radiograph or CT scan
Respiratory failure must not be fully explained by cardiac failure or fluid overload (consider echocardiograph to rule out)
Hypoxemia must be present on minimal ventilator settings
What is mild ARDS?
PaO2/FiO2 >200mmHg but ≤300mmHg
What is moderate ARDS?
PaO2/FiO2 >100mmHg but ≤ 200mmHg
What is severe ARDS?
PaO2/FiO2≤100mmHg
What are the majority of ARDS cases caused by?
Sepsis
Diffuse pulmonary infections
Gastric Aspiration
Mechanical Trauma
What type of bacteria usually cause ARDS form sepsis?
gram negative which activates the complement system
What is the pathogenesis of ARDS?
Imbalance between pro-inflammatory mediators and inflammatory mediators leading to accumulation of neutrophils releasing oxidants, PAF, LKs which damage albeolar epithelium.
What does IL-8 do?
chemotaxic factor for neutrophils
What does IL-1 and TNF do?
activation of endothelial cells and neutrophils
Which transcription factor shifts the balance to a pro-inflammatory state?
Kappa Beta
What is involved after macrophage activation?
cytokine production, IL-1 & TNF effect on endothelial cells
What is involved after Neutrophil activation?
free radicals, PAF, LKTs, proteases
What are the 3 main phases of ARDS?
1) Exudative: diffuse alveolar damage
2) Fibroproliferative: fibrosis and laying down of hyaline cartilage
3) Recover/chronic
Which cells are affected first in exudative phase of ARDS?
Type 1 alveolar pneumocytes
What are the consequences of damage to alveolar pneumocytes?
Swelling
Bleb formation
Necrosis
What cells other than pneumocytes are damaged in the exudative phase of ARDS and what is the implication of this?
Capillary endothelial cells are damaged causing microthrombi. This is indicated by presence of vWF.
What is the implication of diffuse alveolar damage during exudative phase of ARDS?
inc vascular permeablility
What is the implication of basement membrane thickening during exudative phase of ARDS?
dec diffusion of O2= vent-perfusion mismatch
What occurs in the fibroproliferative phase of ARDS?
Persistent hypoxemia: Development of hypercarbia Fibrosing alveolitis Further decrease in pulmonary compliance Pulmonary hypertension Surfactant dysfunction
1st tests to order for ARDS?
CXR ABG CVP CBC Sputum/blood Culture UA Lipase
What tests would you order to rule out cardiogenic pulmonary edema in a ARDS workup?
BNP: BNP < 100 pg/mL bilateral infiltrates & hypoxemia suggests ARDS/ALI
Echocardiogram normal in ARDS
Pulmonary artery catheterizatioin
What is Lung Injury Prediction Score(LIPS)?
Identifies who is unlikely to develop ALI/ARDS based on a point system grading the predisposing conditions
Alerts clinicians to implement prevention strategies for those at risk
Under further investigation and current studies are being done to improve the prediction scoring system
