Respiratory Pathology Flashcards
Obstructive Diseases - Possible Outcomes
Congestion or constriction of the airway → ↑ resistance
Uneven distribution of the air => Disturbance of ventilation and perfusion.
Can lead to altered blood gas values: ↑ PCO2
and ↓ pH value.
Obstructive Disease - Obstructions
Congestion from outside: tumor
Food
Mucus (lung secretion)
Accumulation of gas (main)
Obstructive Diseases
COPD: Chronic Obstructive Pulmonary Disease.
Cystic fibrosis/Mucoviscidosis
Asthma
Bronchiectasis
Central local obstruction (e.g. foreign objects)
COPD - 2 Conditions
Chronic inflammation → structural changes: AIRWAYS/ALVEOLI /BOTH
- Chronic Bronchitis
- Emphysema
COPD - Chronic Bronchitis
Presence of cough and sputum production for at least 3 months in each of 2 consecutive years
- narrowing of airways
- dyspnea, chronic cough, sputum production, wheezing
- disturbance ventilation/perfusion
COPD - Emphysema
Destruction of the gas-exchanging surfaces of the lung (alveoli)
- loss of support for airways (collapse during expiration)
- high compliance, ↓ lung elastic recoil
- air trapping during expiration, hyperinflation.
- dyspnea, chest tightness, cyanosis,…
COPD - Risk Factors
1) Long-term exposure to lung irritants: Smoking, air pollution, chemical fumes, asthma, childhood respiratory infections.
2) Alpha-1 antitrypsin deficiency
Classification of COPD - GOLD
FEV1/FVC FEV1
Stage I - Mild: < 70% -
Stage II - Moderate: < 70% < 50-70%
Stage III - Severe: < 70% < 30-50%
Stage IV - very severe: < 70% <30% or <
Forced vital capacity (FVC): This is the largest amount of air you can breathe out after breathing in as deeply as you can.
Forced expiratory volume (FEV-1): shows how much air you can exhale from your lungs in 1 second.
COPD - Major Diagnostic Tool
Spirometry Accesses: Vital capacity (IRV, VT, ERV) IRV: Inspiratory reserve volume VT: Tidal volume ERV: Expiratory reserve volume
COPD - Symptoms
Dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease.
Lung function test. X-Ray.
Other common features of COPD (not diagnostic):
• Hyperinflated chest
• Resting tachypnea
PaO2 Value ↓ (Hypoxemia)
PaCO2 ↑ (Hypercapnia)
Arterial pH value ↓ (respiratory Acidosis)
COPD - Static Lung Hyperinflation
Increase in end expiratory lung volume above predicted normal value.
increase in lung compliance, decrease recoil pressure. (air trapping)
Thorax and lungs always hyperinflated, diaphragm almost flat at end expiration.
The lungs exert less recoil pressure to counter the recoil pressure of the chest wall, resulting in an equilibrium of recoil forces at a higher resting volume than normal.
result of the permanent parenchymal destruction.
COPD - Dynamic Hyperinflation
Increase in end expiratory lung volume above ‘‘static’’ value. Cannot expire all the air that was inhaled, tidal volume decreases. The ability to fully exhale depends on the degree of airflow limitation and the time available for exhalation. These can both vary, causing greater hyperinflation during during exercise.
COPD - Treatment
- Patient education
- Expiration techniques
- Airway clearance techniques
- Physical activity training/coaching
- Optimization pharmacotherapy + check inhalation technique
Restrictive Lung Diseases
Impairment to thoracic wall(neuromuscular diseases, kyphoscoliosis)
Post-surgery (e.g. lobectomy/ pneumectomy)
Interstitial lung diseases (e.g. fibrosis)
Pleural pathology (e.g. mesothelioma)
Obesity
Cancer
Pneumonia
Tuberculosis
Restrictive Lung Diseases - Characteristics
- Decreased elasticity
- Retraction force elevated
- Total lung capacity reduced (<80%)
- Reduction of the maximal mobilized ventilatory volume (TLC and VT)
- Reduced inspiratory reserve volume (IRV)
Restrictive Lung Diseases - 2 Reasons
- Interstitial space thicker between alveoli and capillary → Elastic recoilment↑ → compliance↓ → total lung capacity↓ → Difficulty to inhale.
- Problem with ventilatory muscle (neuromuscular disease) - Diaphragm total lung capacity↓ → compliance↓ → Difficulty to inhale.
Mixed Diseases - Restrictive and Obstructive
- Pneumectomy in patient with COPD
* Lung cancer: Loss of lung parenchyma (restrictive), obstruction of the airways (obstructive)
Pneumonia - Definition
- Infection that inflames the air sacs (alveoli)
* filled with fluid or pus (purulent material)
Pneumonia - Etiology
Community acquired: bacteria, virus, fungal.
Various germs.
Hospital acquired (nosocomial infection): 48h after admission, bacteria more resistant to antibiotics, high risk for ventilated patients.
Pneumonia - Symptoms
- Fever
- Shivering
- Cough first dry then productive and purulent
- Dyspnea
- Tachycardia
- Chest wall pain
- Confusion
- Fatigue
Pneumonia - Risk Factors
- <2y or >65y
- Being hospitalized
- Chronic (cardiorespiratory) disease
- Smoking
- Weakened immune system
Pneumonia - Diagnosis
Chest X-ray
Blood tests
Sputum test (yellow/green)
Pneumonia - Treatment
• Antibiotics • Oxygen supplementation • Physiotherapy Prevention! → vaccination • Smoking cessation
Cystic Fibrosis - Definition
Inherited disease affecting cells that produce mucus, sweat and digestive juices.
Fluid: becomes sticky and thick, secretions plug up tubes due to salt dysregulation → recurrent infections.
Cystic Fibrosis - Symptoms and Diagnosis
• A persistent cough that produces thick mucus(sputum)
• Wheezing
• Breathlessness
• Exercise intolerance
• Repeated lung infections
• Inflamed nasal passages or a stuffy nose
Genetic test or blood test.
Cystic Fibrosis - Complications
- Hemoptysis (coughing up blood: RED FLAG)
- Chronic infections
- Bronchiectasis
Cystic Fibrosis - Treatment
Patient/Parent education Prevention of infections Medication Airway clearance techniques several times a day Physical activity Inhalations: check technique Final: Lung transplant
Asthma - Definition
Chronic disease of airways that makes breathing difficult and trigger coughing and wheezing.
→ Contraction muscle surrounding airways (narrowing airways)
→ Accumulation of inflammatory cells (swelling + build-up mucus in airways)
Asthma - Symptoms
- Shortness of breath
- Chest tightness or pain
- Trouble sleeping caused by shortness of breath, coughing or wheezing.
- A whistling or wheezing sound when exhaling → harder to breathe out.
- Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.
Bronchial Asthma - Triggers
- Exercise
- Respiratory illness
- Irritants in air
- Allergens
- Extreme weather
- Emotions
Bronchial Asthma - Symptoms and Diagnosis
- Dry nervous cough
- Dyspnea
- Wheezing in expiration, prolonged expiration
- Medical history
- Spirometry
- Allergy tests
Asthma - Treatment
- Expiratory techniques (pursed lips)
- Breathing control in relaxing positions
- Inhalation of medications
- Smoking cessation
- Stress reduction (avoid triggers)
- Expectoration techniques (+ exercise)
Pneumothorax - Definition
• Accumulation of air in pleural space
- Air pushes on the lung
- Collapse of the lung (complete or partly)
Pneumothorax - Symptoms
sudden chest pain (sharp, one-sided)
shortness of breath during inhalation
Can be caused by a chest wound
Pneumothorax - Types
- Spontaneous (non-traumatic): rupture of a small air bleb on the apex of the lung.
- Acquired (traumatic): trauma, post-surgery, rib fracture with rupture of parietal pleura.
- Hemopneumothorax: blood accumulation in the pleural space.
Tension Pneumothorax
All types can lead to it.
- more air in, but no escape from pleural space.
- ↑ respiratory rate and tidal volume.
- hypoxia/respiratory arrest (life threatening).
- shift mediastinal structures.
Pneumothorax - Risk Factors
- Male > female
- Smoking
- Genetics
- Lung disease
- Mechanical ventilation
- Previous pneumothorax
Pneumothorax - Treatment
- Body is able to absorb a little bit of air autonomously (small pneumothorax → spontaneous healing)
- Needle aspiration or drainage to remove excess air
- After 2 spontaneous: surgical management with pleurodesis
Pulmonary Edema - Definition
• Fluid in tissue/airspaces of lungs
- impaired gas exchange
- respiratory failure
Cardiogenic Pulmonary Edema
left ventricle failure → blood backing up in left
atrium → pulmonary veins → pulmonary capillaries → pulmonary hypertension → pulmonary edema.
Non-Cardiogenic Pulmonary Edema
Injury lung parenchyma/vasculature of lung
(chest trauma, pulmonary infections, inhalation toxics) → injury alveoli → inflammation → edema.
Idiopathic Pulmonary Edema
Arising spontaneously or from an obscure or unknown cause.
Pulmonary Edema - Symptoms and Diagnosis
• inspiratory and expiratory crackles • Dyspnea during activity • Dyspnea when lying down • Swelling in legs Waking up at night better with sitting.
Chest X-ray or chest CT scan
Pulmonary Edema - Treatment
- Improving respiratory function
- Treating the underlying cause
- Avoiding further damage to lung
- Cardiogenic therapy: medication to boost heart’s performance and lower blood pressure.
- Improving oxygenation
Lung Cancer - Cause
Smoking (85%) (carcinogens) Passive smoking Asbestosis Air pollution Family history
Lung Cancer - Types
• Small cell lung cancer: Heavy smokers, less common (25%) bronchial carcinoma.
• Non-small cell lung cancer: squamous cell carcinoma
(40%), adenocarcinoma (25%) and large cell carcinoma (10%).
Lung Cancer - Symptoms
A new cough that doesn't go away Coughing up blood (even a small amount) Shortness of breath Chest pain Losing weight without trying Headache Red flags!
Lung Cancer - Treatment
Pulmonary Rehabilitation!
Chemo, radiation therapy, surgery.
Lung Cancer - Prevention
- Don’t smoke (15x to 30x more likely)
- Stop smoking
- Avoid second-hand smoking
- Avoid exposures to toxic chemicals
- Eat healthy
- Physical activity
Interstitial Lung Disease - Definition
Progressive (irreversible) scarring of lung tissue surrounding alveoli (abnormal healing process after injury). Affects ability to breathe and get enough O2
into your bloodstream.
Examples: Idiopathic Pulmonary Fibrosis, Hypersensitivity Pneumonitis, Sarcoidosis, Asbestosis.
Interstitial Lung Disease - Symptoms and Diagnosis
Shortness of breath - dry cough
Spirometry – diffusion capacity testing
Blood test
CT-scan
Biopsy
Interstitial Lung Disease - Cause
Long-term exposure (eg. pollutants, toxins)
Auto-immune diseases
Idiopathic
Interstitial Lung Disease - Treatment
Medication may slow down damage (corticosteroids) – lung transplantation.
Tuberculosis - Definition
Infectious disease mainly affecting lungs, spread via droplets.
Some are drug-resistant.
Can also affect other organs.
Can give rise to restrictive disease (scarring).
Tuberculosis - 2 Types
Latent TBC: Non active – not contagious. Early treatment.
Active TBC: Makes you ill, contagious.
Tuberculosis - Symptoms
Coughing that lasts three or more weeks Coughing up blood Chest pain, or pain with breathing or coughing Unintentional weight loss Fatigue Fever Night sweats Chills Loss of appetite
Tuberculosis - Risk Factors
HIV
Traveling in certain areas (Africa)
Poverty and substance abuse (alcohol, smoking)
Lack of medical care
Working place (health care work, refugee camp)
Tuberculosis - Prevention and Treatment
Prevention: contamination
Treatment: medication, vaccination
Pulmonary Hypertension - Definition
- High blood pressure in pulmonary arteries
- narrowing of arteries + ↑ pulmonary resistance
- ↑ blood pressures in pulmonary arterioles/capillaries
- Extra work for the right cardiac output
- Right heart muscle hypertrophy that can lead to heart failure
Pulmonary Hypertension - Symptoms
Dyspnea Fatigue Dizziness or fainting spells Chest pressure or pain Swelling in your ankles, legs and eventually in your abdomen Cyanosis Heart palpitations
Pulmonary Hypertension - Causes
- Idiopathic
- Left-sided heart failure (↑ left-sided filling pressures)
- Lung disease (eg. emphysema, lung fibrosis)
- Blood clots (eg. pulmonary emboli)
Pulmonary Hypertension - Treatment
- Can’t be cured, but manage and delay progression
- Medication – blood vessels dilators – Anti-coagulants
- Transplantation (in younger people with idiopathic pulmonary arterial hypertension)
Acute Respiratory Distress Syndrome (ARDS) - Definition
- Acute-onset hypoxemic respiratory failure, high mortality.
* Fluid build up in alveoli (pulmonary edema)
ARDS - Symptoms
Severe shortness of breath
Labored and unusually rapid breathing
Low blood pressure
Confusion and extreme tiredness
ARDS - Causes
Sepsis (severe infectious conditions)
Inhalation of harmful substances
Severe pneumonia
Head, chest or other major injury (lung contusions)
ARDS - Treatment
Underlying cause
Artificial ventilation
ICU - Shock Conditions
- Hypovolemic Shock: Loss of blood or blood plasma with a loss of volume in the circulation.
- Cardiogenic Shock: Failure of the heart pump with undersupply of the circulation.
- Septic Shock: Reaction of the whole organism on an infectious condition.
- Anaphylactic Shock: Due to an allergy
- Neurogenic shock: Spinal cord trauma
ICU - Acquired Weakness, Sarcopenia
80% of patients develop neuromuscular dysfunction due to a long period of immobilization in hospital.
Sarcopenia: Muscle loss that occurs with aging and/or immobility. Degenerative loss of skeletal muscle mass, quality and strength.
Bronchiolitis - Definition
- Inflammation of the bronchioles
- < 2 years old (accumulation of secretion, highly susceptible to viral infection).
- Premature babies
- Contagious (droplets – object to person)
Bronchiolitis - Clinical Presentation
- Persistently increased respiratory effort
- Tachypnea
- Nasal flaring
- Intercostal or suprasternal retractions
- Accessory muscle use
- Hypoxemia
- Apnea
- Acute respiratory failure
- Vomiting!
- Fever
Cyanosis
Bronchiolitis - Management
Educate parents Hydration Respiratory support Nasal suctioning Supplemental oxygen
Bronchiolitis - Interventions
Inhaled broncho dilatator
Hypertonic saline
Glucocorticoids
Chest physiotherapy
Primary Ciliary Dyskinesia - Definition and Treatment
• Inherited condition • Cilia structure abnormal - movement in uncontrolled way - ineffective mucociliary transport system - less mucus clearance - respiratory infections No effective treatment strategies. Control infection, removed trapped mucus.
Infant Respiratory Distress Syndrome -
Premature babies.
Not had enough time in utero for their lungs to mature
- lack of surfactant, collapse of alveoli, ↓ gas exchange.
Symptoms similar to ARDS.
Treatment: Oxygen supplementation, artificial surfactant.
Neuromuscular Diseases Related to Respiratory Impairment
ALS
Multiple Sclerosis
Muscular Dystrophies
Spinal Muscular Atrophy
Neuromuscular Diseases - Functional Outcomes and Symptoms
Muscle weakness → Lung restriction and respiratory muscle function loss. Numbness or loss of sensation Muscle atrophy Loss of balance and motor control Breathing and swallowing difficulties
Neuromuscular Diseases - Physiotherapy Treatment Goals
- Improve QoL
- Delay the progression of functional impairments
- Ventilatory support and Respiratory Physiotherapy
- End of life care
Sleep Apnea - Definition and Types
Apnea is the cessation of ventilatory movement for, at least 10 seconds during sleep.
• Ipopnea: reduction of the airflow during sleep .
- Obstructive Sleep Apnea (OSA): relaxation of the upper airway to the complete closure of the airway.
- Central Sleep Apnea: rare, could be idiopathic, or
secondary to the lesion in the SNC respiratory center.
Sleep Apnea - Risk Factors, Diagnosis and Treatment
Risk factor: obesity, metabolic syndrome.
Diagnosis: polysomnography, blood gas analyses
Treatment: CPAP, loss weight, lifestyle changing.
Diaphragmatic Dysfunction - Types
- Eventration: permanent elevation of all or part of the hemidiaphragm.
- Diaphragmatic weakness: partial loss of muscle strength to generate the necessary pressure for adequate ventilation.
- Paralysis: total absence of movement.
Diaphragmatic Dysfunction - Factors and Treatment
Diaphragm goes down 6-7cm normally during contraction → only 4 cm with diaphragmatic dysfunction. Treatment: Surgery (pacemaker, phrenic nerve repair Mechanical Ventilation (life support).
