respiratory pathology 3 Flashcards
how does cigarette smoking contribute to emphysema
inactivation of alpha -1 antitrypsin
activates polymorphonuclear leukocytes to cause emphysema
inflammation of the ear drum
otitis media
inflammation of the larynx
laryngitis
inflammation of the epiglottis
epiglottitis
tonsillitis
inflammation of the tonsils at the back of the throat
croup
Laryngotracheobronchitis
factors to look for in upper respiratory tract infections in children
whether they are breathing fine , hydration and feeding
causes of the upper respiratory tract infections
viral
bacterial in some cases
effects of a bacterial infection
could be locally causing the cardinal roles of inflammation
could be systemic that is affecting other regions of the body
how do the pathogens invade the respiratory system
disruption of the epithelium will lead to entry of the microorganisms into the respiratory tract
diseases where there is local inflammation only
otitis media
tonsillitis
systemic effects of the disruption of the rep epithelium
Otitis media, tonsillitis (local)
Septicaemia (systemic)
Pneumonia (systemic)
Meningitis (systemic)
commensal bacteria
bacteria whose main habitat is in the human body and under normal conditions they do not lead to spread of disease.
for example the nose , mouth , lungs , stomach , colon , sexual organs and skin
pathogenesis in bacteria
viruses invasion are repelled quite quickly as compared to any other pathogen
bacteria type 1 cause the degradation of the epithelium but the immune cells can handle example pneumococcus , staphylococcus , moraxella and haemophilus
examples of bacteria that cannot be fully destroyed by the immune system
pertussis
TB
treatment of upper respiratory tract infections
treatment with analgesia /antipyretic to relieve the pain
is it better to use antibiotics in upper resp infections
no , more side effects
1.Diarrhoea
2.Oral thrush
3.Nappy rash
4.Allergic reaction
5.Multi resistance
natural history in predicting the pattern of a upper respiratory infection
pattern cannot be predicted as it is different with different individuals
rhinitis
could be a prodrome to other illnesses such as pneumonia , bronchiolitis , meningitis , septicaemia
duration of rhinitis
not all the same although 50% of children had a runny nose gone within 11 days after the start
otitis media
primarily a viral infection with a characteristic pink colour which causes the rupture of the ear drum
otitis media as a secondary infection
pneumococcus
influenza flu
duration of otitis media
50% of children recovered within 3 days ; upto 3 day s
treatment of otitis media
analgesia
amoxycillin if the child is less than 2 and has otitis media in both ears; however the disease will still be resolved with both the analgestics and antibiotics but antibiotics have many side effects
testing for bacterial or viral tonsillitis
throat swab
treatment for tonsillitis
either nothing or penicillin
no amoxycillin
duration of a sore throat
50% should be done within 3 days
group 1 strep A disease
more systemic effects
high fever
rashes
more unwell ( lol funny guy)
pathogen that causes croup ( infection of the trachea , bronchi , larynx)
parainfluenza 3
symptoms of croup
quite common
the child is generally well
stridor , hoarse voice , barking cough
oral dexamethasone
treatment of croup
cause of epiglottitis
haemophilus influenza type B
symptoms of epiglottitis
very rare
child generally unwell
stridor breath sounds and drooling of saliva
management of epiglottitis
intubation and antibiotics
duration of croup
mean population within 3 days
recurrent croup
present in older population
related with malacia
commonly presented as asthma symptoms
common bacterial agents
Strep pneumoniae,
Haemophilus influenzae,
Moraxella catarrhalis,
Mycoplasma pneumoniae
common viral agents
Rhinovirus, RSV,
parainfluenza III,
influenza,
adenovirus,
coronavirus,
Human Meta Pneumo Virus
tracheitis
croup that does not get better
fever and sick child
cause of tracheitis
staphylococci
streptococcus
symptoms of tracheitis
systemically unwell
tachycardia
narrowed tracheal lumen
swollen tracheal wall
treatment and management of trachealis
antibiotics
steroids to be used at first
bronchitis in children
common among ages 1 to 4
infection of the bronchi
COPD
emphysema
chronic bronchitis - cough and sputum for at least 3 months present for at-least 2 consecutive years
cause of COPD
inhalation of noxious particles and gases
which leads to the loss of alveolar attachments and thus decreased ability of the lungs to open up during expiration
difference between COPD and asthma
asthma is reversible
prevalence and incidence of COPD
1.2 million people living with a diagnosis of COPD everyday
with males having a greater number of prevalence than women
copd and social deprivation
air pollutants exposure
poor nutrition
low socioeconomic status
FEV -1 of people with COPD
smoking during gestation and childhood has the potential for increasing and increases the individual risks of developing COPD.
known factors that increase the risk of COPD
age
sex
Alpha-1 Antitrypsin Deficiency
rare inherited disease
manifested as COPD in childhood
manufacture of alpha 1 trypsin inhibitor
liver
liver cirrhosis and liver fibrosis cause less production of the enzyme
consequences of alpha -1 - antitrypsin inhibitor
alveolar damage and emphysema
basal predominance to emphysema
symptoms of COPD
cough
breathlessness
sputum
frequent chest pains
wheezing
fatigue
weight loss
swollen legs
factors that contribute to COPD
age
smoking history
onset and progression
examination findings of COPD
peripheral oedema
hyperinflated chest
use of accessory muscles
cyanosis
cachexia
wheeze ( often a musical sound)
mMRC dysponoea scale
scale that is used to measure levels of breathlessness
0-4
diagnostic tests for COPD
post- bronchodilator spirometry to test for airflow obstruction
history and symptoms
chest x ray to show the severity
spirometry tests results for COPD
diagnosed FEV1/FVC which is less than 0.7 post bronchodilator which shows no reversibility
stages of COPD
Stage 1, mild — FEV1 80% of predicted value or higher. With these values, a diagnosis of COPD can only be made on the basis of respiratory symptoms.
◦Stage 2, moderate — FEV1 50–79% of predicted value.
◦Stage 3, severe — FEV1 30–49% of predicted value.
◦Stage 4, very severe — FEV1 less than 30% of predicted value.
chest x ray interpretation of COPD
small heart - that is squashed by the hyperinflated lungs
flat diaphragm
hyperinflation - more than 6 anterior or 10 posterior ribs in the mid -clavicular line at the diaphragm level
vascular hila
differentiating between asthma and COPD
history of smoking or occupational gas particles .
obesity causes decreased airflow into the lungs which can be displayed as anormal spirometry when it is indeed COPD
differences between COPD and asthma
1.Reversibility, asthma spirometry should be normal out with exacerbations
2.PEFR little value in COPD and not used to stratify exacerbation severity
is still not sure about whether it is COPD
pulmonary function test that is measure the lung volumes
1.there is is increased residual volume and total lung capacity
2.there is reduced gas transfer with carbon dioxide levels
3.radiology that is high resolution computed tomography.
acute exacerbation of COPD
1.following a bacterial or a viral infection
2.air pollution
3.stopping treatments
4.poor nutrition
5.drugs such as diuretics
6.inappropriate oxygen administration
7.heart failure pulmonary embolus pneumothorax
symptoms of acute exacerbation of COPD
worsening symptoms of shortness of breath , chest tightness , sputum that is increased volume and purulence and coughing.
signs of a severe exacerbation
breathless that is increased respiratory rate of more than 25
accessory muscle at use
purse lip breathing
cyanosis
signs of sepsis
fluid retention
confusion
management of acute exacerbations
change in inhaler ( technique , device , bronchodilator , increase or add inhaled steroid)
prednisolone tablets ( oral steroids )
antibiotics
self managements
differential diagnosis of acute exacerbation
of COPD
pneumonia
pulmonary embolism
myocardial infarction
left ventricle failure
pleural effusion
pneumothorax
deciding whether to admit someone with COPD or not
social aspects that is care of who is at home
comorbidity and background of the disease
acute exacerbation diagnosis in secondary care
chest x ray
blood gases
FBC 9 full blood count )
sputum culture
VTS( viral throat swab )
treatment of COPD in acute exacerbation in secondary care
oxygen
oral and IV corticosteroid and antibiotic
nebulised bronchodilator ( beta-2 and antimuscarinic )
measuring severity of COPD
1.spirometry
2.nature and magnitude of symptoms MRC breathlessness scale
3.history of moderate and severe exacerbations and future risk
4.presence of co-morbidity
in severe disease
respiratory failure which is caused by
ventilation perfusion mismatch
in type 1 there is reduced oxygen in type 2 there is increased CO2
this leads to flapping tremor when there is increased carbon dioxide retention
severe COPD
cor-pulmonale
secondary polycythaemia
respiratory failure
cor pulmonale in COPD
Tachycardic, oedematous, raised JVP, congested liver
ECG features: Right axis deviation, P pulmonale, T wave inversion V1-V4
Echo: pulmonary hypertension, tricuspid regurgitation
secondary polycythaemia
increased production of erythropoietin in response to low oxygen .
increased haemoglobin , increased haematocrit and increased blood viscosity which leads to strokes
deaths from lung diseases in UK
lung cancer
COPD
admission of COPD in the UK
females is greater than in the UK
Public measures to prevent COPD
public ban
sale of tobacco from vending machines
age of tobacco products purchase
non pharmacological management of COPD
smoking cessation
vaccinations that is pneumococcal and annual flu vaccine
pulmonary rehabilitation
nutritional assessment
psychological support
vaccinations for COPD management
annual flu vaccine
pneumococcal vaccine
treatment for COPD with predominant breathlessnes
SABA
SABA AND LAMA
COPD with exacerbations
SABAand lama
oxygen therapy for COPD patients
partial pressure of less than 7.3 and for only a short duration with the following symptoms
polycythaemia
nocturnal hypoxia
peripheral oedema
pulmonary hypertension
