Respiratory 1 Flashcards
Atelectasis is collapse of lung due to
compression of the lung when fluid or air accumulates in the pleural cavity
pulmonary hypertension results in
increased work and right heart failure (cor pulmonale)
pulmonary emboli may arise where…and pass where….
may arise in deep leg veins and pass in the venous circulation to heart/pulmonary arteries
What occurs in clinical settings marked by venous stasis?
pulmonary emboli
Liver cirrhosis with portal hypertension will result in …
pulmonary thromboemboli
pulmonary emboli are rarely due to non-thrombotic material
1 cancer-embolization of clumps of tumor cells
2 fractures-fat, bone marrow emboli
3 childbirth-amniotic fluid embolism
4 foreign material-bullet materials
What is pneumonia’s pathological method of spread?
1 Air space spread (usually bacterial)
OR
2 interstitial spread (usually viral)
pneumonia clinical classification
1 community-acquired 2 hospital acquired (nosocomial) 3 acquired in special environments 4 immunosupressed patients 5 aspiration pneumonia
bronchopneumonia
acute bacterial pneumonia centered on bronchi that spreads to adjacent alveoli
If broncopneumonia is healed, what happens?
fibrosis
lobar pneumonia
microorganisms colonize distal alveolar air spaces rather than bronchi
What does the lobe of Lobar pneumonia look like?
lobe is consolidated and airless
histopathology of lobar pneumonia
alveoli filled with acute inflammatory exudate which is limited by pulmonary fissures
Can you recover from lobar pneumonia?
**many recover with return to normal structure and function
What gram positive bacteria is 33% of community acquired pneumonia?
Streptococcus pneumoniae
How do we diagnose hospital acquired pneumonia?
bronchial lavage with contaminated expectorated sputum of the oropharynx
when does hospital-acquired pneumonia occur?
- 2 days + after hospitalization
- incidence is 5% of those admitted
What is the most lethal form of viral pneumonia?
influenza, viral interstitial pneumonitis
Fungal Pneumonia
typically in immunosuppressed
Opportunistic infections in the immunosupressed with pneumonia
**candida, asperigillus, pneumocystis jirovecii (alveoli filled with fine, foam like material; fungus)
How does lobar pneumonia spread?
spreads through alveoli to involve whole lobes
most hospital acquired cases of pneumonia is due to what kind of organisms?
gram negative organisms
Bronchiectasis
Permanent abnormal dilation of bronchial tree due to chronic infection with inflammation and necrosis of bronchial wall
Asthma extrinsic type (immune, atopic)
1 mediated by type I hypersensitivity response involving IgE bound to mast cells
2 begins in childhood, usually in families with history of allergy
Emphysema
clinically increased anteriorposterior diameter of the chest (barrel-chest) increased total vital capacity
What has an imbalance between proteases and protease inhibitors?
Emphysema
1 smoking- increases release of proteases (ex elastase) from neutrophils and macrophages; inactivates alpha-antitrypsin
2 congenital-lack of protease inhibitors
Chronic bronchitis
airway obstruction due to luminal narrowing and mucous plugging
What two diseases cause airway narrowing?
chronic bronchitis and asthma
chronic obstructive airway diseases summary part 2
1 emphysema caused by unregulated extracellular protease (secreted from inflammatory cells) activity
-two patterns of generalized emphysema: centrilobular and panacinar
2 in chronic bronchitis, airways show mucus hypersecretion with gland hyperplasia
-may patients with chronic bronchitis have an asthmatic component, as well as emphysema
3 pulmonary hypertension and right sided heart failure are common in long standing obstructive pulmonary disease (COPD)
portal hypertension
increase in the blood pressure within the portal venous system
bronchoalveolar lavage
bronchoscope is passed through the mouth or nose into the lungs and fluid is squirted into a small part of the lung and then collected for examination
pulmonary embolism
obstruction of a blood vessel in the lungs, usually due to a blood clot, which blocks a coronary artery.
polycythemia
disease state in which the proportion of blood volume that is occupied by red blood cells increases
forms of influenza
rhinitis, pharyngitis, tracheobronchitis, interstitial pneumonitis
**Most lethal form of viral pneumonia
Influenza, viral Interstitial pneumonitis
What is hypoxemia?
abnormally low level of oxygen in the blood
hypercapnia
elevated carbon dioxide (CO2) levels in the blood
pulmonary hypertension
increased pulmonary arterial pressure leads to structural changes
venous stasis and pulmonary emboli
primary venous disease, congestive heart failure, prolonged bed rest or immobilization, prolonged sitting while traveling
What causes pulmonary edema?
left ventricular failure
What does pulmonary hypertension cause?
right-sided heart failure
Pulmonary thromboembolism is most commonly from
deep leg vein thrombosis
What may large pulmonary emboli cause?
acute right heart failure and death
What is known as airspace pneumonia?
lobar pneumonia
In what condition is the affected lung firm, airless, dark red or gray?
Bronchopneumonia
In what condition may the pus be in peripheral bronchi?
Bronchopneumonia
What are variable causative organisms of bronchopneumonia?
staph. aureus, Haemophilus, Klebsiella, strep. pyogenes
What occurs when microorganisms widely colonize distal alveolar air spaces rather than bronchi ?
lobar pneumonia
What pneumonia usually occurs in alcoholics and adults?
lobar pneumonia
Lobar Pneumonia
rapid spread through alveolar spaces and bronchioles causes acute inflammatory exudate into air spaces especially with Strep. pneumoniae (pneumococcus) or Klebsiella
What develops from the spread of a tracheobronchial infection?
Bronchopneumonia
What does atypical pneumonia cause?
predominantly interstitial inflammation
different organisms cause community acquired types of pneumonia
most common is due to strep. pneumoniae
What exposure of pneumonia is associated with Legionnaire disease and fungal pneumonias?
specific environmental exposure
Aspiration pneumonia results in both
chemical and mixed infective damage to lungs
What has opportunistic mycobacteria, viruses, fungi, and protozoa in the immunosupressed?
Pneumonia
What causes loss of recoil in the lungs?
emphysema
What is characterized by a chronic inflammatory response in airways, leading to reversible airways obstruction?
asthma
What do muscle spasms, mucous plugging and mucosal edema cause?
airway obstruction
What is is permanent dilation of the respiratory acinus, with destruction of tissue in the absence of scarring?
Generalized edema
3 consequences of hypoxemia
pulmonary hypertension, polycythemia, hypercapnia
What are the common organisms in lobar pneumonia?
strep pneumoniae and klebsiella