Exam 2 Respiratory Disorders

Transcription

1 Exam 2 Respiratory Disorders Common Cold Common Cold Pathology Common Cold Consequences Rhinosinusitis Rhinosinusitis Pathology Rhinosinusitis ostia can close due to Influenza (Flu) Influenza Pathology Influenza Consequences Pneumonia Pneumonia pathology Pneomonia types based on cause Aspirative pneumonia Infective pneumonia common causes Caused by Rhinovirus, adenovirus, RNS Inflammation but no necrosis and shedding of the serous membrane of the upper respiratory tract 1. Uncomplicated rhinotrachetis 2. Viral pneumonia 3. Secondary bacterial infection Inflammation of the nasal cavity and sinuses Obstruction of the ostia (opening) leading to the collection of mucus which attracts organisms 1. Inflammation (infection or allergy) 2. Thick mucus 3. Polyp Caused by Influenza virus A or B (many strains) Inflammation along with necrosis and shedding of the serous membrane of the upper respiratory tract 1. Uncomplicated rhinotrachetis 2. Viral pneumonia 3. Secondary bacterial infection Inflammation of parenchymal structures of lung such as alveoli and bronchioles Consolidation (water logging) This leads to difficulty in oxygenation 1. Aspiration (non infective) 2. Infective Risk factors: elderly, alcoholism, stroke patients. Aspiration of gastric contents, food/water ingested Strep. pneumoniae, hemophilus, kleibsiella, pseudomonas (hospital acquired) viruses Page 1

2 Pneumonia types based on distribution Tuberculosis Tuberculosis Manifest as Primary tuberculosis Secondary tuberculosis Fungal Infection 1. Lobar pneumonia (lobe) 2. Bronchopneumonia (patchy) Caused by mycobacterium tuberculi (airborne droplet) 1. Primary (never exposed before) 2. Secondary a. part of the lung that is first attached by bacteria develops Ghon's Focus b. lymphatic involvement c. Ghon's Complex = Ghon's focus + lymphatic involvement a. immune system is compromised in patient with latent tuberculosis b. second dose of infection *Histoplamosis *Coccidiodomycosis *Blasomycosis *Candidiasis Bird breeders (pigeon) at risk Lung cancer risk factors Lung cancer types Bronchogenic carcinoma types Lung Cancer Manifestations 1. Smoking 2. Industrial hazards (asbestos) 3. Genetic predisposition 1. Secondary (comes from other site through metastisis) 2. Primary 3. Other lung cancer (carcinoid tumor, fibrosarcoma, lymphoma) 4. Bronchogenic carcinoma (arise from bronchial epithelium) 1. squamous cell carcinoma 2. Adenocarcinoma 3. Small cell carcinoma (oat cell carcinoma) Can produce hormones 4. Large cell carcinoma 1. Chronic cough 2. Dyspnea 3. Wheezing 4. Hemoptysis in late stages Page 2

3 5. Hoarseness of voice in late stages 6. Dysphagia in late stages 7. Pleural effusion complications Disorders of lung inflation Pleural effusion Types of pleural effusion Hydrothorax Causes Empyema Causes Chylothorax Causes Hemothorax Causes 1. pleural effusion 2. Pneumothroax 3. Atelectatis Abnormal collection of fluid in the pleural cavity 1. Hydrothorax (clear or serous fluid collection) 2. Empyema (pus collection) 3. Chylothorax (chyle or lymph collection) 4. Hemothorax (blood collection) 1. CHF 2. Renal Failure 3. Liver failure 4. Hypoproteinemia 1. Infective pneumonia 2. Rupture of subdiaphramatic abscess of lung abscess 1. Trauma to thoracic duct 1. Trauma 2. Surgery 3. Aortic aneurysm rupture Pleural effusion can cause lung collapse Pneumothorax Types of pneumothorax Atelectatis Atelectatis Causes Collection of air in the pleural cavity 1. Spontaneous (rupture of air filled bleb) 2. Traumatic (penetrating or non penetrating trauma) 3. Tension (Severe) both 1 and 2 can lead to it, shift mediastinal structures to the opposite side Incomplete expansion of the lung of portion of the lung 1. Respiratory tract obstruction (foreign body) 2. Lung compression (pleural effusion, pneumothorax) 3. Increased recoil of lung due to IRDS Page 3

4 IRDS Obstructive airway disorder Obstructive airway disorder types Chronic Bronchitis Emphysema Bronchiectasis Cystic fibrosis Cystic fibrosis manifestations Cystic Fibrosis Infant respiratory distress syndrome due to decrease in surfactant all lung volumes and capacities are decreased 1. Reversible (bronchial asthma) 2. Irreversible - Chronic bronchitis - Emphysmea - Bronchiectasis - Cystic fibrosis airway obstruction is caused by inflammation of large and small airways Blue Bloater (cyanotic) dyspnea and progressive loss of exercise tolerance cough w/sputum loss of lung elasticity and abnormal enlargement of air spaces distal to terminal bronchioles and destruction of the alveolar walls and capillary beds Pink puffer (acyanotic) marked dyspnea dry cough, barrel shaped chest abnormal blood gases later on Leads to permanent dilation of the bronchi and bronchioles caused by destruction of muscle and elastic supporting tissue resulting from vicious cycle of infection and inflammation symptoms: cough and massive sputum production Also called mucoviscidosis autosomal recessive 1. Chronic respiratory disease due to excessive mucus production 2. pancreatic exocrine deficiency due to mucus blockage of pancreatic duct 3. Elevations of Na in sweat 1. Chronic bronchitis emphysema Page 4

5 Complications Interstitial lung disease Interstitial lung disease causes Pulmonary Embolism Causes Pulmonary Hypertension Pulmonary hypertension causes Cor pulmonale Congenital respiratory 2. Maldigestion 3. steatorrhea 4. electrolyte imbalances 5. diabetes mellitus Restrictive lung disease All lung volumes and capacities decreased EXCEPT FEV1 The intralveolar septa and alveolar capillary septa is thickened leading to decrease in oxygenation of blood. 1. asbestosis 2. silicosis 3. coal miners pneumoconiosis 4. methotrexate 5. ionizing radiation 6. SLE 7. rhematoid arthritis 8. Farmer's lung 1. Blood clot from DVT 2. Amniotic fluid 3. Fat 4. Air elevated blood pressure in the pulmonary trunk or pulmonary artery 1. Increased pulmonary venous pressure - Mitral valve stenosis - Left ventricular failure 2. Increase pulmonary blood flow due to L to R shunt - ASD - VSD - PDA 3. Hypoxemia Right heart failure resulting from PRIMARY LUNG DISEASE and long standing or secondary pulmonary hypertension. 1. tracheal esophageal fistula Page 5

6 disorders Respiratory failure Impaired ventilation examples Respiratory failure impaired matching of ventilation and perfusion examples Respiratory failure impaired diffusion examples Respiratory failure causes (major complication: pneumonia) a. upper airway obstruction - infection - foreign body - laryngospasm - tumors b. weakness or paralysis of respiratory muscle - brain or spinal cord injury - drug overdose - muscular dystrophy c. chest wall injury 1. COPD 2. Restrictive lung disease 3. Severe pneumonia 4. Atelactasis 1. pulmonary edema 2. Acute respiratory distress syndrome 1. impaired ventilation 2. impaired matching of ventilation and perfusion 3. impaired diffusion Page 6