Systemic pathology 400 (Respiratory pathologies 1-2) Flashcards
SSx – potential SSx for respiratory disorders
wheezing, rales
lightheadedness
thicker mucus
cough
shortness of breath (dyspnea)
Dx – potential Dx for respiratory disorders
auscultation
imaging
pt Hx
physical exam
spirometer
biopsy (?)
Tx – potential Tx for respiratory disorders
bronchodilator
anti-inflammatories
Cystic fibrosis
inherited genetic disorder
AUTOSOMAL RECESSIVE
–> most fata autosomal recessive disorder
Affects EXOCRINE glands
–> including pancreas glands
–> and bronchial mucus glands
CF affecting exocrine glands
Defective ion transport channels of Na+ and Cl-
Mucosal secretions become very thick and viscous
which systems are most affected by CF
Respiratory,
digestive,
and reproductive systems are most affected
what does CF predispose individual to?
Predisposes to chronic bacterial airway infections
what does CF progressively lead to?
Progressive loss of pulmonary function
CF incidence – which groups most common in>?
Most common inherited genetic disease in white Europeans
how many new cases are diagnosed per year in US?
Over 1000 new cases diagnosed per year (US)
how many people are carriers of CF?
~1 in 25 are carriers
CF etiology
Autosomal recessive
which chromosome is affected in CF?
Genetic defect on chromosome 7
chromosome 7 affected d/t …?
Spontaneous mutation
CF pathogenesis
Impaired Na+/Cl- channels cause accumulation of salt in tissues
Surrounded mucous is abnormally thick
CF mucus salt concentrations are …
People with cystic fibrosis have a higher than normal level of salt in their sweat
mucous gland secretions viscosity is …?
Dehydrated and INCREASED viscosity of mucous gland secretion
note sweat glands and CF (sweat glands are also exocrine glands)
Elevation of sweat electrolytes (sodium chloride)
CF sweat test (Dx)
A chloride sweat test helps diagnose cystic fibrosis (CF), an inherited disorder that makes kids sick by disrupting the normal function of epithelial cells.
These cells (exocrine cells?) make up the sweat glands in the skin and also line passageways inside the lungs, liver, pancreas, and digestive and reproductive systems.
CF and pancreas
Pancreatic enzyme insufficiency
why pancreatic enzyme insufficiency?
Mucus also collects in the pancreas, which keeps digestive enzymes from reaching the small intestine.
result of pancreatic enzyme insufficiency?
Leads to malabsorption of nutrients
Stools are bulky, greasy and malodorous
Children often show growth abnormalities
most important complicaiton of CF
Most important complication involves bronchial mucosa
Bronchial mucous plugs prevent normal respiration
CF clinical manifetations
Variable
severity of SSx/clinical manifestations of CF associated strongly with …
Severity strongly associated
with socioeconomic status
and access to healthcare
important clinical manifestation (as mentioned above as well)
sweat/skin
Abnormally high sodium and chloride concentrations in
the sweat
CF GI tract manifestations
Poor nutrition (malabsorption)
Weight loss
Growth retardation/FTT (failure to thrive in newborns)
Intestinal obstruction from thick, dry stool
Prolapse of the rectum (??)
why prolapse of rectum during CF
Rectal prolapse probably occurs in CF at least in part because of a combination of voluminous bowel movements and poor nutrition (z), perhaps involving decreased perirectal fat, and may be aggra- vated by secondary manifestations of pulmonary disease such as coughing paroxysms and pulmo,rary overinflation.
meconium ileus & CF
Meconium ileus (10-15% of newborns)
Meconium blocks the ileum
“Meconium ileus is a bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum. Most infants with meconium ileus have a disease called cystic fibrosis.”
CF pulmonary clinical manifestations
80-90% (?) (80-90 experience these SSx (??))
Chronic cough
Purulent sputum (pus)
Hypoxia
Cyanosis
Respiratory failure
CF and barrel chest
As an individual works harder to breathe, they may develop barrel chest
CF and kyphosis
People with CF also report more back and spine pain. These changes to the posture and spine, combined with weakened bones, can result in kyphosis.
CF and pectus carinatum
probably d/t abnormal breathing pattern & mm/bone mechanics
CF and clubbing (digital clubbing)
Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.
why low oxygen lead to digital clubbing?
You make more VEGF when your tissue can’t get enough oxygen, and as a result, you grow more blood vessels, which may change the appearance of your fingers. Clubbed nails occur when your fingertips bulge and the nails curve down and get shiny.
VEFG
Vascular Endothelial Growth Factor (VEGF)
CF – why chronic pulmonary infeciton
Pathogens become trapped in these abnormal lung secretions, leading to chronic infection and persistent inflammation.
CF genitourinary SSx (reproductive system)
Infertility is universal in men and common in women
–> fallopian tubes mucociliary action is comprimised (d/t same reason – thickened mucus secretions w/ excess NaCl)
–> in males, the ductus deferens simple doesn’t even develop
CF and ductus deferens (vas deferens)
Congenital bilateral absence of vas deferens (CBAVD) affects about 1/1,000 males.
It is found in 98% of males with cystic fibrosis and accounts for 6-8% of cases of obstructive azoospermia.
In about 50% of cases, the CBAVD is associated with the absence of the seminal vesicles.
why is it called cystic fibrosis
The name “cystic fibrosis” refers to the characteristic fibrosis and cysts that form within the pancreas.
CF – musculoskeletal clinical manifestaitons
Muscle pain
Decreased bone density
why CF mm pain?
Although the musculoskeletal aspects of CF are less commonly studied, fractures (predominantly spinal), muscle injuries, and joint pain are more commonly seen in the CF population compared to the general public due to their lower bone mineral density, dysfunctional skeletal muscle, and elevated levels of pro-inflammatory cytokines.
CF – endocrine clinical manifestations
Cystic Fibrosis-Related Diabetes (mix of Type 1 and 2)
why CF –> diabetes?
CF can cause scarring of the pancreas because of thick, sticky mucus. This prevents the pancreas from producing normal amounts of insulin so people with CF can have insulin insufficiency and sometimes even become completely deficient.
CF Dx
Genetic testing
Clinical presentation – failure to thrive, respiratory compromise
Sweat test
Pancreatic enzyme tests
Pulmonary function test
CF Tx
Variable depends on the systems involved
Antibiotics
Medications
Chest PT
Adequate nutrition
Supplementation
Lung transplant
which groups live longer with CF?
wealthier – higher socioeconomic class
= better Tx
CF Px
Improving
Median survival rate – 37 years old
Bronchogenic cyst
A rare condition characterized by the formation of a cyst in the middle of the chest, usually behind the manubrium
how are bronchogenic cysts usually found?
Usually found incidentally
(i.e. not generally symptomatic
bronchogenic cyst SSx (?)
Often asymptomatic,
but symptoms may include chest pain,
cough,
shortness of breath
EXTRALOBAR SEQUESTRATION
Extralobar sequestration is a mass of lung tissue that is not connected to the bronchial tree and is located outside the visceral pleura. An abnormal artery, usually arising from the aorta, supplies the sequestered tissue.
extralobar sequestration is considered ..
Considered congenital
extra lobar sequestration – functional tissue ?
Lung sequestration is a rare congenital anomaly characterized by non-functional lung tissue that lacks normal bronchial communication and receives blood supply from an aberrant systemic artery.
Extralobar sequestration (ELS) is less common and usually found in the lower thoracic or upper abdominal regions.
intralobar sequestration
Intralobar sequestration is a mass of lung tissue within the visceral pleura, isolated from the tracheobronchial tree and supplied by a systemic artery.
intralobar sequestration –> is it more or less common than extralobar sequestration?
More common
is intralobar sequestration congenital?
For many years it was thought to be congenital, but is now thought to be acquired.
how is intralobar sequestration acquired?
“The majority of intralobar sequestrations are probably acquired lesions. Patients usually present before the age of 20 years with recurrent infection. At pathologic examination, intralobar sequestration is characterized by inflammation and fibrosis.”
Chest trauma (?)
Common cold (rhinovirus)
Aka – infectious rhinitis
is there fever with common cold ?
usually afebrile
which part of the respiratory tract is affected during common cold?
the upper respiratory tract.
describe the common cold
An acute, usually afebrile, self-limiting viral infection of the upper respiratory tract.
common cold etiology
Rhinovirus (50%)
other viruses that can cause common cold (less common)
Coronavirus
Adenovirus
Parainfluenza virus
Other viruses
parainfluenza define
a disease caused by any of a group of viruses which resemble the influenza viruses.
adenovirus
any of a group of DNA viruses first discovered in ADENOID tissue, most of which cause respiratory diseases.
recall adenoids
Adenoids are a patch of tissue that is high up in the throat, just behind the nose. They, along with the tonsils, are part of the lymphatic system.
common cold clinical manifestations
“Scratchy” or sore throat (pharyngitis)
Sneezing
Rhinorrhea
Nasal obstruction
Cough
Sickness behaviour
“Sickness behaviour” define
Definition. Sickness behavior is a coordinated set of adaptive behavioral changes that occur in physically ill animals and humans during the course of infection. These behaviors include lethargy, depressed mood, reduced social exploration, loss of appetite, sleepiness, hyperalgesia, and, at times, confusion.
hyperalgesia etymoloy
hyper
“algein” = “feel pain”
INFLUENZA
“The flu”
Influenza is a viral respiratory infection causing fever, coryza, cough, headache, and malaise.
coryza define
acute inflammation of the mucous membrane of the nose, with discharge of mucus; a head cold.
from greek:
koruza = nasal mucus
coryza other note about etymology
Greek kóryza, meaning “catarrh.” Catarrh is an inflammation of a mucous membrane and an excessive secretion of mucus. Coryza is a specific kind of catarrh that happens in the nose or nasal cavities.
coryza (google):
“catarrhal inflammation of the mucous membrane in the nose, caused especially by a cold or by hay fever.”
influenza vs mortality
Mortality is possible during epidemics, particularly among high-risk patients.
–> E.g. very old patients, or patients that are ill / immunocomprimised
influenza etiology
Influenza virus most often
Can be other viruses as well (like common cold)
influenza virus – risk factors
Children
Elderly
Chronic disease
Pregnancy
Other disorders
influenza – clinical manifestaitons
Common cold
Conjunctivitis (pink eye)
Chills
Fever
Prostration
Cough
Aches and pain
Headache
Coryza
Scratchy throat (pharyngitis)
Nausea
Vomiting
Abdominal pain
why conjunctivitis during flu?
Some strains of the flu may cause conjunctivitis. However, it’s not nearly as common a cause as adenovirus, Marioneaux says
chills & flu
They are most often associated with a fever. Chills are caused by rapid muscle contraction and relaxation. They are the body’s way of producing heat when it feels cold. Chills often predict the coming of a fever or an increase in the body’s core temperature.
Once the higher temperature is set, your body begins working to increase its temperature. You will feel cold because you are now at a lower temperature than your brain thinks you should be so your body will begin to shiver to generate heat and raise your temperature. This is the chills.
influenza and nausea/vomiting (GI tract SSx)
??
influenza – medical management
Diagnosis - clinical evaluation
Treatment – symptomatic, antivirals
Prognosis - good
____
____
From last slide – why nausea/vomiting?
“These symptoms come from inflammation in your stomach and intestines. (Although the name, gastroenteritis, refers to your stomach and small intestine, inflammation can spread to your large intestine, too). Inflammation is your immune system activating to fight the virus.”
who are the people that die usually from the flu?
very old
already ill
immunocompromised
influenza – COMPLICATIONS
Pneumonia
Encephalitis
Guillain-Barré Syndrome
Renal disease
___
___
Influenza viruses initially infect the upper airways but can directly extend to the lower airways in severe cases, resulting in a viral pneumonia with significant morbidity and mortality.
influenza and encephalitis (compication)
The exact mechanisms by which the virus triggers encephalitis are not fully understood, but it is thought to be related to the immune response and inflammation.
influenza and the pneumonia
Once the immune system is compromised, or while it is fighting a virus, patients have a higher risk of developing more severe infections, such as pneumonia.
most common complication of the flu
Pneumonia is one of the most common complications that can occur as a result of the flu.
The condition can become very serious and even life-threatening (esp old/immunocompromised)
Guillan Barre Syndrome
a disorder of the peripheral nerves, often preceded by a virus infection, usually beginning in the lower limbs and resulting in abnormal sensation and muscle weakness or paralysis.
how long does influenza survive on surfaces?
Influenza A virus can survive for 24 to 48 hours on hard, nonporous surfaces such as stainless steel and plastic, and for approximately 8 to 12 hours on cloth, paper and tissues 20.
how long does rhinovirus survive on surfaces?
“Cold viruses can survive on indoor surfaces for up to seven days, but are infectious only for about 24 hours.”
what is renal disease a complication of the flu?
Although the pathogenesis underlying renal injuries due to influenza A virus has not been delineated, some hypotheses have been advanced, including ATN due to renal hypoperfusion or rhabdomyolysis, glomerular microthrombosis due to DIC, direct viral injury to the kidney, and an altered immune system with systemic …
influenza – prevention
Handwashing –> recall how long the viruses survive on surfaces
Vaccination
cold vs flu
stuffy/runny nose
–> cold more often
sneezing
–> cold more often
sore throat
–> cold more often
nausea
–> cold more often (?)
body aches
–> flu more often
fever
–> flu. cold rare
chills/sweats
–> flu. not during cold
how fast SSx onset?
–> flu fast. cold slower.
sinus function
lighter skull
moisten air
protect against infection
sinusitis
Inflammation of the paranasal sinuses
Can be classified as acute, subacute, recurrent, chronic
sinusitis etiology
Viral, bacterial, fungal infection
Recurrent allergies
sinusitis – clinical manifestations
Variable
Purulent rhinorrhea
Pressure and pain
Nasal congestion and irritation
Tenderness, swelling, erythema
Toothache
Headache
Cough
Tearing
Malaise
sinusitis – tooth pain
The roots of the upper teeth are very near or may even extend into the sinus cavity. Consequently, inflammation in the sinuses might cause pain in nearby teeth.
sinusitis – Dx
History and clinical evaluation
sinusitis – Tx
Drainage
Antibiotics
Surgery
sinusitis – why surgery
If medicines and self-care have not helped with your symptoms, surgery can remove blockages and make the sinus openings bigger.
Endoscopic sinus surgery (?)
acute bronchitis
Inflammation of trachea and bronchi that is of short duration and self limiting with few pulmonary signs
what can cause acute bronchitis?
It can result from chemical irritation such as smoke, fumes, gas
dry cough vs productive (wet) cough
..
influenza –> productive cough
chronic bronchitis –> can be dry cough
what are some other causes of chronic bronchitis?
May occur from viral infections such as
influenza,
measles,
chickenpox,
whooping cough,
or bacterial infection
acute bronchitis – clinical manifestations
URI
Cold
Fever
Dry, irritating cough
Sore throat
Laryngitis
Chest pain
Productive cough
Wheezing
chronic bronchitis –> dry or productive cough?
The following are the most common symptoms of acute bronchitis. However, each person may experience symptoms differently.
Symptoms may include: Cough, first dry (nonproductive), but later with a lot of mucus.
acute bronchitis – Tx
Symptomatic
Vaccination
acute bronchitis – Px
Usually good
Complications include pneumonia
DAY 2
disorders of lower respiratory tract
obstructive disorders of the respiratory tract
lower respiratory tract
below larynx
pneumonia
probably killed more people in history than any other condition
pneumonia
infection of the lower respiratory tract
anything causing lower respiratory tract infection / inflammation
= pneumonia
pneumonitis vs pneumonia
if infectious = pneumonia
if not infectious = pneumonitis
pneumonia = type of pneumonitis
pneumonia incidence
very common
4 million cases diagnosed per year
a leading cause of death worldwide
children are more likely to get
viral pneumonnia
acutls are more likely to get
bacterial pneumonia
pneumonia is caused by
bacterial viral fungal infections
usually via inhalation or aspiration
pneumonia can affect one or both
one or both lungs
pneumonia risk factors
smoking
acute respiratoyr infections
chronic bronhcitis
chronic or critical illness
immune deficiency (esp fungal pneumonia?)
other risk factors for pneumonia
being old/young
—> less effetive immune system
difficulty swallowing
periodontal disease
being disabled (nosocomial?0
altered consciousness?
alered state of consiousness as risk factor for pneumonia
because more likely to “aspirate”
E.g. trouble swallowing, atypical breathing patterns
—> “aspirating fluid/food”
periodontal disease and pneumonia
The specific type of oral bacterium that causes periodontal disease can easily be drawn into the lower respiratory tract. Once the bacteria colonize in the lungs, it can cause pneumonia and exacerbate serious conditions such as COPD.
difficulty swallowing as risk factor for pneumonia
“Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly”
“Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia”
“Community-acquired pneumonia (CAP) is a common disease and a frequent cause of hospitalisation and death among the elderly [1].”
pneumonia classifciationby acquisition
1) Community-acquired - Streptococcus pneumoniae (most common), Haemophilus influenza
2) Hospital-acquired - Staphylococcus aureus
3) Occurring in immunocompromised people (E.g. AIDS)
Classification by area involved (pneumonia)
Alveolar pneumonia – involves alveoli
Interstitial – involves septa
Bronchopneumonia – limited to segmental bronchi
Lobar pneumonia – widespread or diffuse
pneumonia pathogens
Upper respiratory flora
—> Streptococcus, Staphylococcus, Haemophilus
Enteric Saprophytes
—> Candida albicans (rare)
Extraneous pathogens
—> Mycobacterium tuberculosis, viruses
recall candida albicans
“Oral thrush produces slightly raised, creamy white, sore patches in your mouth or on your tongue. Oral thrush — also called oral candidiasis (kan-dih-DIE-uh-sis) — is a condition in which the fungus Candida albicans accumulates on the lining of your mouth.”
“Thrush is a common yeast infection that can occur on different parts of the body. It is caused by a yeast overgrowth known as candida albicans. Vaginal thrush can cause various symptoms including an itchy vagina or vulva, white vaginal discharge and stinging or burning.”
pneumonia classificaotn via DURATION
Acute
Chronic
Recurrent
pneumonia via routes of ifection
INHALATION of pathogens in air droplets
ASPIRATION of infected secretion from URT, e.g. Staph and Strep
ASPIRATION of infected particles from GI, food or drinks, etc.
HEMATOGENOUS spread – from sepsis
hematogneous spread deifne
distributed or spread by way of the bloodstream, as in metastases of tumors or in infections; blood-borne.
pneumonia pathogeneiss
Invading microorganisms cause alveolar macrophages to release biochemical mediators
inflammatory response does not eliminate pathogen
microorganisms multiply and release damaging toxins
inflammatory and immune response damages parenchyma
resolution may lead to scarring and loss of function (loss of parenchyma)
pneumonia clinfcal manifestations
Sudden, sharp pleuritic chest pain
Hacking, productive cough
Rust or green-coloured sputum
Dyspnea
Tachypnea
Cyanosis
Headache
Fatigue
Fever
Chills
Aching
Myalgia
why pneumonia cyanosis
“It is evident that the cyanosis of pneumonia patients is due to the incomplete saturation of venous blood with oxygen in the lungs, and that the various shades of blue observed in the distal parts are caused by an admixture of reduced hemoglobin and oxyhemoglobin in the superficial capillaries.”
Which pneumonia has less symptoms
viral pneumonia typically not as many SSx
pneumonia Dx
Culture
Chest films (CXR)
Physical examination
CXR define
chest X ray
“A chest X-ray uses radiation to create an image of your heart, lungs and bones. A chest X-ray can diagnose health conditions like pneumonia or COPD.”
easier and cheaper than blood test for PNEUMONIA
CXR –> more effective than blood test (?)
Pneumonia Tx
Antibiotics (if bacterial)
Rest
Fluids
Medications
Vaccinations
what lok for in CXR?
“CONSOLIDATION”
–> inflammatory exudate (fluid that is building up b/c of inflammation)
—> more dense (CONSOLIDATION)
—-> IMPORTANT Dx-tic TOOL
fungal infections vs antibiotics?
To treat a fungal infection, you won’t be prescribed an antibiotic. Specific antifungal medications include topical, oral, and intravenous treatments.
pneumonia — COMPLICATIONS
PLEURITIS
ABSCESSES
CHRONIC INFLAMMATION
pleuritis (complication of pneumonia)
Leads to pleural effusion
Pus can fill the pleural cavity (pyothorax, empyema)
Can be encapsulated with fibrous tissue
pleuritis vs restrictive lung disease
Obliterates the pleural cavity
→ lungs cannot expand during inspiration
→ restrictive lung disease
empyema vs pyothorax
i.e. more or less interchangeable (?)
Sometimes called pyothorax or purulent pleuritis, empyema develops when bacteria invades the pleural space.
pyothorax = presence of pus in the pleural cavity, between the membrane lining the thoracic cage and the membrane covering the lung.
empyema = Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space).
Abscesses (complication of pneumonia)
From highly virulent bacteria, esp. staph.
Destroys the lung parenchyma
Pus causes destruction of walls → bronchial dilation (aka bronchiectasis)
abscess define
a swollen area within body tissue, containing an accumulation of pus.
___
empyema vs abscess?
“Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection.”
chronic inflammation as a complication of pneumonia
Esp. with pneumonia that is unresponsive to treatment
End up with destruction of lung parenchyma and fibrosis → aka HONEYCOMB LUNGS on x-ray
honeycomb lungs define
“Honeycomb lung refers to the characteristic appearance of variably sized cysts in a background of densely scarred lung tissue.”
Pneumocystis Jirovecii Pneumonia (PCP)
–> fungal pneumonia
“Pneumocystis pneumonia (PCP) is a serious lung infection that affects people with weakened immune systems.”
Often fatal (if not treated)
fungal pneumonia
Etiology – idiopathic
Risk factors – immunosuppression, chemotherapy, transplantation, malnutrition
Clinical manifestation – fever, impaired gas exchange, progressive dyspnea, fatigue, weight loss, cough, pneumothorax
Diagnosis – lab tests; treatment – antifungal meds
pneumocystis pneumonia AKA
Pneumocystis pneumonia; Pneumocystis jirovecii pneumonia; Pneumocystis jiroveci pneumonia; Pneumocystis carinii pneumonia [outdated term];
LEGIONNAIRE’S DISEASE
Rare infectious disease caused by Legionella pneumophila
Can cause massive consolidation and necrosis of lung parenchyma associated with high mortality
Also causes other severe symptoms including high fever, nausea, vomiting, headache, chills, disorientation, etc.
Treatment - antibiotics
PULMONARY TB
Infectious, inflammatory systemic disease of the lungs that may disseminate to involve lymph nodes and other organs
pulmonary TB may be
May be primary or secondary
primary infection of pulmonary TB is usually
whereas secondary TB develops when …
Primary infection is usually asymptomatic (chronic or latent)
Secondary TB develops when the primary infection becomes active as a result of lowered resistance
PULMONARY TB – Incidence
2 billion cases worldwide
Highest in SE Asia, Africa, eastern Europe
Etiology – TB
Mycobacterium tuberculosis
PULMONARY TB – Risk factors
Immunocompromised
Elderly
Overcrowding
Ethnicity
Immigrants
Drugs, alcohol
Malnutrition
Poor health
Infants and children
Chronic diseases
Low SE status
Pulmonary TB – important RISK FACTOR
Smoking may increase the risk of advanced disease
two types of pneumonia that are rare – & worse prognosis (?)
Pneumocystis Jirovecii Pneumonia
Legionnaire’s disease
pulmonary TB – pathogenesis
Involves inhalation of m. tuberculosis
—> macrophages and lymphocytes aggregate around organism
—> lymphocytes release cytokines
—> transforms macrophages into epithelioid cells
—> multinucleated giant cells
—> cluster around to form granulomas with caseous necrosis
(type IV HS reaction)
pneumocystis jirovecii pneumonia affects specific group
severely immunosupressed individuals
–> “fungal infections don’t generally affect people”
—> people who are immunocomprimised are most at risk
important unique clinicla manifestation of pneumocytsis jirovecii pneumonia
PNEUMOTHORAX
—> pneumothorax is more typically assocaited wiht PCP, but is not the primary cause for mortality
Pumonary TB –> HS type
TYPE 4 HYPERSENSITIVITY REACITON
—> Delayed cell-type HS reaction
pneumocystis Jirovecii & AIDS link
very commonly associated with AIDS
—> I.e. immunocomprimised individuals
—> is diagnostic tool —> if HIV is confirmed, and pneumocystis jirovecii takes place, it is strong evidence that HIV has become AIDS
Pulmonary TB & GHON COMPLEX
Ghon’s complex is a lesion seen in the lung that is caused by tuberculosis.
The lesions consist of a Ghon focus along with pulmonary lymphadenopathy within a nearby pulmonary lymph node.
GHON focus define
A Ghon focus is a primary lesion usually subpleural, often in the mid to lower zones, caused by Mycobacterium bacilli developed in the lung of a nonimmune host.
It is named for Anton Ghon, an Austrian pathologist.
pulmonary TB – Clinical manifestaions
Delayed, insidious, non-specific
Productive cough
Hemoptysis
Weight loss
Fever
Night sweats
Fatigue
Malaise
Anorexia
why called legionnaire’s disease
veterans
veterans spending time @ legion
legion:
“any of the national associations of former servicemen and servicewomen instituted after World War I, such as the American Legion.”
PULMONARY TB – Dx
History
Physical exam
Tuberculin skin test
Culture sputum
tuberculin skin test
“A tuberculin skin test (also called a Mantoux tuberculin test) is done to see if you have ever been exposed to tuberculosis (TB).”
“The test is done by putting a small amount of TB protein (antigens) under the top layer of skin on your inner forearm. If you have ever been exposed to the TB bacteria (Mycobacterium tuberculosis), your skin will react to the antigens by developing a firm red bump at the site within 2 or 3 days.”
Pulmonary TB – Tx
Medications
strucutre meant to destroy TB
granuloma
—> walls of TB
primary TB –> TB gets walled off by grnulomas\
secondary TB –> when immunocomproimised, TB can show up again
is latent TB infetious
no
mycobacterium
fungal bacterial
cities and prisons –> TB
prisons and cities overcrowded
–> very highly assocaited with TB
ghon complex
granulomas forming + adjacent lmyph node involvemnet
–> spread of granuloma + lymph node involvemnet
–> visble on X ray
hemoptysis and TB
not common, but can indicate TB (as opposed to Pneumonia)
night sweats and TB
also typical of TB & may indicate TB (as opposed to pneumonia)
the rest of TB just looks like
pneumonia
antibiotics and TB
LONG DURATION OF ANTIBIOTIC COCKTAIL
E.g. for SIX MONTHS!
lung abscess
localized accumulation of PURULENT exudate.
within the lung
lung abscess usually develops as a complication of …
Usually develops as a complication of pneumonial
lung abscess -TIOLOGY
Aspiration of oral secretions by patients with gingivitis or poor oral hygiene.
—> Typically, patients have altered consciousness as a result of alcohol intoxication, illicit drugs, anesthesia, sedatives, etc.
—> Older patients and those unable to handle their oral secretions, often because of neurologic disease, are also at risk.
what is the most common pathogen of LUNG ABSCESSES?
anaerobic bacteria
others can involve aerobic bacteria as well.
most common aerobic bacteria leading to lnug abscess
streptococci and staphylococci.
which other type of pathogen is a pathogen for LUNG ABSCESS?
Who does this one affect most?
MYCOBACTERIA OR FUNGI
Immunocompromised patients with lung abscess may have infection with MYCOBACTERIA or FUNGI.
lung abscess pathogenesis
Introduction of these pathogens into the lungs first causes inflammation, which leads to tissue necrosis and then ABSCESS formation.
The abscess usually ruptures into a bronchus, and its contents are EXPECTORATED, leaving an air- and/or fluid-filled cavity.
expectorated
to eject from the throat or lungs by coughing or hawking and spitting.
why is there bad breath in patients
Abscesses tend to connect with other airways and erode bronchial walls.
Patients end up with putrid malodourous expectorations.
–> dead tissue / necrosis / pus
Lung abscesses – clinical manifestations
Productive cough
Foul-smelling sputum
Persistent fever
Chills
Dyspnea
Chest pain
Cyanosis
Clubbing
Hemoptysis
lung abscess – cyanosis
same reason as pneumonia
why clubbing (lung abscess – and lung diseases in general)
Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing. Clubbing may result from chronic low blood-oxygen levels.
clubbed fingers –> pathogenesis (?)
Clubbed fingers and thumbs are often linked to underlying health issues like lung or heart disease. While the exact cause is unclear, substances in the blood, such as vascular endothelial growth factor (VEGF), which increases when tissue lacks oxygen, may cause the condition.
liung abscees – Dx
X-rays (CXR to determine underlying condition (?))
Sputum analysis
Imaging
lung abscess – Tx
Antibiotics
Good nutrition
Percussion (massage)
Drainage
COPD
Chronic airflow limitation that is not fully reversible
1) Chronic bronchitis
2) Emphysema
1) Chronic bronchitis
Chronic bronchitis is defined as a productive cough lasting for at least 3 months per year for two consecutive years.
2) Emphysema
Emphysema is destruction of lung parenchyma and pathological accumulation of air in the lungs.
COPD – epidemiology
Incidence - 12 million (US)
Mortality – 3rd leading causing of death
Morbidity - 2nd leading cause of disability*
Estimated to cost US over $800 billion over the next 20 years
Men and women affected equally, but female incidence is climbing
why female incidence climbing?
women are smoking more often
COPD – Etiology & risf actors
Exposure to environmental irritants
Age
Genetics
BUT MOST IMPORTANTLY
—> SMOKING (esp tobacco)
Pathogenesis of Chronic bronchitis (under catgeory of COPD)
Inflammation and scarring of bronchial lining leads to obstruction of airflow and increased mucous production
Irritants cause an increase in size and number of mucous producing glands and hypertrophy of smooth muscle cells
Leads to obstruction of airways
Impaired ciliary function predisposed to infection
Infection results in increased mucous production, bronchial inflammation and thickening
why impaired cilia lead to increased infection
cilia aren’t sweeping irritants / pathogens up the respiratory tract (I.e. the mucociiary elevator is comprimised)
Clinical manifestaitons of Chornic bornchitis
Productive cough
SOB (dyspnea)
Recurrent infection
Fever
Malaise
Cyanosis
Cor pulmonale
Barrel chest (uncommon)
why chronic bronchitis Cor Pulmonale
RIGHT SIDE VENTRICLE HYPERTROPHY
—> “Chronic obstructive pulmonary disease (COPD) is the leading cause of cor pulmonale. Cor pulmonale in COPD is generally known to occur due to loss of vascular bed and chronic hypoxic pulmonary vasoconstriction (HPV) due to alveolar wall destruction.”
Emphysema –> pathogenesis
Destruction of elastin protein in the lung leads to permanent enlargement of acini
Loss of elasticity causes narrowing or collapse of bronchioles which traps air in lungs
Leads to breathing difficulties
—> Hypoxemia and hypercapnia
Pockets of air called BLEBS and BULLAE
emphysema and chronic bronchitis – informal terms
“pink puffers” (emphysema pt)
“blue bloater” (chronic bronchitis pt)
BLEBS AND BULLAE
- Blebs are small 1- to 2-cm subpleural air spaces that a frequently present on the apices of nor- mal lungs.
- Bullae are relatively large air-filled spaces that arise in the apices of the upper lobes and the su- perior segment of the lower lobes.
why blue bloaters vs red puffers
Patients with Blue Bloater phenotype are more likely to be overweight or obese and have a chronic productive cough with sputum production.
Patients with Pink Puffer phenotype are more likely to have a normal or low body weight and pursed-lip breathing.
“The term “pink puffer” was used in the past to refer to patients with emphysema. Doctors used this term because emphysema causes people to have difficulty catching breath. As a result, patients gaps or take short, fast breaths. This often causes them temporary redness or pink coloring on their cheeks and faces.”
“The term “blue bloater” was used in the past to refer to patients with chronic bronchitis. Doctors referred to these patients as “blue bloaters” because chronic bronchitis can cause severe difficulty breathing and decreased oxygen in the body. This can result in a patient’s skin and lips taking on a blueish tint.”
Clinical manifestations of Emphysema
Marked exertional dyspnea
Dyspnea at rest
Thin, barrel chest, hypertrophy of accessory muscles of respiration
Tachypnea
Anxiety
Wheezing
Cough
COPD – Dx
History
Physical exam
Pulmonary function tests
X-ray (CXR?)
CT scan
Blood tests (arterial oxygen saturation, as well as other markers for differential)
COPD – Tx
Quit smoking
Medications
Airway clearance
Exercise
Avoiding irritants
Diet
Oxygen
Surgery
diet and COPD (??)
“Breathing requires more energy for people living with COPD. Your muscles may require 10 times more calories than someone without COPD. The foods you eat provide your body with nutrients like carbohydrates, fats and proteins. Eating a diet with less carbohydrates and more fat may help you breathe easier.”
??
COPD – Px
Poor
Mortality rate 10 years after diagnosis is greater than 50%
Bronchiectasis
Progressive form of obstructive lung disease characterized by irreversible destruction and dilation of airways
Generally associated with chronic bacterial infections and CYSTIC FIBROSIS
what is another type of obstructive lungdisease
Bronchiectasis
what major condition is bronchiectasis strongly associated with?
CYSTIC FIBROSIS
what does bronchiectasis involve?
irreversible destruction and dilation of airways
Bronchiectasis risk factors & Etiology
1) Any condition that produces a narrowed lumen of the bronchioles
—> TB, viral infections, pneumonia, structural anomalies
2) Immunodeficiency
3) Genetic conditions
4) Cystic Fibrosis
—> Almost everyone with CF eventually gets bronchiectasis
Bronchiectasis —> Pathogenesis
All the causative conditions impair airway clearance mechanisms and host defenses, resulting in an inability to clear secretions and predisposing patients to chronic infection and inflammation.
Due to frequent infections, airways become filled with viscous mucous that contains inflammatory mediators and pathogens.
Airways slowly become dilated, scarred, and distorted.
Histologically, bronchial walls are thickened by edema, inflammation, and neovascularization.
Destruction of surrounding interstitium and alveoli causes fibrosis, emphysema, or both.
BRONCHIECTASIS — Clinical manifestations
I.e. VERY SIMILAR TO PREVIOUS LOWER RESPIRATORY TRACT CONDITIONS WE LOOKED AT
Persistent coughing with large amounts of purulent sputum
Dyspnea
Fatigue
Weight loss
Anemia
Fever
Hemoptysis
Weakness
Clubbing
Foul-smelling sputum
Bronchiectasis —> Dx
Imaging
History
Clinical manifestation
Genetic testing
bronchiectasis – Tx
Bronchodilators
Antibiotics
Corticosteroids
Hydration
Surgery
Why bronchodilators for pt w/ bronchiectasis??
for some patients it relieves their symptoms. Reason not clear (?)
