Respiratory Disease I and II Flashcards
Upper middle and lower airway
Upper:
Nose, mouth, nasopharynx, oropharynx.
Middle: Laryngeal
Lower: trachea, bronchi, brocnhioles
3 Respiratory system functions
- Ventilation: air into and out of body
- Gas exchange/diffusion
- Metabolism:
- Convert angiotensin 1 to 2
- Deactivation of bradykinin
- Regulate pH
Diffusion requirements of alveoli
Intact, non thick. 0.5mm
Minimal interstitial space without additional fluid
Central and peripheral chemoceptors (CN 10) are stimulated by
pH of CSF
partial pressure of O2 and Co2
Drives skeletal muscles of respiration
All respiratory diseases can be categorized into 3 things:
- Ventilation - Asthma
- Diffusion - Emphysema, COPD
- Perfusion - Pulmonary embolism
How can ventilation and diffusion lead to cell death?
Ventilation:
Blockage of airflow or inhibition of neural stimulation= hypoxia, hypercapnia = acidosis = cell death.
Diffusion:
Increased thickness or decreased partial pressure = blocked transfer of O2 = hypoxia and hypercapnia = acidosis = cell death
Hemo vs pneumo thorax
Hemo- blood enters pleural sac.
Pneumo- Air enters pleural sac.
80% of common cold is caused by
Rhinovirus. Spread thru respiratory droplets.
infection may spread to sinus, larynx, bronchus.
Sinitus
Swollen membranes prevent entry of air into sinus
Can be acute, chronic or recurrent.
Air, pus, mucus trapped.
Infection can move into orbit, more common in children.
Restrictive lung disease
Limited lung expansion, reduced lung volume. Increased respiratory effort.
Could be due to
- fibrosis
- Neuromuscular disease. Defective innervation.
- obesity
- kyphosis (curvature of spine, no room for lungs)
- Infection
Types of restrictive lung diseases
- Pulmonary fibrosis
- Occupational lung disease- pneumoconiosis
- Sarcoidosis
- Pneumonia
- Tuberculosis
- Pulmonary edema (Cardiogenic, non cardiogenic)
- Acute respiratory distress syndrome (non cariogenic pulmonary edema causes this)
Types of obstructive respiratory diseases
- Sleep apnea
- Cystic fibrosis
- Asthma
- COPD Chronic obstructive pulmonary disease
- Emphysema
- Chronic Bronchitis
Pulmonary fibrosis (restrictive lung diseases)
Group of pulmonary connective tissue diseases
Results in secondary HTN and right heart failure
Causes: Mainly idiopathic, then autoimmune diseases.
Symptoms: progressive SOB
Occupational lung disease (pneumoconiosis)
restrictive lung diseases
Lung disease associated with inhalant of small inorganic particles.
- Most common is antracosis. “Coal miners lung, black lung”
- Silicosis
- Asbestosis
Predisposing factors:
- Exposure to pollutants
- pre existing lung diseases
- Duration, amount and particle size during exposure
Pathogensis: Macrophage secretes lysozyme to break down particles- ends up breaking down alveoli. Enzyme damage causes deposition of collagen.
Tx is palliative.
Sarcoidosis
restrictive lung diseases
Autoimmune disease caused by chronic granulomas that results in multiple organ damage- mostly lungs, but also lymph nodes, skin and eyes. (Can effect all parts of the eyeball, usually due to inflammation)
30-40 year old, AA > White, Women > men
Classic triad: Pulmonary involvement, Skin granulomas, eye and joint lesions.
Pneumonia
restrictive lung diseases
Inflammatory process secondary to infection (bacteria, virus, fungi)
Lung fills with fluid and exudate
Symptoms: Cough with sputum, fever, sharp chest pain on inspiration.
Viral cause: Rhinovirus, influenza
Bacterial cause: M or S pneumonia, B pertussis.
Types: Bronchial, lobar, interstitial.
Tuberculosis
restrictive lung diseases
Inhaled droplet nuclei bypass upper airway defenses. Alveolar macrophage ingest bacterium but are unable to destroy them–> causes caveating granuloma.
- Primary, asymptomatic. 90%
- Secondary, reinfection after dormant. Damaging. 5%
- Progressive primary. After first infection. 5%
Symptom: Weight loss
Tb of the eye: Occurs in 1.4% of cases. Occur anywhere in orbit or adnexa.
Choroiditis > anterior uveitis > Sclerokeratitis
Pulmonary edema (restrictive lung diseases)
Fluid in and around alveoli. This interferes with gas exchange and increases work of breathing.
2 types-
Cardiogenic: heart failure.
Non-Cardiogenic: Acute respiratory distress syndrome, pulmonary embolism, viral infection or toxins.
Non cariogenic pulmonary edema may lead to:
Acute respiratory distress syndrome
restrictive lung diseases
Widespread pulmonary inflammation causes severe hypoxia.
Mortality rate is 30-60% even with treatment.
Could be caused by noncardiogenic pulmonary edema, >40% caused by sepsis, fibrosis, or atelectasis (alveolar collapse due to disruption of surfactant), emboli, or shock.
How does ARDS progress in the alveoli.
Inflammatory response causes increased capillary permeability, which impairs gas exchange. leads to more inflammation and more tissue damage. Then deposition of hyaline and fibrosis. This decreases gas exchange and increases route gas has to travel.
What is obstructive respiratory disease
Inability to completely exhale.
Obstructive sleep apnea
Upper airway collapse during sleep.
Leads to reduction of airflow, oxygen desaturation, arousal from sleep, and excessive daytime sleepiness.
Most common type of sleep disordered breathing. More common in men.
Risk factors: Age, obesity, family Hx, neck circumference (17+ in men, 15+ in women) enlarged tonsils.
Dx with polysomnography (5+ on apnea hypopnea index)
Tx with cpap
Systemic effects: 2.5x stroke, 3x HTN, 3x CAD,
Ocular effects: Floppy eyelid syndrome, dry eye.
Cystic fibrosis
Autosomal recessive disease
White»_space; hispanic, AA< asian
Chloride transport defect: Thick mucus with low water content.
Multi organ effects: lungs mainly
Symptoms: Delayed growth due to decrease nutrient uptake Pneumonia Infertility. Testes in males Pancreatitis- blocks glands- cysts.
Tx:
Mucolytics, antibiotics, chest percussion, lung transplant, hydration.
Asthma
Intermittent or persistant airway obstruction
Bronchial hyper-responsiveness.
Type I hypersensitivity: histamines replaced with leukotrienes.
Airflow obstruction: Bronchoconstriction, mucous production, inflammatory cell migration.
Risk factors may be associated with low SES
Triggers: meds, weather changes, irritants, allergens, exercise.
# cause of death COPD and flu/pneumonia
3 and 8
COPD
Emphysema and or chronic bronchitis Inflammation of alveoli and bronchi Progressive, irreversible. Unlike asthma, never goes away or gets better. 80-90% are former smokers.
Pathogenesis: Increased mucous production, loss of elastic recoil and airway collapse, leads to right HF.
Emphysema due to COPD
Irreversible enlargement of alveolar spaces- disrupts wall of alveoli.
Destruction of alveoli walls and loss of elastic recoil.
Body adapts by making chest bigger: Barrel Chest.
Causes: #1: Smoking. Activates neutrophils that release elastase to break down pathogen which breaks down alveoli. #2: Congenital: Deficiency of alpha1 antitrypsin. Natural product of lung that counteracts elastase! #3: IV drug use.
Chronic Bronchitis due to COPD
Persistant, productive cough with excessive mucous production.
Causes: #1 is chronic smoking. #2 infection or pollution.
Effects:
Hyperplasia of bronchial mucous glands and smooth muscles. Destruction of cilia. Squamous cell metaplasia. Brochial wall thickening and development of fibrosis. (Fibrosis is less common in asthma)
Lung cancer
80-90% due to smoking.
10-15% due to environmental carcinogens.
men= women
18% 5 year survival.
Most malignant is small cell carcinoma.
Most common symptom: Persistent, productive cough. Weight loss, SOB.
**Paraneoplastic syndrome. Systemic symptoms that arise due to cancer cells regaining ability to release hormones. Help with Dx.
Pancoast syndrome due to lung cancer
Non-small cell carcinoma.
At pulmonary apex.
Signs: Horners (sympathetic trunk) shoulder pain (Brachial plexus) hoarse voice (Vocal cord paralysis) cough
ocular manifestations of pneumonias
Pneumonias- roth’s spots, septic retinitis (lodged in choroid)
ocular manifestations of asthma with steroid tx
Steroid cataract and glaucoma.
ocular manifestations of emphysema
Steroid cataract and glaucoma
Papilledema due to coughing. (causes increased ICP)
ocular manifestations of cystic fibrosis
Macular holes, papilledema, Optic neuritis,
ocular manifestations of bronchogenic carcinoma
Metastasis to eye
