Respiratory Disorders
Terms
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- Asthma
- 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
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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
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Immediate bronchoconstriction upon exposure. ⬢Mediators released from mast cells
⬢Sx develop in 10-20 min
⬢Subside 1-2 hours - Late Phase Response in Asthma
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⬢Develops 4-8 hours after exposure to asthma trigger
⬢Involves inflammation & increased hyper-responsiveness
⬢Prolongs asthma attack
⬢Lasts for several days to weeks - COPD
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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 - Emphysema
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⬢ 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
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•“Pink Puffer†= cyanosis absent even late in disease; compensate by ↑ RR
•Barrel Chest 1:1
Chronically elevated PC02 level - Chronic Bronchitis
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⬢Airway obstruction caused by airway inflammation
⬢Excess mucus produced =
שׁHypertrophy & hyperplasia of mucus secreting glands
⬢Loss of ciliary function - S/S Bronchitis
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Cyanosis
•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
- Pneumonia
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⬢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
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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
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⬢Infection acquired in the hospital
⬢Occurs > 48 hours after admission to hospital
⬢Pathogens:
שׁPseudomonas Aeruginosa - Strep Pneumonia
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⬢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
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⬢CNS: HA, Confusion
⬢GI: N, V, D
⬢Hyponatremia - Mycoplasm
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⬢Atypical pathogen
⬢Characteristics of both virus and bacteria, does not produce consolidation
transmitted by close contact. >5, <35 - S/s Mycoplasm Pneumonia
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•Mild “Walking†Pneumonia
•Dry Hacking Cough
•Cough may persist > 6 weeks
•Scant mucoid sputum - Tuberculosis
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⬢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
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Reactivation of previously healed lesion; Active TB
⬢90% of cases result from reactivation of a previously healed lesionb - Ghon Focus
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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
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⬢Positive PPD
⬢Negative Sputum Culture
⬢Negative Chest x-ray
⬢No symptoms
⬢Not contagious - S/s Secondary TB
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⬢Positive PPD
⬢Positive Sputum Culture
⬢Positive Chest -ray
⬢Are contagious - PPD
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⬢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
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⬢Malignant neoplasm marked by the uncontrolled growth of cells
poor prognosis avg. 5 yr. survival rate. - Risk factors of lung cancer
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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
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⬢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
שׁAdenocarcinoma
שׁLarge Cell Carcinoma - Small Cell Carcinoma
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•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
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⬢Accounts for 25-40% of cases
⬢Found mostly in men
⬢Correlates closely with smoking
⬢Originates in central bronchi as an intraluminal growth - Adenocarcinoma
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⬢Accounts for 20-40% of cases
⬢Most common type found in women who are non-smokers - Large Cell Carcinoma
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⬢Accounts for 10-15% of cases
⬢Highly anaplastic (undifferentiated)
⬢Poorly differentiated; poor prognosis - Peumothorax
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⬢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
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⬢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
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⬢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
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•↓ Chest expansion on affected side
•↑ RR
•SOB/Dyspnea - Tension Pneumo
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⬢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
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⬢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