Respiratory 2 (Use this LATEST edition!) Flashcards
what causes right heart failure?
pulmonary hypertension
left heart failure causes
pulmonary edema
restrictive pulmonary disease
restrics lung expansion, decreases lung volume, increases work of breathing, inadequate ventilation/oxygen
restrictive pulmonary disease results in
hypoxia + diffusional defect when there’s edema + fibrosis of alveolar walls
restrictive pulmonary disease has 3 phases to damage alveolar walls
hyaline membrane in alveolar sacs
edema + inflammation of interstitium
fibrosis
Acute respiratory distress syndrome (ARDS)
produced by diffuse alveolar damage (DAD) leading to systemic metabolic derangements
ARDS increases alveolar capillary permeability causing
leakage of fibrin rich edema fluid into alveoli
Phase 1 of ARDS : Acute exude
forms hyaline membranes in alveolar spaces; exudation of fibrin rich edema fluid mixed with cytoplasmic + lipid remnants of necrotic epithelial cells
Phase 2 of ARDS: Late organization
cell proliferation and fibrosis; congested, impaired ventilation; regeneration of type II alveolar lining cells and organization of hyaline membrane with pulmonary fibrosis
When does interstitial fibrosis with thickening of alveolar walls or fibrous obliteration of alveolar spaces occur?
phase 2 of ARDS
ARDS treatment
mortality reduced to 40%
AdULT respiratory distress syndrome interstitial fibrosis leads to
honeycomb lung
2 causes of chronic interstitial lung disease (inhaled)
- extrinsic allergic alveolitis (immune rxn to inhaled organic dusts),
- pneumoconiosis- inhaling industrial (mineral) dusts
intrinsic diseases that cause chronic interstitial lung disease
- idiopathic interstitial pneumonitis (inflammation of alveoli)
- non-organ specific autoimmune CT diseases
- sarcoidosis
immune reaction in lung to inhaled antigens causes extrinsic allergic alveolitis (hypersensitivity pneuonitis)
- proteins in bird droppings
- contaminated vegetable derived material
- actinomyces + fungi in rotting crops
Farmer’s lung- moldy hay
Bird Fancier’s lung- Pigeon feces
Bagassosis- moldy sugarcane
4 types of pneumoconiosis
- antracosis
- coal worker’s pneumoconiosis
- silicosis
- asbestosis
what causes coal worker’s pneumoconiosis?
inhalation of coal dust with carbon and silica
progressive massive fibrosis (restrictive pulmonary disease) in Coal Worker’s is usually surrounded by
emphysema
Silicosis
silica particles within nodules under polarized light; silica in macrophages cause TB
Asbestosis long latent period often seen of up to
50 years b/w exposure and onset of clinical disease
asbestosis
a lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma (cancer of the pleura)
Ferruginous bodies
asbestosis bodies within macrophages; long thin fibers coated w/ hemosiderin and protein to form yellow brown filaments w/ a beaded or drumstick pattern
sarcoidosis
granulomatous lung disease, non-caseating histiocytic granulomas in lung interstitum
histiocytic and giant cell inflammation in
sarcoidosis
other granulomatous lung diseases
(TGIF) TB Granulomatous Vasculitis Inhaled Foreign bodies (e.g. pneumoconiosis) Fungal infections (e.g. histoplasmosis)
sarcoidosis prognosis
70% recover via steroid tx
What affects interstitium of lungs, causing fibrosis
restrictive pulmonary disease
restrictive pulmonary disease
diffuse alveolar damage (DAD) is initial response
ARDS is an acute form of
diffuse alveolar damage caused by sepsis and shock
progressive pulmonary interstitial fibrosis leads to
honey comb lung
idiopathic interstitial pneumonitis leads to
idiopathic progressive fibrosis of lung interstitium
Farmers Lung is an example of
an extrinsic allergic alveolitis due to hypersensitivity to inhaled allergens
pneumoconiosis exhibits fibrosis caused by
reactions to inhaled mineral dusts
coalworker’s pneuoconiosis has what two forms
simple and progressive massive fibrosis
asbestos predisposes
interstitial fibrosis, lung cancer, and mesothelioma
sarcoidosis + autoimmune CT diseases cause
interstitial fibrosis
lung cancer histopathological types
- adenocarcinoma 38%
- squamous cell carcinoma 20%
- small cell anaplastic carcinoma 14%
- large cell anaplastic carcinoma 3%
- mixed 25%
most common form of lung cancer in females
adenocarcinoma
lung cancer spreads in 4 ways
local, lymphatic, transcoelomic, hematogenous
main sites of hematogenous spread
brain, bone, liver, adrenal glands
bone sites of hematogenous spread
rib, vertebrae, humeri + femora with pain or pathological fracture
squamous cell carcinoma
usually in males; central and close to carina w/ features related to bronchial obstruction
4 histopathological patterns of adenocarcinoma
(MAPS) mucinous acinar papillary solid
most malignant lung cancer
small cell anaplastic carcinoma of the lung
small cell anaplastic carcinoma of the lung
bronchial epithelium but differentiates into neuroendocrine cells
Ectopic hormone like ACTH (from small cell anaplastic carcinoma of the lung) leads to
paraneoplastic syndrome
lung cancer symptom
cough (80%) ; infection distal to airway is blocked
lung cancer metastasis
frequent sign present in 70%;
hematogenous spread of lung cancer
(LPCH) leukoerythroblastic anemia pathological fracture CNS symptoms Hepatomegaly and jaundice
Pancoast tumor
superior sulcus tumor at apex of lung; w/ invasion of sympathetic chain
What leads to Horner syndrome
pancoast tumor
Horner Syndrome
ptosis, enopthalmos, small pupils (miosis), lack of sweat (anhydrosis)
lung cancer
very sensitive to radiotherapy and chemotherapy but survival is poor
complete local response in 30%
median survival= 11 mos.
one year survival= 45%
coin lesions
rounded, solitary radiopaque lesion on chest radiograph; 1/3 of cases (>50 yrs) caused by lung carcinoma
common causes of coin lesions
primary bronchiole or lung carcinoma
metastatic tumor
granulomatous inflammation like TB
lung abscess
uncommon causes of coin lesions
fungal mycetoma
lung cancer survival
5 yrs; 5-30% depending on type and stage; median approximately 15%
Pleural Fluid Types
Cool PB FEAT!
Chylothorax (lymphatic fluid) - leak from lymphatic duct
Pus-empyema due to infection
Blood- hemothorax; due to trauma or surgery
Fluid effusion
Exudate-high protein
Air- pneumothorax
Transudate-low protein fluid due to movement of excess fluid through normal vessels
Malignant Mesothelioma latent period of
25 to 45 years
pediatric lung disease
- due to deficiency of surfactant in lungs
- hyaline membrane disease caused by a deficiency of surfactant as a result of immaturity + damaged type II pneumocytes
50% mortality if
Cystic Fibrosis
Defective fxn in a membrane cl channel of epithelial cells; decreased release of Na+ and H20 to liquify mucus; bronchi and bronchioles become obstructed
Problem with cystic fibrosis
bronchiectasis and hemoptysis
median survival age of people with cystic fibrosis
30 years old
