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Fundamentals of disease > Respiratory system > Flashcards

Respiratory system Flashcards

1
Q

List and define the major disorders of the pulmonary system

Understand signs and symptoms of cyanosis

A

Goals for respiratory lecture

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2
Q

Provides the mechanisms for transport of oxygen from air into blood
Remove carbon dioxide from blood

A

Purpose of respiratory system

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3
Q

passageways that conduct air between atmosphere and lung

A

Upper respiratory tract

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4
Q

trachea, bronchial tree, lungs
where gas exchange takes place

Also pulmonary circulation, muscles, nervous system

A

Lower Respiratory tract

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5
Q

Mucous secreting cells: trap particles
Cilia: sweep mucous and debris out of respiratory tract

Too much mucous or particles: sneeze or cough

Smoking: irritation impairs cilia
Squamous cells replace ciliated epithelium

A

Respiratory Mucosa

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6
Q

Food and air: separate at esophagus and trachea
Epiglottis: protects opening into larynx
Trachea: is windpipe: composed of smooth muscle and elastic tissue with cartilaginous C rings

A

Pharynx

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7
Q

Sympathetic stimulation
Relax smooth mm
Dilate/enlarge bronchioles

Bronchiolesalveolar ducts alveoli

A

Bronchodilation

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8
Q

Single layer of simple squamous epithelial cells
Promotes diffusion of gasses

Respiratory capillary membrane: combined alveolar and capillary wall: gas exchange

Pulmonary capillaries in close contact with alveoli

Macrophages in alveoli: remove foreign material

A

Alveoli

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9
Q

Detergent action
Decreases surface tension
Facilitates inspiration
Prevents collapse of alveoli when expires

A

Surfactant

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10
Q

Air flows from high pressure to low pressure area

Pressure change in lungs from alteration in size of thoracic cavity

A

Ventilation

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11
Q

Ventilatory capacity
Measure air moving in and out of lungs
Disease processes may change this

A

Pulmonary Volume

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12
Q

Residual volume: volume remaining in lung after maximal expiration (1500ml)
Vital capacity: max amount of air that can be moved in and out of lungs (4000ml)
Dead space: areas where gas exchange cant take place
Tidal volume: air entering lungs with normal breath (500ml)
Inspiratory reserve; max volume air inspired after max expiration (2500ml)
Expiratory reserve: max volume of air expired following passive expiration (1000ml)
Total lung capacity: total volume of air in lung after max inspiration (5500ml)
Forced Expiratory volume in 1 sec (FEV1) volume of air forcibly expired after maximal inspiration in 1 sec (approx 80% of VC) 3200ml
Minute ventilation: Tidal volume x Rate of Ventilation 500 x 15 = 7500
Inspiratory capacity: TV+ IRV
Functional Residual Capacity; ERV+RV-air left after normal exhalation
Vital Capacity: IRV+TV+ERV-max air exhaled after max inhalation

A

Pulmonary volumes

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13
Q

Measured with peak flow meter
Reached within
100 milliseconds of expiration
Used to evaluate asthma

A

Peak Expiratory Flow

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14
Q

Medulla and pons
Inspiration: medulla: basic rhythm: phrenic nerve to diaphragm
Expiratory center: used when need forced expiration
Pons: coordination
Depression: meds, shallow breathing, hypothalamus
CO2 levels inhibit voluntary control
Chemo receptors: respond to elevations in CO2 or decrease in oxygen

A

Control of Ventilation

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15
Q

Must drop significantly (105 to 60mm Hg) before body responds to hypoxemia
Gas exchange: depends on relative concentration of gases
Gases move from high pressure area to low pressure area
Gas exchange can depend on thickness of membrane
Accumulation of fluid: oxygen diffusion is impaired
Extra fluid impairs blood flow

A

Oxygen levels

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16
Q

Affected by surface area
Decreased surface area, decrease in gas exchange
Emphysema or fibrosis
Most oxygen is carried bound to hemoglobin
Oxygen is released so can absorb into cells
Partial pressure of dissolved oxygen determines how much oxygen is released
CO2 diffuses: easily carried out

A

Gas exchange

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17
Q 
Partial pressure of oxygen in blood
Hypercapnia
Hypoxemia
PaO2: 95-100mmm Hg
PaCO2 35-40 mmHg
Measure arterial blood gasses in radial artery
Pulse oximater
Normal pulse ox 96-100%
A

Arterial blood gasses

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18
Q

pH is usually slightly basic 7.35-7.45
Scale 0-14 (acid-base)
Low pH: acidosis
High pH: alkalosis
High PaCO2: respiratory acidosis: chronic bronchitis
Low PaCO2: respiratory alkalosis: pneumonia

A

Acid Base Balance of Blood

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19
Q 
Radiographs:
Change in lungs
Opacities: lesions
CT: x-rays at various angles
Detailed
MRI
More sophisticated
A

Chest imaging

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20
Q 
Pulmonary arteriography/angiography
Blood vessels
Detect emboli, vascular abnormalities
Use catheter through femoral vein
Bronchoscopy
Examination of trachea and bronchi
Uses flexible tube
Can take biopsy
Exercise Tolerance
A

Other testing

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21
Q

Increase in negative pressure

Children, paralysis of intercostal muscles

A

Intercostal indrawing

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22
Q

Exhalation over trachea: higher pitched, longer than inhalation
Lung: vesicular sounds
Inhale: whoosh
Exhale: quiet
Sounds you might hear
Tracheal sounds over lungs (Pneumonia), absence of sound (effusion, collapsed lung, pneumothrax), crackles, wheezing

A

Breath sounds

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23
Q

Spirometry: test volumes and airflow
Arterial blood gas: check oxygen, CO2, bicarbonate, serum pH
Exercise tolerance: use with COPD: monitor progress
X-rays: tumors and infections
Bronchoscopy: biopsy check lesion
Culture and sensitivity
Peak expiratory flow: use with asthma
Acid base balance: usually 7.35-7.45 pH
Resp acidosis (pH low) resp alkalosis (pH high)
CT: use to rule out or in several pathologies
MRI:
Pulmonary angiography: look at blood vessels:
Exercise Tolerance
Graded Ex tolerance test: cardio and pulmonary status
Metabolic Equivalent (MET) 1 MET= amnt oxygen required with body at rest in sitting
CBC

A

Diagnostic Tests

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24
Q 
Upper respiratory infection 
Common cold: 
Viral
Many organisms
Usually self limiting
Spread by respiratory droplets
Mucous membranes red and swollen
Increase in secretions
Sore throat, fever, headache
Treatment: symptomatic: acetaminophen, decongestant
A

Infectious Disease

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25
Q

Streptococcus pneumoniae

Inflamed, necrotic mucous membranes

A

Secondary infection

26
Q 
Bacterial?
Usually obstructed drainage
Pressure builds
Haemophilus influenzae, pneumococci, streptococci
Nasal congestion
Fever
Sore throat
Treat: decongest, analgesic, antibiotic
A

Sinusitis

27
Q 
Viral
Upper and/or lower respiratory tract
Viruses mutate
Sudden onset, fever, marked fatigue, aching pain
Can get secondary infection
A

Influenza

28
Q

Primary infection or secondary to another condition
Aspiration or inflammation of lung
Classify by agent (bacterial, viral, fungal), location, epidemiology, pathophysiologic changes
Lobar pneumonia: usually strep
Manifestations: sudden onset, high fever, chills, fatigue, leukocytosis, dyspnea, tachypnea, tachycardia, pleuritic pain, rales, productive cough

A

Pneumonia

29
Q

Diffuse infection
Lower lobes
Pooled secretions

A

Bronchopneumonia

30
Q

Atypical pneumonia
Spreads rapidly
High mortality rate
Risk factors: travel to China, Hong Kong, Taiwan

A

Severe Acute Respiratory Syndrome

31
Q 
At one time considered controlled
Now increasing globally
Prevalence difficult to estimate
Caused by  Mycobacterium tuberculosis
Hard to kill
Primary infection: upper lobe local inflammatory rctn
Produce granuloma with caseation: usually wall off
Ghon complexes

Miliary TB: progressive form, doesn’t respond well to treatment
Secondary: “active”
Transmitted by oral droplets, milk in some countries
Crowded conditions, situations when resistance is low
Signs/symptoms: anorexia, malaise, fatigue, weight loss
Cough: more severe and productive
Sputum: purulent, blood
Positive TB test, chest x-ray, CT

A

Tuberculosis

32
Q

Home or hospital
Combination of drugs
Treat 3 months to a year

A

Tuberculosis treatment

33
Q 
Cystic Fibrosis
Inherited
Genetic
Thick secretions; mucous is tenacious
Obstructs lungs and pancreas
Bronchial walls become damaged
Infections are common
A

Obstructive Lung Disease

34
Q 
Salty skin
Malabsorption
Steatorrhea: bulky, fatty, foul stools
Frequent respiratory infections
Hypoxia, fatigue, exercise intolerance
Diagnose: sweat test
Treat: pancreatic enzymes, bile salts, chest therapy, bronchodilators, aggressive treatment when necessary
A

Cystic Fibrosis

35
Q

Primary and secondary cancers
3rd most common cancer
90% lung cancer related to smoking
Metastatic cancer: due to lymphatic and venous return

A

Lung Cancer

36
Q 
Broncho genic carcinoma
From bronchial epithelium
Most common malignant tumor
Oat cell (small cell) carcinoma
Rapid growth
Usually near major bronchus
Very invasive, metastasize early
Large cell
Found in periphery of lung
Rapid growth, metastasize early
A

Pathophysiology of lung cancer

37
Q

Most common malignant lung tumor
First change: metaplasia
Chronic irritation
Lung tissue more vulnerable
Tumor: obstruction, inflammation, pleural effusion
Para neoplastic syndrome: secretes hormones (ADH)

A

Bronchogenic carcinoma: from bronchial epithelium:

38
Q 
Persistent, productive cough
Chest x-ray evidence
Hemoptysis
Chest pain
Weight loss, anemia
A

Signs/symptoms of lung cancer

39
Q

Chest x-ray
MRI/CT
Mediastinoscopy

A

Diagnosis for lung cancer

40
Q

Surgery

Photodynamic therapy

A

Treatment for lung cancer

41
Q

Severe/reversible bronchial obstruction
Hypersensitive or hyper responsive airways
Acute or chronic
Rate from mild to severe

Extrinsic: type I hypersensitivity: immune rctn to smoke, perfumes, strong smells, molds, dander
Intrinsic: nonimmune, occur in adults; respiratory infx, exposure to cold, exercise, medications, psychological stress

A

Asthma

42
Q

Inflammation of mucosa
Edema
Contraction of smooth muscles
Increase in thick mucous

Partial obstruction of small bronchi, bronchioles: air trapping
Hard to get fresh air in

A

Pathophysiologic changes in asthma

43
Q

Total obstruction of airway
Mucus plugs block airflow
Atelectasis occurs
Section of lung can collapse

Oxygen levels are reduced
Vasoconstriction
Reduced blood flow through lungs
Increase workload of right side of heart

A

Pathophysiologic changes of asthma

44
Q

May develop irreversible damage to lungs
Bronchial walls thicken
Fibrous tissue in areas of atelectasis

A

Chronic asthma

45
Q

Family history of hay fever, asthma, eczema
Viral URI
Air pollution
Sedentary lifestyle with poorly ventilated houses

A

Etiology of asthma

46
Q 
Cough, dyspnea, tight feeling in chest
Wheezing
Thick, sticky mucous
Tachycardia
Hypoxia
Hyperventilation
Hypoventilation
Can lead to respiratory failure
A

Signs and symptoms of asthma

47
Q 
Check for allergens
Avoid triggers
Good ventilation
Exercise (swimming)
Prophylactic medication
Inhalers: relax bronchiole smooth muscles
Breathing techniques
glucocorticoids
A

Treatment of asthma

48
Q

Alveolar walls are destroyed
Permanent permanently inflated air spaces

Genetics: alpha1 –antitrypsin: inhibits activity of proteases (present during inflammation)
Cigarette smoking: increases neutrophils and decreases effectiveness of alpha 1 –antitrypsin

A

Emphysema

49
Q 
Breakdown alveolar walls
Surface area for gas exchange decreases
Loss of pulmonary capillaries
Decreased elastic fibers
Alter  ventilation/perfusion ratio
Decrease support for small bronchi: collapse walls
Fibrous thickening of bronchial walls
Narrow airways
Weakened walls
Difficulty with passive expiration
A

Emphysema

50
Q

Air trapping
Over inflation of lungs
Barrel chest
Diaphragm flattened

A

Progressive problems with expiration with emphysema

51
Q 
Large airspaces, blebs
Tissue near bleb can rupture
Hypercapnia increases
Hypoxic drive  for inspiration
Frequent infections
Pulmonary hypertension
A

Advanced emphysema

52
Q

Cigarette smoking
Genetics (early development)
Air pollution

A

Etiology Emphysema

53
Q

Dyspnea on exertion (DOA) progress to dyspnea at rest
Hyperventilation, use of accessory muscles
Anorexia, fatigue
Clubbed fingers

A

Signs and symptoms Emphysema

54
Q

Chest x-ray
Pulmonary function tests:
Increased residual volume
Increased total lung capacity

A

Diagnostics Emphysema

55
Q

Avoid irritants
Stop smoking
Immunization against influenza and pneumonia
Pulmonary rehab: appropriate breathing techniques
Pursed lip breathing
Maintain hydration and nutrition
Lung reduction surgery

A

Treatment Emphysema

56
Q

Constant irritation from smoking or industrial pollution
Irreversible and progressive
Inflammation of mucous
Hypertrophy of mucous glands: secretions are increased, increase in goblet cells
Decreased ciliated epithelium
Bronchial walls thicken, are fibrosed: leads to obstruction
Secretions pool
Low oxygen levels
Episodes of coughing: may develop cyanosis

A

Chronic bronchitis

57
Q

dyspnea, hyperventilation, over inflation- what you may call people with emphysema.

A

Pink puffer:

58
Q

low oxygen level, cyanosis, edema- what you may call people with chronic bronchitis.

A

Blue boater

59
Q

Cigarette smoking
Industrial area
Heavy smog

A

Etiology Chronic bronchitis

60
Q 
Chronic productive cough
Tachypnea, SOB
Cough more severe in morning
Hypoxia, cyanosis, hypercapnia
Polycythemia
Severe weight loss
Systemic edema
A

Signs and symptoms Chronic bronchitis

61
Q 
Reduce exposure to irritants
Vaccines
Expectorants, bronchodilators
Chest therapy to remove mucous
Low flow oxygen
A

Treatment Chronic bronchitis

62
Q

Bluish color of skin and mucous membranes
Results from large amounts of unoxygenated hemoglobin
Peripheral or generalized
Cardiovascular conditions or Respiratory disease
Not a good early indicatory of hypoxia

A

Cyanosis

Fundamentals of disease (19 decks)

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