Unit 5: Respiratory Flashcards
Atelectasis
Collapse (or incomplete expansion) of alveoli
ie collapsed lung
Atelectasis: Causes
Deficient surfactant
Lung compression
Resorption of air distal to obstruction
Cystic Adenomatoid Malformation
Multiple adenomatous cysts in terminal bronchioles
Congenital, rare
Tracheal Diverticulum
Sac or pouch in tracheal wall
Congenital or acquired (chronic coughing)
Pulmonary Lobar Sequestrations
Congenital lung disorder characterized by cystic or solid masses in the thorax
Presents as lung infections
Men more than women
Intralobar Sequestrations
AKA intrapulmonary
Mass of lung tissue within the visceral pleura
Isolated from tracheobronchial tree; supplied by systemic artery
Originally thought to be congenital; now maybe acquired
Extralobar Sequestrations
AKA extrapulmonary
Mass of lung tissue not connected to bronchial tree; located outside the visceral pleura.
Supplied by abnormal artery
Congenital
Infant Respiratory Distress Syndromes
AKA hyaline membrane disease
Deficiency in surfactant
Usually in preemies
Adult Respiratory Distress Syndrome
AARDs
Changes in the lungs that lead to respiratory failure
Caused by injury to endothelial cells or alveolar lining cells
May cause cardiac failure. High (2/3) mortatlily
Causes: shock, trauma, burns, acute cardiac failure, pneumonia, toxic lung injury, aspiration
Acute Bronchitis
Inflammation of the bronchia and trachea (upper respiratory)
Short duration, self-limiting
Chemical irritation, viral or bacterial infection
Upper Respiratory Tract Infections
Bronchitis, colds, sinusitis, tonsilitis, otitis media
Mostly viral, mostly self-limiting
Runny nose, coughing, sneezing, sore throat
Good prognosis
Colds
Acute, afebrile, self limiting, viral URI
Rhinovirus (50%), coronavirus, adenovirus etc
Sinusitus
Inflammation of paranasal sinuses
Acute, subacute, recurrent, chronic
Viral, bacterial, fungal, alergies
Tonsilitis
Viral Inflammation of the tonsils (lymphoid tissue)
Sore throat, painful swallowing, swollen lymph nodes, fever, white patches on tonsils
Otitis Media
Inflammation of the middle ear
Fluid build up, bacterial movement from sinuses along eustachian tubes (which in more horizontal in children)
Bacterial, viral, RSV, influenza
Pharyngitis
Inflammation of the pharynx (lymphoid tissue)
Viral or bacterial
Sore throat, painful swallowing, muscle ache, fever
Croup
A form of laryngitis
Infection/inflammation of the false vocal cords
Bacterial, viral. Usually parainfluenza
Barking cough, stridor (wheeze with inspiration), drooling, severe throat pain
Usually resolves on its own, but can result in fatal upper airway obstruction
Epiglottitis
A form of laryngitis
Inflammation/infection of the epiglottis
Most commonly caused by H. influenza
Rare
Respiratory tract obstruction. May require intubation
Muffled voice, sore throat, drooling, stridor, cervical lymphadenopathy
Streptococcus Pneumonia
Lower respiratory tract infection
Most common cause of pneumonia, bacterial meningitis, otis media, etc.
SARS
Severe Acute Respiratory Syndrome
Viral
Highly contagious, potentially fatal
Respiratory Failure
Lung disease caused by failure of either gas exchange mechanism and/or ventilatory pump of the lungs
Type 1 Respiratory Failure
Low O2 and low-to-normal CO2 (decreased O2 intake, but gas exchange still possible)
Caused by damage to lung tissue (pulmonary edema, pneumonia, acute respiratory distress)
Type 2 Respiratory Failure
Low O2 and High CO2 (O2 intake and gas exchange both affected)
Diminished alveolar function: COPD, chest wall deformity, respiratory muscle weakness
V/Q Ratio
Ventilation Perfusion Ratio
Ratio of alveolar ventilation to amount of blood coming into the alveoli (ie the two determinants of blood O2 and CO2 concentratioin)
Pneumothorax
Accumulation of air or gas in the pleural cavity due to a defect in the visceral pleura or chest wall.
May result in a collapsed lung (atelectasis)
Primary or secondary (COPD, CF, emphysema, trauma)
Pneumothorax: Sx
dyspnea sharp, pleuritic chest pain hypotension weak and rapid pulse SOB
Pneumothorax: Pathogenesis
Air enters pleural cavity
Separation between visceral and parietal pleura
Destroys negative pressure of the pleural space
Lung collapses
Mediastinal shift may compress the other lung as well
Spontaneous pneumothorax
Generally occurs due to blebs and bullae, but also can occur due to TB, abscess, and other lung diseases.
Tall skinny smoker guys?
Traumatic pneumothorax
Results from chest trauma
Open pneumothorax
“Sucking chest wound”
A type of traumatic pneumothorax that occurs with the pressure in the pleural space equals barometric pressure.
Open wound between outside world and pleural space. Loss of negative pressure.
Tension pneumothorax
Valve-like rupture allowing inspiration but not expiration
Constantly increasing pressure may collapse lung pressure, displace other organs
Pneumonia
Inflammation of the lung parenchyma
Lower respiratory tract infection
50% viral; also bacterial, toxic, aspiration
Most common cause of community acquired pneumonia
Strep. pneumoniae
also Haemophilus influenza
Most common cause of hospital acquired pneumonia
Staph. aureus
Atypical pneumonia
“Walking pneumonia”
Less severe
Pneumonia: Sx
Chest pain Hacking productive cough Rust-coloured or green sputum Dyspnea Fatigue Fever Myalgia
Pneumonia: possible complications
Pleuritis
Chronic lung disease
Abscesses
Pleuritis
Inflammation of pleura
May lead to pleural effusion, pyothorax, empyema
Possible result: restrictive lung disease
Pyothorax
Empyema in pleural cavity
Empyema
Accumulation of pus within a naturally existing anatomical cavity.
Honeycomb lungs
Appearance of lungs after fibrosis, destruction of parenchyma
Result of chronic lung disease
Pneumocystis jirovecii
Formally PCP (pneumocystis carinii pneumonia)
Progressive, often fatal pneumonia
Affects mostly the immunocompromised
Fungal
Legionnaire’s Disease
Rare infectious pneumonia
Massive consolidation and necrosis of lung tissue.
80% mortality if untreated.
Legionella pneumophila
Pulmonary TB
Infectious, inflammatory systemic disease
Mycobacterium tuberculosis
From lungs may disseminate to lymph nodes and other systems
TB: pathogenesis
Inhale infected droplets
Granulomas with caseous necrosis (Ghon complex)
Latent TB
Active TB
What type of hypersensitive reaction is TB?
Type IV
Cell-mediated delayed type
TB: Sx
85% have respiratory Sx Cough Hemoptysis Chest pain Weight loss Anorexia Fever
Can also have CNS, GI, Sx
Potts Disease
Spinal TB
Back pain, stiffness, arthritis, possible LB paralysis
Miliary TB
Widespread dissemination of TB throughout lungs and body
Lung Cancer
Malignancy of the epithelium of respiratory tract
Leading cause of death worldwide
5 year survival 10-15%
Small cell lung cancer (SCLC)
AKA oat cell lung cancer
20% of all lung cancers
Highly aggressive
Almost always in smokers
60% widespread metastases at time of Dx
Non-small cell lung cancer (NSCLC)
80% of all lung cancers
Include squamous cell carcinoma, adenocarcinoma (most common), large cell carcinoma
40% metastatic at time of Dx
Most common sites of lung cancer metastases
Liver and brain (MC)
Also bones, kidneys, adrenals
Sarcoidosis
Non-caseating granulomas developing in a wide range of tissues
Idiopathic
Autoimmune
Usually good prognosis
Most common location of sarcoidosis
Lungs
Hilar lymph nodes
Also: uvea, skin, liver
Rarely: heart, nervous system
Sarcoidosis: Sx
5% Asymptomatic
45% systemic (fever, anorexia, joint pain)
50% pulmonary (dyspnea, cough, hemoptysis)
20-60% uveitis
Painful inflamed nodules
Absestosis
Pulmonary fibrosis, pleural fibrosis, pleural plaqueS, caused by exposure to asbestos
Mesothelioma
Rare lung cancer that develops from cells of pleural lining (mesothelioma)
Asbestosis
Almost always fatal
Pleural Effusion
Increase of Transudate or exudate in the pleural space
Congestive heart failure, cirrhosis with Ascites, nephrotic syndrome, or injuries that increase vascular permeability.
Pleurisy
Aka pleuritis
Inflammation of pleura caused by infection, injury or tumor
Idiopathic, or complication of lung disease (especially pneumonia), TB, influenza, SLE, RA
Dry Pleurisy
No change in serous fluid between visceral and parietal layers –> two layers rub together –> pain
Wet pleurisy
Aka pleurisy with effusion
No chaffing so no pain
Increased serous fluid
Can become infected
Pneumoconioses
Lung diseases caused by inhalation of mineral dusts, fumes, or other particulates
Mostly occupational
Coal workers lungs
Silicosis
Asbestosis
Pneumoconioses: biochemical composition of inhaled dust
Coal dust: inert
Silica: reactive; prominent injury
Asbestos: insoluble; get stuck
Coal miners lung
Black lung
Pneumoconiosis caused by inhaled coal dust, which is then ingested by macrophages.
Somewhat expectorated
Silicosis
Pneumoconiosis caused by inhaling silica dust
Dust ingested by macrophages, which release substances that stimulate formation of collagenous nodules
Nodules destroy lung parenchyma and cause massive fibrosis.
Common complication of silicosis
TB
Asbestosis
Asbestosis particles are inhaled and engulfed by macrophages.
Inflammation
Increased risk of cancer, especially mesothelioma
Pulmonary embolism
Thrombi lodge in right side of heart into pulmonary vessels, where it may occlude pulmonary circulation.
Most commonly originate in proximal leg.
May cause cor pulmonale
Pulmonary embolism: Sx
Severe and sudden chest pain
LOC
Pulmonary Arterial Hypertension (PAH)
High blood tension in pulmonary arteries
Sx: fatigue, weakness, chest pain, peripheral edema, SOB
5-10 mmHg above normal (which is 15-18 mmHg)
Primary PAH
Rare pulmonary arterial hypertension
Neonates, women
Idiopathic. Possible family history
Secondary PAH
Pulmonary arterial hypertension associated with respiratory and/or cardiovascular disorders that increase presume of pulmonary arteries
Pulmonary Edema
Excess fluid (interstitial, alveoli) in lungs, which inhibits gas exchange
Pulmonary Edema is most commonly associated with
Left sided heart failure
Acute hypertension
Mitral valve disease
Pulmonary Edema predisposes the development of
Pneumonia
Pulmonary Edema: Sx
Asymptomatic intially
Anxiety Cold Sx Cough, dyspnea, exercise intolerance Wheezing Productive cough with frothy sputum
COPD
Chronic obstructive pulmonary disease
Spectrum of disorders that cause airway obstruction that is not fully reversible.
Chronic bronchitis
Bronchiectasis
Emphysema
Chronic bronchitis
Productive cough lasting 3 months/year for two consecutive years
“Blue bloaters”
Inflammation and scarring –> mucous production –> HT smooth muscle –> obstruction. Also impaired cilia
Increased chance of infection just compounds the problem.
Emphysema
Destruction of lung parenchyma and pathological accumulation of air in the lungs.
“Pink puffers”
Loss of elasticity in bronchioles –> trapped air
Blebs and bullae
Pockets of trapped air associated with emphysema
Severe dyspnea, hypoxemia and hypercapnia are associated with:
Emphysema
Bronchiolitis
Middle respiratory syndrome affecting epithelial cells of bronchi and bronchioles (not alveoli)
Edema and desquamation of epithelial cells –> blockage. Wheezing fever SOB
Infants and small children
Usually viral
Bronchiectasis
Complication of CF, chronic bronchitis, or any disorder that causes narrowing of the lumen.
Inability to clear mucous –> chronic infection, inflammation –> dilation, fibrosis, HT of bronchial walls
Bronchiectasis may lead to
Emphysema
Bronchiectasis: Sx
Persistent productive cough Abundant purulent sputum Dyspnea Fatigue Anemia Weight loss Fever Clubbing
Allergic rhinitis
Allergies
Acute vasomotor response mediated by histamines released by mast cells coated with IgE
Type I HS Rxn
Asthma
Airway hyper-responsiveness
Mucous plugs, bronchial spasms, vascular congestion
Reversible COPD
Wheezing coughing SOB
Repeated asthma attacks may lead to
Barrel chest
Elevated shoulders
HT mm of respiration
Status asthmaticus
Asthma attack that doesn’t respond to normal care
Medical
emergency
Influenza
Viral respiratory infection
Fever, coryZa, headache, malaise
Influenza: complications
Pneumonia
Encephalitis
Myocarditis
Renal disease
Cystic fibrosis
Recessive disorder of the exocrine glands
Viscous mucous secretions, pancreatic enzyme insufficiency, salty sweat
80-90% pulmonary Chronic productive cough Purulent sputum Hypoxia Clubbing Frequent infection
Obstructive sleep apnea
Upper airway blocked causing temporary absence of breathing during sleep
Central sleep apnea
Apnea caused by decreased respiratory muscle activity
Mixed sleep apnea
Starts central
Then obstructive
