Pulmonary Pathophysiology (Exam 3) Flashcards
What characterizes asthema?
Airway inflammation
airway hyper-responsiveness
Increased secretions
How does asthma manifest?
cough, dyspnea, wheezing and inability to expel air
What are some different aggravating factors for asthma?
Exercise (exercise > 90% HRmax, 6-8 mins after starting activity)
Viral respiratory tract infections
Occupations: cotton, bakers, metal salts, wood and vegetable dusts, pharmaceutic agents, industrial chemicals, plastics, biologic enzymes, animal/bird/fish/insect proteins
Weather changes: cold or dampness
High levels of air pollution
Pharmacologic agents: aspirin, drug additives (tartrazine yellow dye #5) and food preservatives (sulfites)
Emotional or psychological factors
What is atelectasis?
Incomplete expansion or collapse of all or part of lung
The alveoli never fully expand
What is atelectasis caused by?
Diseases with decreased chest wall compliance respiratory muscle weakness los of surfactant bedrest secretions tumor
What is COPD?
Chronic Obstructive Pulmonary Disease, a disease of the respiratory tract that obstructs air flow
What happens to the lungs and diaphragm during COPD
Hyperinflation of the lungs and flattening out of the diaphragm
What are the two types of COPD?
Chronic bronchitis or emphysema?
What happens during chronic bronchitis?
inflammation of bronchial lining causing hypersecretion of mucus causing productive cough most days for 3 months x 2 years
What size airways does chronic bronchitis start in?
Starts in large airways w/o obstruction and progresses to smaller. With more small airway involvement-more disability
What gender is chronic bronchitis more common in?
Men
What are the cellular changes with chronic bronchitis?
bronchial lumen and ciliated cells decrease
smooth muscles in bronchial wall, mucus production, and goblet cells increase
atrophy of the cartilage in the bronchial wall
What are some causes of chronic bronchitis?
Chronic iritation-SMOKING!!! pollutants 2nd hand smoke occupational exposure to dusts exposure to vegetable dusts
What is emphysema?
an abnormal/permanent enlargement of air spaces distal to terminal non-respiratory bronchioles with concomitant destruction of alveolar walls
How is emphysema manifested?
Loss of elastic recoil
excessive collapse of airways on exhalation
chronic airflow obstruction
pathological accumulation of air in tissues
pulmonary hypertension develops from capillary loss and vessel intimal thickening
What are some clinical features of emphysema?
SOB
Scant sputum
decreased subcostal angle (horizontal ribs)
Shortening of pecs
pink puffer (thin, rosy skin tones)
Increased retrosternal air, flattened diaphragm
What is cystic fibrosis?
defect in the CFTR gene causing decreased water secretion making mucus thick and sticky.
Collects in small distal airways then moves proximal causing areas of chronic bronchitis and bronchiectasis
What type of people mostly get CF?
Caucasians of European descent
Which ribs are most commonly fractured?
Ribs 5-9 (not as protected as ribs 1-4
What can a rib fracture be associated with?
hemothorax–>effusion–>empyema
What is a flail rib?
A free floating segment of ribs due to an anterior and posterior rib fracture.
What is the breathing pattern of those with a flail chest?
A paradoxical breathing pattern, inward during inspiration and outward during expiration
What other pathology is a flail chest associated with?
Lung contusion
What is kyphoscoliosis?
anteroposterior and lateral curve of thoracic spine
What is the ratio of females:males with kyphoscoliosis?
4:! females to males
What is a pleural effusion?
Fluid that abnormally accumulates in the pleural space.
How much fluid is normally in the pleural space? How much liquid can be drained out?
5cc’s. ~1 litres can be removed with pleural effusion
What are some clinical signs of a pleural effusion?
Pain
short inspiratory phase of breathing
Decreased breath sounds
Pleural friction rub present on auscultation
What is aspiration? What can it lead to?
Inflammation of lungs and bronchial tubes due to inhalation of foreign material
can lead to inflammatory reaction, pneumonia or lung abscess
In which lung are aspirations more common in?
Right upper lung due to R mainstem anatomy
What is the pathophysiology of bacterial pneumonia?
Bacteria enters lower respiratory tract
edema fluid + leukocytes phagocytoze bacteria
Fibrin deposited in inflamed areas
antibodies fight infection ~ day 5
What is the onset of bacterial pneumonia?
Abrupt onset
What are some symptoms of bacterial pneumonia?
lobar consolidation high fever chills dyspnea tachypnea productive cough pleuritic pain leukoctyosis
What is the etiology of viral Pneumonia?
Virus localizes in respiratory epithelial cells–>destruction of cilia and mucosal surface–>loss of mucociliary function
What happens if the viral pneumonia reaches the alveoli?
you may have edema, hemorrhage, hyaline membrane formation and development of ARDS (acute respiratory distress syndrome)
What is the onset of viral pneumonia?
insidious onset
What are the symptoms of viral pneumonia?
patchy, diffuse bronchopulmonary infiltrates, moderate fever, dyspnea, tachypnea, nonproductive cough, myalgia,
NORMAL WBC count
What is pulmonary edema?
increase in the amy of fluid in the lung
What is affected first with pulmonary edema? then?
interstitial affected first, THEN alveolar spaces
What are the two causes of pulmonary edema?
Increase in pulmonary capillary hydrostatic pressure due to left ventricle failure
Increase alveolar capillary membrane permeability (loss of integrity of plum. capillary endothelial cells)
What are some causes of pulmonary edema?
toxic levels of O2, sulfur dioxide aspirated water viruses medications shock or trauma
Pulmonary edema may also lead to ?
Pleural effusions
What is the protein concentration of pulmonary edema?
Has an increased protein content
What is a pulmonary embolism?
When a clot breaks off and travels to the RA–>RV–> pulmonary arteries
Where are the venous thrombi from (in the body)?
95% fron LE
5% from thorax
look at pathophysiology of a pulmonary embolism
read it
What is interstitial pulmonary fibrosis?
Inflammatory process involving all parts of the alveolar wall allowing fibrin to enter alveolar spaces and causing scarring
How do you get interstitial pulmonary fibrosis?
present with occupational dust diseases, post radiation changes
What is life expectancy with interstitial pulmonary fibrosis?
< 6years from diagnosis
What happens with breathing and interstitial pulmonary fibrosis?
The overall work of breathing increases.
What are the three issues with smoking
besides not looking any cooler…
- Thermal injury to upper airways
- Chemical injury to tracheobronchial tree
- systemic poisoning due to carbon monoxide or cyanide
What happens to your cough with a spinal cord injury? LEading to what?
ineffective cough–>increased pulmonary infections
What happens to your inspiratory muscles with a spinal cord injury? Leads to what?
weakness of inspiratory muscles–> increased atelectasis
What happens to the sigh reflex with a spinal cord injury? Leads to what?
Loss of sigh reflex. Leads to increased atelectasis and alveolar collapse
What happens to the breathing pattern with a SC injury?
paradoxical breathing
What happens to pulmonary and chest wall compliance w/ SC injury?
pulmonary and chest wall compliance decrease over time
