Topic 32-37: Upper respiratory tract, restrictive and obstructive disorders Flashcards
infections of the upper respiratory tract include:
rhinitis sinusitis acute pharyngitis tonsillitis otitis media
rhinitis includes several types. briefly describe
allergic rhinitis: hay fever, IgE response
Infectious rhinitis: common cold, catarrhal discharge, sneezing, sore throat. Viral!
Chronic rhinitis:repeated acute rhinitis attacks causing secondary bacterial infection with purulent exudate. occurs with nasal polyp
sinusitis includes several types. briefly describe
acute sinusitis: preceding acute or chronic rhinitis. typically bacteria from oral cavity
chronic sinusitis: prolonged sinusitis, mixed microfloral infection or even mucor
acute pharyngitis, descibe
can be viral or bacterial,
- rhinovirus, echovirus, adenovirus
- group a strep (more severe with tonsillitis, exudates)
- EBV
tonilitis:
can be viral or bacterial, more often viral!!
- reddening, swollen, exudative tonsils
- streptococcal tonsillitis should be checked because it can lead to peritonsillar abscess, post strep glom nephritis, and acute rheumatic fever
otitis media: what is it generally and it has two types
infection of middle ear typically due to eustachian tube, associated with hearing loss, especially seen in young children.
- acute OM- abrupt ear pain, blacked E tube leads to buildup of air, can be bacterial or viral
- chronic OM - no symptoms, buildup of fluid, can be bacterial or viral
tracheitis is what ? complications?
inflammation of the trachea, almost always bacterial
- seen in children
- can cause airway obstruction
- symptoms are stridor, cough, fever, chest pain
long term incubation causes decubitus
laryngitis has several types
- acute bacterial epiglottitis
- acute laryngitis
- laryngotracheobronchitis
acute laryngitis is what? what are some rare forms that you should know?
inhalation of an irritant or infectious agent.
tuberculosis - coughing up infectious sputum
diphtheritic - pseudomembrane (fibropurulent exudate)
laryngotracheobronchitis is what
normally due to parainfluenzae virus
- normally in children who live in dry places
- scary stridor and cough, can narrow airways to cause respiratory failure
vascular pulmonary diseases include:
- pulmonary emboli –> hemorrhage and infarct
- pulmonary hypertension
- diffuse pulmonary hemorrhage
- atelectasis
pulmonary embolisms are dependant on size of the occluded artery. what are the consequences depending on the artery occluded?
small
- alveolar hemorrhage
- If peripheral - infarct (only 10%)
- silent
medium
-alveolar hemorrhage
large
- decreased co
- RSHF
- hypoxemia
- death (due to >60% vasculature occlusion with large or multiple small emboli)
what is the fate of the pulmonary emboli?
60-80% silent
10-15% - small or medium a obstruction –> infarct
5% death
pulmonary hypertension is typically due to what?
Primary:
- idiopathic
- familial
secondary
- COPD or interstitial lung disease
- recurrent pulmonary emboli
- antecedent heart disease (atrial stenosis, right->left shunts, LVHF)
- NOTE: can be pulmonary arterial or venous hypertension in pathogenesis!!
in primary pulmonary HT, what is the name of the condition and general pathogenesis?
uncommon familial pulmonary HT: proliferation of SM and vascular endothelial cells due to mutations of bone morphogenetic protein receptor type 2
diffuse alveolar hemorrhage causes
goodpasture syndrome
idiopathic pulmonary hemosiderosis
wegener granulomatosis
goodpasture syndrome is what?
antibodies against alpha3 chain of type 4 collagen
- shows linear Ig pattern
- hemorrhage and fibrosis
idiopathic pulmo hemosiderosis is what?
unknown etiology, looks like goodpasture w/o Ig
wegener granulomatosis is what?
pulmonary necrotizing vasculitis and granulomas, hemorrhage, upper airway involvement with sinusitis, nasal perforation
C-ANCA
++Remember Polyarteritis nodosa (p-anca) thus the other one is the other anca
acquired atelectasis has three types
resorption
compression
contraction
resorption atelectasis is:
airway obstruction causes trapped air to be resorbed and alveoli collapse
lung volume decreases and mediastinum is pushed towards the collapsed lung
compression atelectasis
pleural cavity gets filled with fluid or air causing lung to be compressed
mediastinum shifts away from collapsed lung
contraction ateletasis
fibrosis of pleura or lung prevents full expansion
COPD is which 4 disorders? what is their FEV1/FVC ratio
asthma
emphysema
chronic bronchitis
bronchiectasis
ration is normal or decreased
what are the anatomical locations of COPD?
all in the large airways/bronchi except emphysema is in the alveoli
asthma is defined as what? what are the types?
chronic inflam of the airways
- atopic asthma - most common type
- non-atopic asthma - idiopathic, perhaps viral
- drug induced asthma - aspirin sensitivity with nasal polyps
- occupational asthma - fumes, dusts, gases
what is the 2 wave reaction?
early: bronchocontriction, mucus production and vasodilation
late: inflam, active eosiophils, neutrophils, epithelial cells and leukocytes
recurrent attacks lead to what?
bronchial wall remodelling
- hypertrophy of SM and glands
- inc vascularity and subepithelial collagen
emphysema: types?
centriacinar
panacinar
distal acinar
irregular
what are the genetic factors that play a role in emphysema? what also contributes to emphysema?
polymorphisms in response to injury enzymes:
-alpha 1 antitrypsin def
polymorphism in MMP expression
-high MMP 9 and 12
Toxin exposure also contributes
chronic bronchitis is associated with what two main symptoms
hypersecretion of mucous (hypertrophy of glands) airway obstruction (due to mucous plugs and fibrosis)
bronchiectasis is what? what are the predisposing conditions?
dilation of the bronchioles and bronchi
- bronchial obstruction
- hereditary conditions (CF, immunodef, kartagener syndrome)
- necrotizing/ suppurative pneumonia
what is the general pathogenesis of bronchiectasis?
obstruction and chronic persistent infections
diffuse alveolar damage is a histological pattern of what condition? This condition is formed by two mechanisms
Acute respiratory distress syndrom (ARDS)
formed by
- direct lung injury - pneumonia, aspirations, hemorrhage
- indirect lung injury - sepsis, shock, etc
damage will cause inc permiability of vessels, alveolar flooding, loss of diffusion capacity and surfactant abnormalities
ARDS has two morphological stages
acute phase - dark, heavy, congested lungs filled with exudate. hyaline membrane formation,
organized phase - proliferation of type II pneumocytes, organization of fibrin exudate
pneumoconiosis is due to what and what are the three most common causative agents?
- caused by inhalation of dust
- coal, silica, and asbestos
What particle size is most dangerous and why?
1-5 micrometers because they get lodged in the bifurcations.
larger particles are cleared away, smaller ones act like gases and move in/out
coal dust pneumoconiosis has 3 different morphologies
- anthracosis
- simple coal workers pneumoconiosis
- complicated coal workers pneumoconiosis
simple coal workers pneumoconiosis is characterized by what?
Coal macules - coal laden macrophages
coal nodules- coal macules with collagen
complicated coal workers pneumoconiosis is generally what?
progression of simple coal workers pneumoconiosis that needs years to develop black scar lesions with dense collagen. causes pulmonary disfunction, HT and cor pulmonale
silicosis is associated with what actions
sandblasting, rock-mining, roofing. these actions allow silica crystals to be inhales and phagocytosed by pulmonary macrophages, causing fibrosis
what is characteristic of silicosis?
silicotic nodules - concentrically arranged collagen fibers (whorled appearance)
These eventually join together to form a large scar
asbestosis is associated with which health problems?
- pulmonary interstitial fibrosis (asbestosis)
- fibrous plaques
- pleural effusions (due to inflam)
- bronchogenic carcinoma (or other primary lung cancers)
- mesothelioma
- laryngeal carcinoma
asbestos is carcinogenic how?
it can be a tumor initiator, promoter because it can even absorb harmful carcinogens in tobacco smoke
what is the anatomical fibrosis progression is asbestosis, silicosis, and CWP?
asbestosis starts in the lower lobes and moves up
silicosis and CWP moves down from the upper lobes
what is the most common manifestation of asbestosis?
pleural plaques
