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Respiratory Disorders


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Chronic inflammatory disorder of the airways. Airways narrow and restricts air flow in and out of the lungs.
Two airway problems associated with Asthma
Inflammation and Bronchospasms.
Asthma Pathogenisis
Exposure to allergen --> Type 1 IgE Mediated Hypersensitivity Reaction
--> Mast cells release histamine, interleukins, leukotrienes and prostaglandins
--> Activates Immune cells: eosinphils, macrophages, T-lymphocytes
--> Results in airway inflammation & bronchospasm
Early Phase Response in Asthma
Immediate bronchoconstriction upon exposure. ⬢Mediators released from mast cells
⬢Sx develop in 10-20 min
⬢Subside 1-2 hours
Late Phase Response in Asthma
⬢Develops 4-8 hours after exposure to asthma trigger
⬢Involves inflammation & increased hyper-responsiveness
⬢Prolongs asthma attack
⬢Lasts for several days to weeks
Chronic airflow obstruction. includes: Emphysema, Chronic Bronchitis, Unremitting Asthma
⬢As COPD progresses, pts often have some degree of both emphysema and chronic bronchitis
4th leading cause of death F>M
⬢ Enlargement of airways distal to terminal bronchiole
⬢Destruction of alveolar walls/septum
⬢Destruction of capillary bed
⬢Collapse of bronchioles during expiration
⬢Loss of lung elasticity
S/S Emphysema
•“Pink Puffer” = cyanosis absent even late in disease; compensate by ↑ RR
•Barrel Chest 1:1
Chronically elevated PC02 level
Chronic Bronchitis
⬢Airway obstruction caused by airway inflammation
⬢Excess mucus produced =
שׁHypertrophy & hyperplasia of mucus secreting glands
⬢Loss of ciliary function
S/S Bronchitis
•Barrel Chest 1:1
•↑ Sputum = Lots of sputum produced
•Pursed Lip Breathing, •ABG’s ↓ PO2 ↑ PCO2 Respiratory Acidosis
•Increased hemoglobin
Complications of COPD
Cor Pulmonale (causes vasoconstriction of pulmonary capillary bed), Respiratory Failure, Lung Cancer
⬢Inflammation/Infection of lower respiratory tract
⬢Pathogens: Bacteria, Viruses, Protozoa, Fungi
⬢Alveoli & bronchioles fill with pus + other liquids
⬢Consolidates = solidifies
6th cause of death, Leading infectious cause of death in US
How pathogens gain access to the lungs
Inhale Pathogen
Aspirate Pathogen from
Naso/Oropharynx or GI, Hematogenous Spread
Community Acquired Pneumonia
Streptococcus Pneumonia (Typical bacteria), Mycoplasma Pneumonia (Atypical), Legionella Pneumonia (Atypical), and virus
Hospital Acquired
⬢Infection acquired in the hospital
⬢Occurs > 48 hours after admission to hospital
שׁPseudomonas Aeruginosa
Strep Pneumonia
⬢Pneumococcal Pneumonia *most common cause of bacterila pneumonia
⬢Accounts for 50-75% of cases
⬢Often follows URI
Legionella Pneumophilia
named after American legion convention. Rare in healthy people.
S/S Legionella Pneomophilia
⬢CNS: HA, Confusion
⬢GI: N, V, D
⬢Atypical pathogen
⬢Characteristics of both virus and bacteria, does not produce consolidation
transmitted by close contact. >5, <35
S/s Mycoplasm Pneumonia
•Mild “Walking” Pneumonia
•Dry Hacking Cough
•Cough may persist > 6 weeks
•Scant mucoid sputum
⬢Infectious Disease caused by Mycobacterium tuberculosis
⬢Slow growing
⬢Resistant to destruction
TB Transmission
Airborne infection spread by droplet nuclei. ⬢ Upper airway prevents most inhaled organisms from reaching lungs 10% develop active disease. more easily transmitted in a close/confined space or repeated exposure
Primary TB
initial infection that results from inhaling droplet nuclei. Person infected w/ tuvercle bacilli but pathogen is dormant/walled off
Secondary TB
Reactivation of previously healed lesion; Active TB
⬢90% of cases result from reactivation of a previously healed lesionb
Ghon Focus
שׁSingle, white/gray circumscribed lesion
שׁContains tubercle bacilli, macrophages and other immune cells
caseous necrosis
soft, yellow, cheesy mass formed when T-Lymphocytes attack Ghon Focus
S/s of Primary TB
⬢Positive PPD
⬢Negative Sputum Culture
⬢Negative Chest x-ray
⬢No symptoms
⬢Not contagious
S/s Secondary TB
⬢Positive PPD
⬢Positive Sputum Culture
⬢Positive Chest -ray
⬢Are contagious
⬢Purified Protein Derivative
⬢Used to screen for TB
⬢Measures delayed hypersensitivity reaction(Type IV)
⬢ Does NOT differentiate between primary infection & active disease
PPD Interpretation
0-4mm Negative, 5-9mm positive for high risk groups, >15mm positive for people with no risk factors
Lung Cancer
⬢Malignant neoplasm marked by the uncontrolled growth of cells
poor prognosis avg. 5 yr. survival rate.
Risk factors of lung cancer
1. Smoking: Responsible for > 85% of cases
2. Second Hand Smoke,
3. Radon: 2nd leading cause of lung cancer,
4. occupation Exposure: commonly Asbestos
Asbestos exposure plus smoking is 50-
Bronchogenic carcinoma
⬢Constitutes 90-95% of all lung cancer
⬢Originates in epithelial lining of major bronchi
⬢Subdivided into four major categories
שׁSmall Cell Carcinoma
שׁSquamous cell Carcinoma
שׁLarge Cell Carcinoma
Small Cell Carcinoma
•Represents 20-25% of cases
•Referred to “oat cell” carcinoma because cells look like oats under microscope
•Strongly associated with smoking
•Rapid onset, very aggressive, highly malignant
•Associated with secretion of hormones: ACTH, ADH, PTH
•Avg survival after dx = 9-10 months
Squamous Cell Carcinoma
⬢Accounts for 25-40% of cases
⬢Found mostly in men
⬢Correlates closely with smoking
⬢Originates in central bronchi as an intraluminal growth
⬢Accounts for 20-40% of cases
⬢Most common type found in women who are non-smokers
Large Cell Carcinoma
⬢Accounts for 10-15% of cases
⬢Highly anaplastic (undifferentiated)
⬢Poorly differentiated; poor prognosis
⬢Accumulation of air in pleural space
⬢Air causes build up of positive pressure
⬢Produces either a partial or complete collapse of the affected lung
⬢Normally pleural space contains NO air
Spontaneous Pneumothorax - primary
⬢Caused by rupture of air-filled bleb (blister)
⬢Usually found on top of lung
⬢Occurs in healthy young males who are tall
Spontaneous Pneumothorax - seondary
⬢More serious than primary
⬢Usually occurs 2nd to an underlying lung disease
⬢Emphysema, Asthma, TB, Lung Ca., Cystic Fibrosis
Traumatic Pneumo -
Open Pneumo
⬢ Penetrating type injury --> gunshot wound or stab wound
⬢Air leaks into pleural space from opening on chest wall (outside)
Traumatic Pneumo -
Closed Pneumo
⬢Non-Penetrating Injury ==> fx rib penetrates visceral pleura
⬢Air leaks into pleural space from opening within the lung
S/S traumatic Pneumo
•↓ Chest expansion on affected side
•↑ RR
Tension Pneumo
⬢Occurs in either spontaneous or traumatic pneumo
⬢Injury acts like one-way valve
⬢Permits air to enter on inspiration & closes on expiration
⬢Pressure builds up
⬢Affected lung collapses
⬢Unaffected lung gets compressed (compression atelectasis)
⬢Mediastinal structures shift towards unaffected side
Pulmonary Embolism
⬢Embolism travels from venous circulation to right side of heart
⬢Right heart pump blood clot into pulmonary circulation
⬢Obstructs blood flow to lungs
⬢Decreased oxygenation of blood ==> Hypoxemia
almost all arise from DVT

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