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Organ System Anatomy, Physiology and Pathology - BPT06 > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

Obstructive Diseases - Possible Outcomes

A

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.

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2
Q

Obstructive Disease - Obstructions

A

Congestion from outside: tumor
Food
Mucus (lung secretion)
Accumulation of gas (main)

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3
Q

Obstructive Diseases

A

COPD: Chronic Obstructive Pulmonary Disease.
Cystic fibrosis/Mucoviscidosis
Asthma
Bronchiectasis
Central local obstruction (e.g. foreign objects)

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4
Q

COPD - 2 Conditions

A

Chronic inflammation → structural changes: AIRWAYS/ALVEOLI /BOTH

  • Chronic Bronchitis
  • Emphysema
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5
Q

COPD - Chronic Bronchitis

A

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
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6
Q

COPD - Emphysema

A

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,…
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7
Q

COPD - Risk Factors

A

1) Long-term exposure to lung irritants: Smoking, air pollution, chemical fumes, asthma, childhood respiratory infections.
2) Alpha-1 antitrypsin deficiency

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8
Q

Classification of COPD - GOLD

A

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.

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9
Q

COPD - Major Diagnostic Tool

A 
Spirometry
Accesses: Vital capacity (IRV, VT, ERV)
IRV: Inspiratory reserve volume
VT: Tidal volume
ERV: Expiratory reserve volume
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10
Q

COPD - Symptoms

A

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)

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11
Q

COPD - Static Lung Hyperinflation

A

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.

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12
Q

COPD - Dynamic Hyperinflation

A

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.

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13
Q

COPD - Treatment

A
  • Patient education
  • Expiration techniques
  • Airway clearance techniques
  • Physical activity training/coaching
  • Optimization pharmacotherapy + check inhalation technique
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14
Q

Restrictive Lung Diseases

A

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

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15
Q

Restrictive Lung Diseases - Characteristics

A
  • 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)
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16
Q

Restrictive Lung Diseases - 2 Reasons

A
  1. Interstitial space thicker between alveoli and capillary → Elastic recoilment↑ → compliance↓ → total lung capacity↓ → Difficulty to inhale.
  2. Problem with ventilatory muscle (neuromuscular disease) - Diaphragm total lung capacity↓ → compliance↓ → Difficulty to inhale.
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17
Q

Mixed Diseases - Restrictive and Obstructive

A
  • Pneumectomy in patient with COPD

* Lung cancer: Loss of lung parenchyma (restrictive), obstruction of the airways (obstructive)

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18
Q

Pneumonia - Definition

A
  • Infection that inflames the air sacs (alveoli)

* filled with fluid or pus (purulent material)

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19
Q

Pneumonia - Etiology

A

Community acquired: bacteria, virus, fungal.
Various germs.
Hospital acquired (nosocomial infection): 48h after admission, bacteria more resistant to antibiotics, high risk for ventilated patients.

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20
Q

Pneumonia - Symptoms

A
  • Fever
  • Shivering
  • Cough first dry then productive and purulent
  • Dyspnea
  • Tachycardia
  • Chest wall pain
  • Confusion
  • Fatigue
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21
Q

Pneumonia - Risk Factors

A
  • <2y or >65y
  • Being hospitalized
  • Chronic (cardiorespiratory) disease
  • Smoking
  • Weakened immune system
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22
Q

Pneumonia - Diagnosis

A

Chest X-ray
Blood tests
Sputum test (yellow/green)

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23
Q

Pneumonia - Treatment

A 
• Antibiotics
• Oxygen supplementation
• Physiotherapy
Prevention! → vaccination
• Smoking cessation
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24
Q

Cystic Fibrosis - Definition

A

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.

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25
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.
26
Cystic Fibrosis - Complications
* Hemoptysis (coughing up blood: RED FLAG) * Chronic infections * Bronchiectasis
27
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 ```
28
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)
29
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.
30
Bronchial Asthma - Triggers
* Exercise * Respiratory illness * Irritants in air * Allergens * Extreme weather * Emotions
31
Bronchial Asthma - Symptoms and Diagnosis
* Dry nervous cough * Dyspnea * Wheezing in expiration, prolonged expiration * Medical history * Spirometry * Allergy tests
32
Asthma - Treatment
* Expiratory techniques (pursed lips) * Breathing control in relaxing positions * Inhalation of medications * Smoking cessation * Stress reduction (avoid triggers) * Expectoration techniques (+ exercise)
33
Pneumothorax - Definition
• Accumulation of air in pleural space - Air pushes on the lung - Collapse of the lung (complete or partly)
34
Pneumothorax - Symptoms
sudden chest pain (sharp, one-sided) shortness of breath during inhalation Can be caused by a chest wound
35
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.
36
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.
37
Pneumothorax - Risk Factors
* Male > female * Smoking * Genetics * Lung disease * Mechanical ventilation * Previous pneumothorax
38
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
39
Pulmonary Edema - Definition
• Fluid in tissue/airspaces of lungs - impaired gas exchange - respiratory failure
40
Cardiogenic Pulmonary Edema
left ventricle failure → blood backing up in left | atrium → pulmonary veins → pulmonary capillaries → pulmonary hypertension → pulmonary edema.
41
Non-Cardiogenic Pulmonary Edema
Injury lung parenchyma/vasculature of lung | (chest trauma, pulmonary infections, inhalation toxics) → injury alveoli → inflammation → edema.
42
Idiopathic Pulmonary Edema
Arising spontaneously or from an obscure or unknown cause.
43
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
44
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
45
Lung Cancer - Cause
``` Smoking (85%) (carcinogens) Passive smoking Asbestosis Air pollution Family history ```
46
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%).
47
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! ```
48
Lung Cancer - Treatment
Pulmonary Rehabilitation! | Chemo, radiation therapy, surgery.
49
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
50
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.
51
Interstitial Lung Disease - Symptoms and Diagnosis
Shortness of breath - dry cough Spirometry – diffusion capacity testing Blood test CT-scan Biopsy
52
Interstitial Lung Disease - Cause
Long-term exposure (eg. pollutants, toxins) Auto-immune diseases Idiopathic
53
Interstitial Lung Disease - Treatment
Medication may slow down damage (corticosteroids) – lung transplantation.
54
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).
55
Tuberculosis - 2 Types
Latent TBC: Non active – not contagious. Early treatment. | Active TBC: Makes you ill, contagious.
56
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 ```
57
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)
58
Tuberculosis - Prevention and Treatment
Prevention: contamination Treatment: medication, vaccination
59
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
60
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 ```
61
Pulmonary Hypertension - Causes
* Idiopathic * Left-sided heart failure (↑ left-sided filling pressures) * Lung disease (eg. emphysema, lung fibrosis) * Blood clots (eg. pulmonary emboli)
62
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)
63
Acute Respiratory Distress Syndrome (ARDS) - Definition
* Acute-onset hypoxemic respiratory failure, high mortality. | * Fluid build up in alveoli (pulmonary edema)
64
ARDS - Symptoms
Severe shortness of breath Labored and unusually rapid breathing Low blood pressure Confusion and extreme tiredness
65
ARDS - Causes
Sepsis (severe infectious conditions) Inhalation of harmful substances Severe pneumonia Head, chest or other major injury (lung contusions)
66
ARDS - Treatment
Underlying cause | Artificial ventilation
67
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
68
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.
69
Bronchiolitis - Definition
* Inflammation of the bronchioles * < 2 years old (accumulation of secretion, highly susceptible to viral infection). * Premature babies * Contagious (droplets – object to person)
70
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
71
Bronchiolitis - Management
``` Educate parents Hydration Respiratory support Nasal suctioning Supplemental oxygen ```
72
Bronchiolitis - Interventions
Inhaled broncho dilatator Hypertonic saline Glucocorticoids Chest physiotherapy
73
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. ```
74
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.
75
Neuromuscular Diseases Related to Respiratory Impairment
ALS Multiple Sclerosis Muscular Dystrophies Spinal Muscular Atrophy
76
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 ```
77
Neuromuscular Diseases - Physiotherapy Treatment Goals
* Improve QoL * Delay the progression of functional impairments * Ventilatory support and Respiratory Physiotherapy * End of life care
78
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.
79
Sleep Apnea - Risk Factors, Diagnosis and Treatment
Risk factor: obesity, metabolic syndrome. Diagnosis: polysomnography, blood gas analyses Treatment: CPAP, loss weight, lifestyle changing.
80
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.
81
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). ```

Organ System Anatomy, Physiology and Pathology - BPT06 (34 decks)

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