Week 6 Flashcards
Atelectasis
inadequate expansion of airspaces: aspiration, pneumothorax, pleural fibrosis
Acute Respiratory Distress Syndrome (ARDS)
progression of acute injury and damage from activated neutrophils
COPD congestive obstructive pulmonary disease:
emphysema, asthma, bronchietasis-very common
• Associated with emphysema, chronic bronchitis, asthma
• Main cause is cigarette smoke
Emphysema
destruction of alveolar walls and permanent enlargement of airspaces: smoking, alpha-1 antitrypsin deficiency (imbalance of proteases and antiproteases), air pollution
-barrel chest with hyperinflation
Chronic bronchitis
persistent cough > 3 months in 2 consecutive years: smoking, air pollution. Hypersecretion of mucus by airways: infection often present
Bronchiectasis
obstruction of bronchi and persistent necrotizing infections: destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis
Asthma
reactive airway disease and narrowing of airways-hyperreactivity: hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy
• Types:
Atopic- childhood onset often with allergic rhinitis
Non-atopic- non-immune, occupational exposures
Fibrosing lung diseases
e.g., associated with collagen vascular diseases such as rheumatoid arthritis-restrictive lung disease: stiff lung and hard to expand lungs
Occupational lung diseases
restrictive, e.g., mineral dust-induced, silicosis, asbestosis [mesothelioma]
Sarcoidosis
restrictive disease-abnormal connective tissue and reduced elastic properties; multi-organ involvement
Pulmonary embolus
- Can cause sudden death if in pulmonary artery
- Origin from deep veins in legs
- Cause: prolonged bed rest, surgery, congestive heart failure
Pulmonary hypertension
- Causes: heart disease, recurrent thromboemboli
* Cor pulmonale- right ventricular failure
What are the 3 types of lung diseases?
- Restrictive: caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs
- Vascular: gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious
- Obstruction: blocked airways; gas exchange through septal walls not impaired; unable to exhale
Tuberculosis
- caused by mycobacterium tuberculosis
1. Usually lungs but can affect other organs
2. Flourishes in crowded, impoverished areas
3. Non-contagious during long periods of dormancy
4. Problems with multidrug antibiotic resistance
5. Forms necrotizing granulomas
Fungal infections-
histoplasmosis
Pneumonia in immunocompromised (e.g., AIDS)
⎫ Can be caused by micro-organisms including from normal flora
⎫ CMV (cytomegalo virus-common infection) causes ‘owl’s eye’ histology
Lung tumors-
leading cause of cancer deaths in the world in men and women
- 95% primary lung cancers are carcinomas (adeno and squamous cell [contains keratin] types most common)
- Smokers 10-55X more likely to develop than general population
2 “relievers” of asthma?
albuterol is the only true reliever
salmeterol
Inhaled corticosteroid
fluticasone, nose bleeds, thrush, interfere with growth
Theophylline
a methylxanthine, increase CAMP, phosphodiesterase inhibitor, combined with steroids to reduce the amount of steroid needed
ipratropium
reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscrinics with beta 2 agonists, dry mouth
montelukast
leukotriene modifier
prophylaxis or chronic treatment for pt who have had trouble with inhaled treatments
aspirin induced asthma
block leukotriene binding to receptor
cromolyn
mast cell stabilizer
inhibits the release of histamine
prophylactic (before exercise)
omalizumab
inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma
COPD (Congestive Obstructive Pulmonary Disease)
1. Causes:
- Treatment:
- Long smoking hx, or exposure to environmental irritants
- Airflow limitations-due to progressive, irreversible airway remodeling
- Not fully reversible in contrast to asthma which can be at least partially reversible
- Longer acting bronchodilators such as tiotropium bromide (Spireva)
- Longer acting beta 2 agonists such as salmeterol
- Theophylline with glucocorticoids (glucocorticoids alone not very effective)
- Typically responses not as good as with asthma
Oseltamivir (Tamiflu)-
prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential (can decrease the duration of flu 1-2 days)
-works against type A and B flus
Antismoking medication
- Nicotine replacement—gum or patch
2. Bupropion (not buproprion) –it is an antidepressant (smoking cessation name is Zyban)
Chronic renal disease
Main cause is hypertension
-aterionephrosclerosis caused by hypertension or diabetes
-hyaline thickening of arterioles
• Diabetes
• Chronic glomerulonephritis—can be acute or chronic
Renal diseases
Single or fused kidney Renal dysplasia Adult polycystic kidneys –genetic • Renal insufficiency • Linked to intracranial aneurysm • Other organs also have cysts • Enlarged kidneys
Urinary obstruction
- more than 3 weeks causes permanent damage
- Get dilated ureter and hydronephrosis
- If distal to bladder can get dilated bladder with a thickening of the bladder wall
Hydronephrosis
unable to concentrate the urine Identify symptoms: • Anuria • Polyuria • Bladder distention • Sometimes asymptomatic
Signs of kidney stones
- Renal colic
- Hematuria
- Pyelonephritis
- Sometimes asymptomatic
What are the 4 types of kidney stones?
calcium/calcium oxalate
struvite
uric acid
cystine
Pyelonephritis (10-20% kidney failure)
- Define
- Cause
- Consequences
- Can have acute or chronic (more scarring) types
- Retrograde spread from cystitis
- Common with urinary obstruction, stenosis
- Diabetes and immunocompromised (diabetes is the most common cause)
- Flank pain
- Fever
- 10-20% chronic renal failure
- Kidney scarring
Renal cell carcinomas
80-90% of renal malignancies—most frequent
Often asymptomatic (and not discovered until large)
Most likely metastasizes to lungs or bone, sometimes to regional lymph nodes
Wilms tumor (nephroblastoma)
- Most common in first 3 years of life
2. Most common congenital renal tumor
Shistosomoiasis
- infection from snails
- leading cause of squamous cell carcinoma in bladder
- primarily from middle east
- shitosomoiasis eggs deposited in bladder
