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Pathoma - Respiratory Tract Pathology > Respiratory Distress Syndromes > Flashcards

Respiratory Distress Syndromes Flashcards

1
Q

What is Acute Respiratory Distress Syndrome?

A

ARDS - Diffuse damage to the alveolar capillary interface (diffuse alveolar damage)

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2
Q

What is the pathogenesis of Acute Respiratory Distress Syndrome?

A

Leakage of protein-rich fluid leads to edema that combined with necrotic epithelial cells to form hyaline membranes in alveoli.

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3
Q

What is the seen in the alveoli of ARDS?

A

Hyaline membranes

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4
Q

What is seen in ARDS on CXR?

A

‘White-out’ of the lung

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5
Q

What are the symptoms associated with ARDS?

A

-Hypoxemia
-Cyanosis
. . .with respiratory distress

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6
Q

What causes the hypoxemia, cyanosis and respiratory distress seen in ARDS?

A

Thickened diffusion barrier and collapse of air sacs (increased surface tension) –> “sticky” air sacs

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7
Q

What is Acute Respiratory Distress Syndrome secondary to?

A

A variety of disease processes:

  • Sepsis
  • Infection
  • Shock
  • Trauma
  • Aspiration
  • Pancreatitis
  • DIC
  • Hypersensitivity reactions
  • Drugs
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8
Q

What is the pathogenesis of ARDS caused by disease processes?

A

Activation of neutrophils induces protease and free radical-mediated damage of type I and II pneumocytes

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9
Q

How do you treat ARDS?

A
  1. Adress the underlying cause

2. Ventilation with positive end-expiratory pressure (PEEP)

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10
Q

What might recovery from ARDS be complicated by?

A

Interstitial fibrosis

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11
Q

What can cause interstitial fibrosis in ARDS recovery?

A

Damage and loss of type II pneumocytes leads to scarring and fibrosis

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12
Q

What does damage and loss of type II pneumocytes in ARDS cause?

A

Scarring and fibrosis

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13
Q

What are the two main functions of Type II pneumocytes?

A
  1. Stem cell of the lung

2. Produces surfactant

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14
Q

What is Neonatal Respiratory Distress Syndrome?

A

Respiratory distress due to inadequate sufactant levels

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15
Q

What makes surfactant?

A

Type II pneumocytes

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16
Q

What is the major component in surfactant?

A

Phosphatidylcholine (lecithin)

17
Q

What is the purpose/function of surfactant?

A

Surfactant decreases surface tension in the lung, preventing collapse of alveolar air sacs after expiration.

18
Q

What does lack of surfactant lead to?

A

Collapse of air sacs and formation of hyaline membranes.

19
Q

What three situations is Neonatal Respiratory Distress Syndrome associated with?

A
  1. Prematurity
  2. Caesarian section delivery
  3. Maternal diabetes
20
Q

When does surfactant production begin?

A

28 weeks

21
Q

When are adequate surfactant levels reached?

A

34 weeks

22
Q

What is used to screen for lung maturity?

A

Amniotic fluid lecithin to sphingomyelin ratio (L:S ratio)

23
Q

How does the L:S ratio change through out pregnancy?

A

Lecithin increases from 28-34 weeks, but S stays the same!

24
Q

What happens to lecithin and sphingomyelin as surfactant is produced?

A
  • Phosphatidylcholine (lecithin) levels increase as surfactant is produced.
  • Sphingomyelin remains constant
25
Q

What L:S ratio indicates adequate surfactant production?

A

A ratio >2

26
Q

How does Caesarian delivery cause Neonatal Respiratory Distress Syndrome?

A

Due to lack of stress-induced steroids

27
Q

What do steroids provide the fetus during delivery?

A
  • Steroids increase the synthesis of surfactant.

- They cause surfactant in type II pneumocytes to be released into the lung

28
Q

How does Maternal diabetes lead to Neonatal Respiratory Distress Syndrome?

A

Insulin decreases surfactant production.

29
Q

How does insulin lead to NRDS?

A

High blood sugar in mom —> goes to baby –> baby’s pancreas produces insulin –> insulin inhibits surfactant –> increases risk for NRDS

30
Q

What happens to a NRDS baby at birth?

A

Increasing respiratory effort at birth, tachypnea with use of accessory muscles, and grunting

31
Q

What are two other clinical signs of NRDS?

A

Hypoxemia and cyanosis

32
Q

What is seen in an X-ray of NRDS?

A

-Diffuse granularity of the lung (‘ground-glass’) appearance

33
Q

What is a complication related to hypoxemia in NRDS?

A

Hypoxemia increases risk for persistence of patent ductus arteriosus and necrotizing enterocolitis.

34
Q

What complication is supplemental oxygen use in NRDS associated with?

A

Increased risk for free radical injury.

35
Q

What specific damage can free radical injury in NRDS cause?

A

Retinal injury —> leads to blindness

Lung damage –> broncopulmonary dysplasia (lung didn’t form properly)

36
Q

What used to be a major cause of blindness in neonates?

A

Use of O2 in NRDS

Pathoma - Respiratory Tract Pathology (9 decks)

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