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PATHOPHYSIOLOGY > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

Give two obstructive pulmonary disorders:

A

Asthma and COPD

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2
Q

What are obstructive pulmonary disorders characterised by?

A

Difficulty breathing (especially breathing out) due to an obstruction in the airflow (for example inflammation).

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3
Q

Give 2 examples of a restrictive pulmonary disorders

A

Pulmonary fibrosis and pheumonia

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4
Q

What are restrictive pulmonary disorders characterised by?

A

A restriction on lung expansion causing a restriction in lung capacity.

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5
Q

Why may restriction within the lungs occur?

A

Due to the destruction of lung tissues, problems with the breathing muscles or damage to the nerves supplying the lungs.

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6
Q

What is the predominant function of the respiratory system?

A

To deliver oxygen to the cells of the body for cellular respiration.

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7
Q

Which other body system does the respiratory system work alongside to deliver oxygen to cells and remove waste products?

A

The cardiovascular system.

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8
Q

What is the process involving inspiration and expiration called?

A

Pulmonary ventilation.

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9
Q

What does the upper respiratory tract include?

A

The nasal cavity, pharynx and larynx.

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10
Q

What does the lower respiratory tract include?

A

The trachea, the bronchi and the bronchioles.

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11
Q

What regulates the diameter of the airways?

A

The smooth muscle in the walls of the airway.

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12
Q

What are the airway walls lined with and what is the function of this specific cell type?

A

Cilliated epithelial cells. The role of cilliated epithelial cells is to trap inhaled particles and remove them from the airways.

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13
Q

Which type of cell secretes mucous?

A

Goblet cells.

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14
Q

How is mucous moved up and out of the respiratory tract?

A

The cilia of the respiratory tract beat continuously to move particles out of the tract.

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15
Q

What is meant by airway resistance?

A

The resistance to airflow through the airways- for example when the airway becomes obstructed.

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16
Q

What is meant by airway compliance?

A

A measure of the ease in which the lungs and chest cavity can expand.

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17
Q

Where does gas exchange take place?

A

In the alveoli

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18
Q

Briefly describe alveoli:

A

Tiny air sacs which exist in massive quantities. They are supplied with capillaries from the pulmonary circulation and have very thin cell walls to allow for the diffusion of oxygen and carbon dioxide.

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19
Q

What is the barrier/ interface between the air and the blood also known as? What does it consist of?

A

The respiratory membrane. It consists of the walls of the alveoli and the walls of the blood capillaries (both of which are very thin).

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20
Q

What is between the two layers of cells (alvioli cells and capillary cells) making up the respiratory membrane?

A

The ‘interstitium’ which is the name given to the very thin space which exists between the alveoli and the blood capillaries.

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21
Q

What is gas exchange driven by?

A

Gaseous exchange occurs due to diffusion which is driven by a difference in concentration gradients. The role of respiration is to maintain diffusion gradients.

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22
Q

What supplies blood to the lungs for gaseous exchange?

A

The pulmonary circulatory system: arising from the right side of the heart starting with the pulmonary artery. Pulmonary veins bring back de-oxygenated blood to the left side of the heart.

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23
Q

What is hypoxaemia?

A

Low oxygen levels in the blood.

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24
Q

What is hypercapnia?

A

High levels of carbon dioxide in the blood.

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25
Q

What regulates breathing?

A

Respiratory centres in the brainstem.

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26
Q

What is the most important stimulus to increase breathing rate and depth?

A

The acid base balance of the blood- respiratory acidosis evokes a strong stimulus to increase breathing rate. Retention of carbon dioxide due to breathing difficulty is one of the main causes of acidosis.

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27
Q

Define asthma:

A

A chronic inflammatory condition affecting the airways.

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28
Q

Name 4 typical symptoms of asthma:

A
  • Breathlessness
  • Chest tightness
  • Coughing
  • Wheezing
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29
Q

What are the three physiological characteristics of asthma?

A
  1. Airflow limitation
  2. Airway hyper-responsiveness
  3. Inflammation of the bronchi
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30
Q

Give 6 stimuli thought to exacerbate asthma:

A
  1. environmental allergens
  2. respiratory tract infections
  3. exercise
  4. cold air
  5. ingestion of NSAIDs
  6. emotional stress
  7. exposure to bronchial irritants such as cigarette smoke
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31
Q

What happens after a patient with asthma is exposed to an allergen?

A

The body produces T helper 2 cells which release cytokines. Cytokine production leads to B cell production of antibodies and the recruitment of white blood cells (in particular eosinophils). Antibodies bind to mast cells located within the airways. This further sensitises individuals to further exposure of the allergen in the future.

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32
Q

What happens on subsequent exposure to an allergen with asthma?

A

The allergen will be recognised and bind to mast cells stimulating the release of histamine, prostaglandins and pro-inflammatory cytokines. This immediate reaction results in oedema, airway swelling and excessive mucous production.

33
Q

What is bronchospasm caused by within asthma?

A

Direct stimulation of the smooth muscle cells within the airway and reflexes of the nervous system.

34
Q

What controls the relaxation of the smooth muscle located within the walls of the airway?

A

The autonomic nervous system causes bronchodilation (widening of the airway bronchi) by relaxing the smooth muscle.

35
Q

What controls the constriction of the smooth muscle located within the walls of the airway?

A

The parasympathetic nervous system causes bronchoconstriction by causing the smooth muscle to constrict.

36
Q

The immediate allergic reaction to asthma results in the narrowing of the airways and increased resistance to airflow through which three mechanisms?

A
  1. Airway swelling
  2. Increased mucous secretion
  3. Bronchospasm
37
Q

What is meant by a ‘late’ asthma reaction?

A

A reaction occuring 8-12 hours later due to immune cells (neutrophils, lymphocytes and eosinophils) damaging the linings of the airways by thickening the walls and creating scar tissue.

38
Q

Give 7 clinical features (symptoms) of asthma:

A
  1. tight chest
  2. breathlessness
  3. increased heartrate
  4. increased respiration rate
  5. accessory muscle use
  6. low blood pH
  7. low oxygen level in the blood combined with high carbon dioxide level in the blood
39
Q

What does COPD occur following?

A

Progressive lung damage and gradual worsening of lung functionality.

40
Q

What is COPD characterised by?

A

Airflow obstruction which is not fully reversible.

41
Q

What is the main cause of COPD?

A

Smoking or exposure to environmental pollutants.

42
Q

Give 5 clinical features of COPD

A

Wheezing, breathlessness, persistent cough, chest tightness and susceptibility to frequent lung infections.

43
Q

Which muscles do patients with COPD use for breathing?

A

Their accessory muscles due to poor chest expansion.

44
Q

What test is used to determine lung functionality?

A

A spirometry test which measures lung volume and the rate at which air can be exhaled from the lungs.

45
Q

Which two elements make up COPD?

A

Emphysema and chronic bronchitus.

46
Q

Within COPD, the immune response to inhaled smoke is excessive causing damage to the lung tissue- resulting in bronchitus. What is bronchitus?

A

Inflammation of the bronchial tubes causing increased mucous secretion (leading to a productive cough) and airway inflammation (resulting in swelling and oedema).

47
Q

What is emphysema characterised by?

A

Enlargement of the airway spaces and destruction of the alveolar walls. Increased air spaces leads to reduced surface area for gas exchange leading to reduced blood oxygenation and reduced removal of carbon dioxide.

48
Q

Which two imbalances exist in the lungs of those with emphysema?

A

A protease/anti-protease imbalance

A oxidant/anti-oxidant imbalance

49
Q

What is meant by the protease/anti-protease imbalance in those with emphysema?

A

Cigarette smoke cause epithelial linings of the lungs to attract macrophages and neutrophils which produce proteases. Proteases are enzymes that break down proteins (elastic and collagen fibres) of the lung tissue. In normal lungs, there is a significant number of anti-protease enzymes which effectively balance out the proteases to minimise their destructive action. However in emphysema patients, the number of proteases is greater than the number of antiproteases.

50
Q

What is meant by the oxidant/anti-oxidant imbalance in those with emphysema?

A

Oxidants from smoke and reactive oxygen species released from inflammatory cells de-activate anti-proteases. This further contributes to an imbalance of proteases and anti-proteases (in favour of the destructive proteases). Healthy individuals have antioxidants present in their lungs, however tobacco smoke contains oxidants which outweight these antioxidants.

51
Q

What does airway obstruction in COPD result from?

A

Inflammation and narrowing of the airways.

52
Q

What does the loss of elastic tissue in emphysema cause?

A

Airways to narrow and eventually collapse. Also prevents the normal elastic recoil of the lungs from occurring (making breathing in easier but breathing out more difficult).

53
Q

Air becomes trapped in the lungs due to reduced elastic recoil resulting in reduced ability to expire air. What complications does this lead to?

A

Air left in the lungs reduces the amount of air which can be inhaled causing breathlessness, reduced O2 intake and increased CO2 presence.

54
Q

What is hypoxaemia?

A

Reduced blood oxygen levels

55
Q

What is hypercapnia?

A

Increased blood carbon dioxide levels?

56
Q

What is the main stimulus for COPD patients to breath?

A

Low oxygen levels.

57
Q

Why must oxygen be given slowly to COPD patients?

A

Because low oxygen levels are the main driving factor for patients to breath. If oxygen is given too quickly, patients drive to breath independently decreases.

58
Q

What is pulmonary hypertension?

A

Blood vessels supplying the lungs remain un-ventilated automatically constrict causing increased resistance to blood flow and raises the pulmonary blood pressure- causing the right ventricle to need to work harder causing it to enlarge and weaken

59
Q

COPD is an umbrella term for which two other conditions?

A

Emphysema and chronic bronchitus

60
Q

Is COPD restricive or obstructive?

A

Obstructive- causes difficulties in breathing (in particular breathing out).

61
Q

What is emphysema (COPD):

A

An obstructive disease characterised by destruction of alveolar walls and connective tissue resulting in the loss of elastic recoil

62
Q

What can cause emphysema?

A

Smoking, air pollution, exposure in work environment, hereditory factors.

63
Q

Describe the pathophysiological effects of emphysema:

A

Alveoli stretch out of shape and become abnormally large- losing their elastic recoil. Leading tp potential airway collapse and obstruction. Airways also become inflamed.

64
Q

Describe bronchitus:

A

An obstructive disease characterised by hypertrophy of the airways and excessive mucous production.

65
Q

A ‘pink puffer’ refers to:

A

A patient with emphysema

66
Q

A ‘blue bloater’ refers to:

A

A patient with bronchitus

67
Q

Describe the pathophysiology of bronchitus:

A

Irritation, inflammation and swelling of the airway. Increased number of mucous secreting glands. Obstruction of airways by excessive mucous. Bacterial colonisation of normally sterile airways (impaired resistance to infections).

68
Q

What is the pathophysiology of asthma?

A

The overreaction of sensitised lung tissue mast cells. Contraction of the smooth muscle in the airway as well as increased vascular permeability and increased mucous production. Infiltration of immune cells leading to epithelial damage.

69
Q

What can exacerbate asthma?

A

Smoking, emotions, hormones, exercise.

70
Q

Give features a severe asthma attack:

A

Cannot talk in full sentences, use of accessory muscles to breathe, increased respiration and pulse rate, peak flow less than 50% of normal score.

71
Q

Give features of a life threatening asthma attack:

A

Feeble respiratory effect, cyanosis, bradycardia and hypotension, confusion, coma, peak flow less than 33% of normal score.

72
Q

What are the three main characteristics of asthma?

A
  • airflow limitation
  • airway hyperresponsiveness to various stimuli resulting in bronchospasm as the stimuli cause the smooth muscle to contract
  • chronic inflammation of the bronchi resulting in long term airway swelling and mucous production that causes the symptoms of asthma
73
Q

What is the difference between COPD and asthma with regards to the airway?

A

COPD airway inflammation is non-reversable whereas asthma airway inflammation is normally reversable

74
Q

How does chronic inflammation affect the airway of an asthmatic?

A

Causes smooth muscle to contract resulting in narrowing of the airway. This is further reduced by excessive mucous production.

75
Q

What are the main causes of COPD?

A

Smoking, air pollution, work environment exposure, hereditory factors.

76
Q

What is bronchiolitus?

A

A respiratory infection lasting 3-7 days which occurs in infants

77
Q

Is bronchiolitus caused by a bacteria, virus or parasite?

A

The syncitial virus

78
Q

What happens in terms of patophysiology of bronchiolitus?

A

The mubmucosa becomes inflamed and oedematous resulting in less than effective gas exchange.

PATHOPHYSIOLOGY (14 decks)

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