Respiratory Pathophysiology

Question 1

Obstructive Lung Diseases

Answer 1

~Cannot get the air OUT of the lungs

Cystic fibrosis, Cancer, Aspiration pneumonia, Asthma, Emphysema, Chronic bronchitis

Question 2

Restrictive Lung Diseases

Answer 2

~Cannot get the air INTO the lungs

Chest wall abnormalities, Connective tissue abnormalities (pneumoconiosis)

Question 3

Upper Infectious Diseases

Answer 3

~Upper Respiratory infection (URI)

Question 4

Lower Infectious Diseases

Answer 4

~Affect more
~Bronchiolitis (RSV)
~Pneumonia
~SARS/MERS
~TB
~Fungal diseases

Question 5

Vascular disorders

Answer 5

~Pulmonary edema
~Pulmonary embolism

Question 6

Expansion disorders

Answer 6

~Atelectasis
~Pleural effusion
~Pneumothorax

Question 7

Upper Respiratory infection (URI)

Answer 7

~Acute inflammatory process that affects mucus membrane of the upper respiratory tract
~Includes one or more of these problems: Rhinitis, Pharyngitis, Laryngitis, Sinusitis
~Symptoms: Low-grade fever, malaise, sore throat, discharge
~Etiology: >200 different viruses have been implicated, can get 2ary bacterial infection

Question 8

Lower Respiratory infection
~Pneumonia

Answer 8

~6th leading cause of death in US; incidence highest in elderly
~Etiology: Common bacteria (pneumococcus), Viral most common in children
~Fungi - Coccidiomycosis (Valley Fever)
~Trauma to lungs
~Foreign body aspiration

Question 9

Lower Respiratory infection
~Tuberculosis (TB)

Answer 9

~TB incidence began increasing in the late 1980’s: HIV population–>opportunistic infections
~Mycobacterium tuberculosis is quite resistant to eradication and can live in an inactive form for long times
~Very contagious via air droplets
~Symptoms: Fever, Chills, Night sweats, Productive cough, Loss of appetite, Weight loss, Fatigue

Question 10

Lung Cancer

Answer 10

~Broadly classified into 2 types
—>Non-small cell
—>Small cell
~Based upon the microscopic appearance of the tumor

Question 11

Chronic Obstructive Pulmonary Disease (COPD)

Answer 11

~Irreversible progressive obstruction of air flow in lungs
—>Chronic Bronchitis
—–>Bronchiectasis
—>Emphysema
~Air goes into lungs easily but unable to come out; air trapped in distal alveoli, causing hyperinflation & over-distension

Question 12

Chronic Bronchitis

Answer 12

~Chronic inflammation of mucus membrane
~Chronic mucus producing cough most of the days of the month…
~Hyperplasia of mucosa & destruction of cilia (chronic, deep, productive cough)
~Long-term smoking, certain env. factors such as textile dust fibers
~Symptoms: Productive cough, SOB, wheezing

Question 13

Bronchiectasis

Answer 13

~Permanent, irreversible DILATION & distortion of bronchi
~Takes years to develop
~Primarily in the lower lobes
~Symptoms: chronic productive cough

Question 14

Emphysema

Answer 14

~Destructive disease of alveolar septa
~Chest x-ray shows: translucent appearing lungs, flattened diaphragm, & cardiomegaly
~Increased lung compliance
~Decreased lung elasticity

~Lungs expand but due to lack of elasticity, lungs stay out and can’t push air out

Question 15

Asthma

Answer 15

~Chronic inflammatory disorder associated with airway hyper-responsiveness leading to recurrent episodes
~Often reversible airflow limitation
~Prevalence increasing in many countries, especially in children

Question 16

Characterized by decreased airway compliance

Answer 16

Restrictive lung diseases (no air in)
2 groups

Question 17

Abnormalities of chest wall which limits lung expansion
(Restrictive)

Answer 17

Kyphosis, Scoliosis, Polio, ALS, Muscular dystrophy, Burn scar

Question 18

Disease affecting lung tissue that provides supporting framework
(restrictive)

Answer 18

Occupational diseases (pneumoconiosis), Idiopathic pulmonary fibrosis (autoimmune disease), Pulmonary edema, Acute respiratory distress syndrome (ARDS)

Question 19

Pulmonary edema

Answer 19

~Fluid collection (edema) in all lung tissues
~Affects gas exchange
~Affects lung expansion
~KEY: Pulmonary capillary pressure increases & fluid moves into alveoli
~Capillaries rupture & get bloody sputum (hemoptysis)
~True medical emergency
~Etiology: Left sided heart failure, Inhalation of toxic gases, Lymphatic blockage

Question 20

Pulmonary Emboli

Answer 20

~Clot of foreign matter that occludes artery in pulmonary system
~Size of embolus & general health of patient determine degree of damage and amount of symptoms
~Thrombus (most common)
—>Air, fat, bacteria, tissue (large bone Fx can result in fat emboli)
~Risk increased by CHF, lung disease, stasis with varicosities
~90% originate from deep veins (primarily in leg)

Question 21

Atelectasis

Answer 21

~Collapsed pulmonary tissue
~Results in degrees of hypoxia
~Causes: Pleural effusion, Obstruction of the bronchial tree (absorption atelectasis), Compression atelectasis

Question 22

Pleural Effusion

Answer 22

~Fluid separates the 2 pleural membranes
~Lungs do not expand properly during inspiration since there is no cohesion btw lung/visceral pleura/parietal pleura
~Types:
—>Transudates = hydrothorax
—>Blood = hemothorax
—>Pus = empyema

Question 23

Pneumothorax

Answer 23

~Collection of air or gas in pleural cavity resulting in collapse (partial/full) of lung
—>Spontaneous-tear in visceral pleura leads to air entering pleural space from lung
—>Open -usually 2ary to trauma
—>Tension

Question 24

Cor Pulmonale

Answer 24

~Pulmonary heart disease
~Disease of the RIGHT side of the heart from pulmonary hypertension
~Does not include pulmonary hypertension as a result of LEFT sided heart failure
~Causes: COPD, Pulmonary fibrosis, Persistent atelectasis, PE, Pulmonary vascular sclerosis
~Right ventricle develops hypertrophy and over time the right ventricle is unable to maintain cardiac output