Respiratory pathologies Flashcards
Asthma
Asthma is a chronic airway disease with reversible narrowing of the bronchi and bronchioles.
Extrinsic (or ‘atopic’) asthma:
• Immunologically mediated with an increase in IgE antibodies.
• Brought on by exposure to allergens e.g., pollen, dust, animal dander
Intrinsic asthma:
• A bronchial reaction not due to antigen-antibody stimulation.
• Usually adult onset.
• Common triggers - anxiety, chemicals, exercise, cold air, drugs (NSAIDs, beta blockers), stress, dust, etc.
• Asthma can develop at any age, most commonly affects children <10 years, and the elderly.
• Makes up atopic triad -asthma, hay fever & atopic eczema.
Pathophysiology:
• Inflammatory condition with bronchial hyper-responsiveness and varying degrees of immune cell infiltration.
• Airflow obstruction due to oedema; mucus builds up and smooth muscle proliferation problems exhaling.
• Leukotrienes are key chemical inflammatory mediators in asthma - bronchoconstrictors.
Causes:
• Early weaning.
• Inadequate exposure to pathogens in childhood.
• Inherited dysbiosis (imbalance of gut flora) and antibiotic use in children.
• Food additives.
• Leaky gut syndrome.
• Nutritional deficiencies (C, D, E, magnesium)
Signs and symptoms:
• Recurrent episodes of breathlessness and chest tightness.
• Wheezing when exhaling.
• Nocturnal coughing, occasionally with thick, clear or yellow sputum.
• Accessory muscles of ventilation are overused aching in the neck and upper back.
Diagnostic:
• Based on signs / symptoms and case history.
• Spirometry.
Allopathic treatment;
• Bronchodilators - blue inhaler
. Corticosteroids - brown inhaler
Complications:
• Asthma attacks – life threatening
Bronchitis
Bronchitis describes inflammation of the bronchial tubes.
Inflammation can be acute (< 2 weeks) or chronic (longer lasting).
Pathophysiology:
• When an irritant enters the airways, goblet cells secrete mucus to flush it out.
• If mucus is overproduced, the respiratory system attempts to clear it, but struggles to do so.
• This can increase airway resistance, hence breathing difficulties.
Causes:
• Viral or bacterial infections can result from compromised immunity.
• Can be associated with environmental irritants.
Signs and symptoms:
• Hacking unproductive cough, becoming productive within days (thick yellowy mucus).
• Fever, sore throat, shortness of breath, headache, runny or blocked nose, muscle pain.
• Signs: Crackles on auscultation, tachypnoea, tachycardia, cyanosis.
Allopathic treatment;
• Antibiotics
Chronic Obstructive Pulmonary Disorder (COPD)
COPD causes airflow limitation that is progressive and not fully reversible.
The airflow limitation is due to airway and functional lung tissue damage.
Pathophysiology:
• A chronic inflammatory response of the lungs (usually to inhaled toxins).
• COPD refers to a progressive disease with a combination of two main pathologies (of varying proportions):
• Emphysema walls of the alveoli
damaged and destroyed, leading to reduced gas exchange.
• Chronic bronchitis the bronchial lining is constantly irritated and inflamed thick mucus.
Causes:
• Smoking.
• Exposure to lung irritants (air pollution, industrial chemicals, dusts, etc.).
• Genetic susceptibility.
Signs and symptoms:
• Chronic cough with sputum.
• Dyspnoea.
• Prolonged expiration and wheeze.
• Frequent infections.
• Signs: Tachypnoea, breathlessness on exertion, pursed lips breathing, patients may lean forward and rest arms on the table, flapping tremor, cyanosis, hyperinflation of chest (barrel chest), clubbed nails.
• Chronic bronchitis - cough and wheezing.
• Emphysema - breathlessness.
Allopathic treatment:
• Smoking cessation
• Bronchodilators
• Corticosteroids
• Oxygen therapy
• Mucalitics (break down mucus)
Complications:
• Chronic hypoxaemia -pulmonary hypertension.
• Recurrent respiratory infections.
• Respiratory failure.
Common Cold
Infection of the upper respiratory tract – Rhinovirus
Causes:
• Lower immunity - infections with rhinovirus
Signs and symptoms:
• Gradual onset Lasts 2-7 days
• Rhinorrhoea (runny nose)
• Sneezing
• Sore throat
• Mild fever
• Localised symptoms (to upper respiratory tract)
Allopathic treatment;
• Painkiller
• Decongestants
Cystic Fibrosis
A multi-organ genetic disease that affects chloride channels and subsequently key exocrine glands
Pathophysiology:
• Chloride channels help maintain proper balance of salt & water within a cell. A genetic mutation causes a dysfunction of salt & water balance
• Mucus (or secretions) are thick and clog up the lungs and some digestive organs
• Causes chronic respiratory infections and pancreatic insufficiency
• Lung disease is the principle cause of death
Causes:
• Genetic defect on chromosome No. 7.
Signs and symptoms:
• Persistent cough
• Sputum production
• Recurring lung infections
• Wheezing
• Chest pain
• GIT symptoms;
• Bloating
• Obstruction
• Bleeding
• Dyspepsia
• Malnutrition
Allopathic treatment:
• Antibiotics
• Physiotherapy
• Bronchodilators
• Mucolytics
Influenza
Influenza is an acute respiratory disease associated with various strains of the flu virus
Pathophysiology:
• Rapid onset
• Incubation period; 1-4 days (time between microbial exposure & first symptoms)
Causes:
• Those with lower immunity become infected with influenza virus
Signs and symptoms:
• Sudden onset
• Fever and shivering
• Malaise
• Muscle and joint pain
• Rhinitis
• Sore throat
• Systemic symptoms
• Symptoms - systemic, more severe & last longer (7-14 days)
Allopathic treatment:
• Anti viral drugs – reduces viral shedding. Have to be taken with 48 hours, but very poor effectiveness and adverse effects
• Antibiotics to prevent secondary bacterial infection
• Flu vaccine in vulnerable populations
Complications:
• Secondary infections while the immune system is depleted due to primary flu infection
• Post viral syndrome (chronic fatigue syndrome) following compromised immune system
• Morbidity/mortality
Other:
• Flu vaccinations often don’t provide effective immunity as the virus mutates (the vaccine also produces significant adverse effects)
Laryngitis
Laryngitis describes inflammation of the larynx
Causes:
• Can be acute or chronic:
• Acute; Viral, bacterial
• Chronic; Overuse – repeated strain
. Irritants (smoke, fumes)
• Acid reflux
Signs and symptoms:
• Hoarseness, weak voice or loss of voice
• Sore / dry/ tickly throat
• Dry cough
• Difficulty breathing (in children)
Allopathic treatment;
• Antibiotics (adverse effects)
• Avoid smoking and smoke
• Maintain oral hygiene
Nasal Polyps
Nasal polyps are soft, non cancerous (benign) masses of oedematous nasal mucosa
Pathophysiology:
• Chronic inflammation causes the blood vessels in the lining of the nose and sinuses to become more permeable allowing water to accumulate in the cells
• Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps
Causes:
• End product of chronic inflammation, due to:
• Viral, bacterial or fungal
• Allergies: chronic rhinitis
Signs and symptoms:
• Difficulty breathing
• Runny nose
• Persistent stuffiness
• Chronic sinus infections
• Reduced sense of smell
• Dull headaches
• Snoring
• Mouth breathing
• Can cause sleep apnoea
Allopathic treatment:
• Intranasal steroids (adverse effects)
• Anti-histamines
• Anti-fungals
• Surgery
Complications:
• Can cause sleep apnoea
Pharyngitis
An acute inflammation of the mucous membrane of the pharynx
Causes:
• Usually accompanies colds & tonsillitis & is often accompanied by swollen lymph nodes
Signs and symptoms:
• Sore throat
• Red inflamed throat
Allopathic treatment:
• Painkillers for virus
• Antibiotics
Pleurisy
Pleurisy describes pleural inflammation
Pathophysiology:
• The pleural surface becomes coated with inflammatory materials and hence roughened, (producing the friction rub on auscultation)
Causes:
• Tumour
• Infection (e.g. pneumonia)
Signs and symptoms:
• Dyspnoea
• Sharp chest pain while breathing – aggravated by inspiration, coughing, sneezing or moving
• Dry cough
• May be relieved by shallow breathing
• Dullness with percussion
• Friction rub on auscultation
Pneumonia
Pneumonia is an infection of the alveoli & terminal bronchioles, mostly bacterial
Pathophysiology:
• Associated with an infiltration of neutrophils with inflammation and oedema
• Most common in infants, children & the elderly
Causes:
• Higher risk if the patient is immune suppressed
Signs and symptoms:
• Cough & purulent sputum-can be blood stained
• Breathlessness
• Fever
• Malaise
• Tachypnoea, crepitations on auscultation
Pneumothorax (collapsed lung)
A pneumothorax describes air accumulation within the pleural cavity, causing part or all of a lung to collapse
Pathophysiology:
• Air enters via detect in visceral or parietal pleura (e.g. rib fracture)
• Can be ‘simple’ (i.e. heart remains central) or ‘tension’ (unstable – progressive build up of air shifting the heart away)
Causes:
• Spontaneous;
• Rupture of cyst / pocket of air
• Tuberculosis
• Cystic Fibrosis
• Emphysema
• Traumatic (damage to pleura);
• Fracture
• Surgical complication
Signs and symptoms:
• Dyspnoea
• Pleuritic (sharp) chest pain
• Cyanosis
• Loss of consciousness
• Coma
• Reduced breath sounds
• Decreased cardiac output
Allopathic treatment:
• Requires a chest drain (via lateral ribcage) where accumulated air can be expelled
• Oxygen
. Medical emergency
Complications:
• Pneumothorax causes pleurisy
Pulmonary Embolism
A pulmonary embolism results from obstruction within the pulmonary arterial tree
Two types of clots;
• Thrombosis (fixed clot)
• Embolism (circulating clot)
Causes:
• The embolus (mobile clot) often occurs as a result of a thrombosis, travelling up from one of the deep veins in the legs (i.e. a DVT).
• Fat embolisms can occur following bone fractures
Signs and symptoms:
• Dyspnoea
• Pleuritic chest pain
• Cough
• Coughing blood
• Calf pain (if following a DVT)
• Tachypnoea
• Tachycardia
• Crackles on chest auscultation
Allopathic treatment:
• Anti-coagulation therapy
• Oxygen
• Acute medicine required
• Medical emergency
Complications:
• Poor prognosis if untreated. Potentially life threatening as it can lead to cardiac arrest and heart failure
Pulmonary Fibrosis
Gradual replacement of the one layer thick epithelial cell lining in alveoli with fibrotic tissue
Pathophysiology:
• Fibrotic (scar) tissues are less able to exchange oxygen & CO2
Causes:
• Ideopathic (IPF); unknown, may be genetic, presents around 70 years
• Smoking
• Asbestos
• Some drugs
• Radiation therapy
• Accompanies some diseases (AI e.g. RA)
Signs and symptoms:
• Progressive dyspnoea
• Chronic cough
• Fatigue
• Discomfort in the chest
• Loss of appetite
• Weight loss
Allopathic treatment:
• No effective allopathic treatments/ cure; palliative care to help support quality of life & treat symptoms
Rhinitis
Rhinitis is inflammation of the nasal mucosa
Pathophysiology:
• The inflammation leads to mucosal swelling and an increase in the volume and viscosity of nasal secretions (mucus)
Causes:
• Immune compromise (leads to viral, bacterial, fungal infections) i.e. related to emotional stress, medication, diet etc
• Allergic rhinitis (e.g. due to pollen, spores, mites) – IGE stimulates mast cells to release histamine
• Non allergic rhinitis (associated with environmental and lifestyle changes e.g. pollution, diet, drugs such as NSAIDS, stress, etc.)– environment/lifestyle
Signs and symptoms:
• Itchy runny nose
• Sneezing
• Stuffy nose
• Loss of smell
Allopathic treatment:
• Anti-histamines
• Decongestants
• Steroid nasal sprays
Complications:
• Nasal polyps
• Ear infections
• Loss of smell
