Pulmonary Pathophysiology (Exam 3) Flashcards by s y

What characterizes asthema?

Airway inflammation
airway hyper-responsiveness
Increased secretions

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How does asthma manifest?

cough, dyspnea, wheezing and inability to expel air

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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

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What is atelectasis?

Incomplete expansion or collapse of all or part of lung

The alveoli never fully expand

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What is atelectasis caused by?

Diseases with decreased chest wall compliance
respiratory muscle weakness
los of surfactant
bedrest
secretions
tumor

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What is COPD?

Chronic Obstructive Pulmonary Disease, a disease of the respiratory tract that obstructs air flow

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What happens to the lungs and diaphragm during COPD

Hyperinflation of the lungs and flattening out of the diaphragm

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What are the two types of COPD?

Chronic bronchitis or emphysema?

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What happens during chronic bronchitis?

inflammation of bronchial lining causing hypersecretion of mucus causing productive cough most days for 3 months x 2 years

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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

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What gender is chronic bronchitis more common in?

Men

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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

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What are some causes of chronic bronchitis?

Chronic iritation-SMOKING!!!
pollutants
2nd hand smoke
occupational exposure to dusts
exposure to vegetable dusts

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What is emphysema?

an abnormal/permanent enlargement of air spaces distal to terminal non-respiratory bronchioles with concomitant destruction of alveolar walls

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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

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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

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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

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What type of people mostly get CF?

Caucasians of European descent

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Which ribs are most commonly fractured?

Ribs 5-9 (not as protected as ribs 1-4

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What can a rib fracture be associated with?

hemothorax–>effusion–>empyema

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What is a flail rib?

A free floating segment of ribs due to an anterior and posterior rib fracture.

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What is the breathing pattern of those with a flail chest?

A paradoxical breathing pattern, inward during inspiration and outward during expiration

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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… 1. Thermal injury to upper airways 2. Chemical injury to tracheobronchial tree 3. 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