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Sensory aspects of respiratory pathology Flashcards

1
Q

What is a symptom?

A

An abnormal or worrying sensation that leads to seeking medical attention

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2
Q

What is the pathway from sensory stimulus to the evoked sensation?

A

sensory stimulus, transducer, excitation of sensory nerve, integration at CNS, sensory impression (neurophysiology) perception, evoked sensation (behavioral psychology)

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3
Q

What is the purpose of a cough?

A

Important defence mechanism to protect lower RT from:

  • foreign bodies
  • excess mucus
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4
Q

What normally precedes a cough?

A
  • mucociliary response but in disease this may be damaged
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5
Q

What is the expulsive phase of a cough?

A
  • once mucus is in large airways stimulates cough
  • high velocity airflow generated
  • mucus or foreign body removed
  • facilitated by mucus secretion and bronchoconstriction
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6
Q

How are nerve arranged on epithelium so they can easily trigger coughs?

A

Nerve terminal on surface of the epithelium so that mechanical stimulation can trigger cough

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7
Q

Where are cough receptors found?

A
  • numerous in the posterior wall of the trachea
  • Found at main carina
  • less in the distal airways
  • not present beyond bronchioles
  • mainly in proximal airways
  • found at branching points of large airway
  • found in larynx, pharynx and external auditory meatus (part of ear)
  • found in diaphragm, pleura , pericardium and stomach
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8
Q

What are the three types of sensory receptors in the lungs and airways?

A
  • slow adapting stretch receptors
  • rapidly adapting stretch receptors
  • c fibre receptors
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9
Q

What does capsaicin (sensory nerve stimulant) do to the three receptors?

A
  • stimulates c fibres (when enters through IV)

- No effect on rapid and slow receptors

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10
Q

How are the rapidly and slow adapting stretch receptors stimulated?

A

by inflation - increase in tracheal pressure

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11
Q

How do the rapidly and slow adapting stretch receptors respond to high tracheal pressure?

A
  • Rapid ones stop firing
  • Slow ones stimulated to fire
    (these two involved in coughing)
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12
Q

What is the structure of the c fibre receptor, what do they respond to, what do they release and where are they located?

A
  • have free nerve endings
  • small and unmyelinated so slow conduction
  • respond to chemical irritants and inflammatory mediators
  • larynx, trachea, bronchi and lungs
  • release neuropeptide inflammatory mediators
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13
Q

Give examples of the inflammatory mediators that c fibre receptors release

A
  • Substance P
  • Neurokinin A
  • Calcitonin Gene Related Peptide
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14
Q

What is the structure of the rapidly adapting stretch receptor, what do they respond to and where are they located?

A
  • myelinated
  • in naso-pharynx, larynx, trachea and bronchi
  • mechanical, chemical irritant stimuli and inflammatory mediators
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15
Q

What is the structure of the slow adapting stretch receptor, what do they respond to and where are they located?

A
  • myelinated
  • in trachea and main bronchi (smooth muscle)
  • mechanoreceptors so respond to mechanical change like lung inflation
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16
Q

What are the two types of sensory receptors that cause a cough?

A
  • mechanoreceptors

- nociceptors

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17
Q

What are mechanoreceptors activated by?

A
  • citric acid

- mechanical displacement

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18
Q

What are nociceptors activated by?

A
  • caspaicin
  • bradykinin
  • citric acid
  • cinnamaldehyde
19
Q

Which of the two receptor types look like a tree?

A

mechanoreceptors

20
Q

What is the cough pathway?

A
  • Sensory info via vagus, through the brainstem to the cough centre (medulla) and also to cerebral cortex
  • The cough centre consists of the nucleus tractus solitarius
  • The reflex is probably a brainstem reflex
  • From the medullary cough pattern generator you get stimulation of various muscles needed to produce the cough (e.g. diaphragm, external intercostals, glottis is closed)
21
Q

What is the tractus solitarius?

A

A collection of neurons that are connected to the medullary cough pattern generator

22
Q

When are you able and unable to cough, and why?

A

When you go to sleep and under general anaesthetic, the cough reflex is inhibited so you need to be awake to cough because the cerebral cortex is involved

23
Q

What are the three main phases involved during the cough?

A

Inspiratory Phase - trachea opened
Glottic Closure -
Expiratory Phase

24
Q

Whilst coughing what happens to the intrapulmonary pressure and what does this lead to?

A

Increase, it causes the compression of the posterior membrane of the trachea which pushes through and narrows the trachea into a crescent shape
This increases flow and contributes to the sound produced

25
Q

What are some of the common causes of coughs?

A
  • acute infections e.g. viral pneumonia
  • chronic infections e.g. cystic fibrosis
  • airways disease e.g. asthma
  • parenchymal disease e.g. emphysema
  • tumours
  • foreign bodies
  • middle ear pathology
  • cardiovascular disease
  • drugs
  • others e.g. obstructive sleep apnea
26
Q

What is the most common cause of an acute cough <3 weeks?

A

rhinovirus

27
Q

What are the causes of a persistent cough (>3 weeks)?

A

In order of frequency:

  • Asthma and eosinophilic-associated
  • Gastro-oesophageal reflux
  • Rhinosinusitis
  • Chronic Bronchitis
  • Drugs
  • Post-viral
  • Idiopathic
28
Q

Why does gastro-oesophageal reflux cause a cough?

A

The protons coming up from the stomach can activate the cough receptors which, in turn, activate brainstem cough receptors

29
Q

What is the Cough Hypersensitivity Syndrome, what triggers are there and how can it be measured?

A
  • They are difficult to control
  • Triggers include: deep breath, laughing, talking too much, vigorous exercise, cigarette smoke, cold air, changing temperatures, lying flat
  • Sensitivity of the cough reflex can be measured using caspaicin. Caspaicin an activate nociceptors through TRPV1 receptors
30
Q

Which mechanism malfunctioning can lead to the cough hypersensitivity syndrome?

A

Neural mechanisms-
increased excitability of the afferent nerves by chemical mediators, increase in receptors like TRPV1 and increase in neurotransmitters in brainstem. There could be an increase in inflammatory mediators, which affect the reactivity of the nerves to stimuli like caspaicin

31
Q

What other disease could cause increased sensitivity causing the ‘chronic cough’?

A

Asthma leading to smooth muscle hypertrophy. Could affect the slowly adapting receptors resulting in hypersensitivity

32
Q

What drugs could be used to suppress excessive coughing (antitussives)?

A
  • opiates e.g. codiene but have many side effects (symptomatic therapy)
  • disease specific therapies include eosionophil associated e.g. inhaled corticosteroids
33
Q

How can cough hypersensitivity syndrome be managed?

A
  • speech pathology management

- drugs like opiates, gabapentin, amitryptiline and experimental ones like TRPV1 blockers

34
Q

Where does sensory input for chest pain come from?

A
  • lungs (vagus)
  • chest wall (spinal nerves)
  • nose (trigeminal)
  • pharynx (glossopharyngeal and vagus)
  • larynx (vagus)
35
Q

Compare the anatomical pathways of touch and pain?

A
  • touch goes via A alpha and A beta fibres via dorsal horn
  • pain goes via A delta and C fibres via dorsal horn
  • touch goes to the contralateral side at the level of the caudal medulla
  • pain goes to the contralateral side at the same anatomical level in spinal cord
36
Q

What is the importance of touch and pain pathways in relation to the Brown- Sequard Syndrome?

A
  • It is hemisection of the spinal cord

- if left side of spinal cord is removed than touch on opposite side is fine but pain on other side is affected

37
Q

What are the different types of pain?

A
  • somatic, very localised
  • visceral - hard to localise as number of afferent is fewer than somatic so pain in thoracic cavity and chest wall overlap making diagnosis hard
  • neuropathic
38
Q

What respiratory diseases cause chest pain?

A
  • pleuropulmonary disorders (plerual infection, pneumothorax)
  • tracheobronchitis
  • inflammation or trauma to chest wall
  • referred pain from shoulder tip or diaphragm
39
Q

What non respiratory diseases cause chest pain?

A
  • Cardiovascular disorders (MI, pericarditis, aortic valve disease)
  • Gastrointestinal disorders (oesophageal rupture, reflux)
  • Psychiatric disorders (panic)
40
Q

How is dsypnoea measured?

A

Using a scale from 0 to 4, where 0 is none and 4 is severe (called clinical dyspnoea scale by American Thoracic Society)

41
Q

What is the modified Borg Scale?

A

Used to rate from 0 to 10, where 0 is nothing bu 10 is maximum

42
Q

What are some conditions presenting with chronic dyspnoea?

A
  • impaired pulmonary function e.g. asthma
  • cardiovascular problems e.g. MI, pulmonary vascular disease
  • anaemia
  • metabolic acidosis
  • hypoxia
  • pregnancy
  • severe exercise
43
Q

What are some respiratory descriptors?

A
  • hunger for air, starved, suffocation (air hunger cluster)
  • breathing needs effort, work, uncomfortable (work/effort cluster)
  • tightness, heaviness (tightness cluster)

Respiratory (23 decks)

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