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SysPath: Respiratory 1
Terms in this set (92)
inherited genetic disease in
Genetic defect chromosome 7
-Spontaneous mutation (rare)
-Higher socioeconomic groups have better prognosis
-Predisposes to chronic bacterial airway infections
-Progressive loss of pulmonary function
Which glands are affected with CF?
Ex: sweat, salivary, mammary, lacrimal, sebaceous, and mucous.
glands that produce and secrete substances onto an epithelial surface by way of a duct. Examples include sweat, salivary, mammary, ceruminous, lacrimal, sebaceous, and mucous.
defective gene for a protein that allows chloride to pass into and out of the plasma membrane of epithelial cells
, including kidney, gut and airways.
Salt accumulates in the cells lining the lungs and digestive tissues
, making the surrounding
mucus abnormally thick and sticky
What systems are affected with CF?
Clinical manifestations CF
-dehydrated, increased viscosity of mucus
-increase sweat electrolytes (Na/Cl)
-pancreatic enzyme insufficiency
How does CF affect the respiratory system
-Chronic cough, Purulent sputum
-Mucus is an excellent medium for bacterial growth
-Hypoxia, Cyanosis, Clubbing
-Barrel chest, Pectus carinatum, Kyphosis
-Chronic pulmonary infection
fingernail widening because the tissue under the nail plate becomes thicker. This can be caused by a number of conditions that lead to a decrease in the amount of oxygen in your blood, such as lung disease and heart disease.
How does CF affect pancreas?
-Thick secretions block pancreatic ducts
-Prevents pancreatic enzymes from reaching
leading to impaired digestion and absorption of nutrients
-Bulky, frothy, malodorous stool
How does CF affect GastroIntestinal (GI):
-Meconium ileus (10-15% of newborns)
-Prolapse (slipping forward/down) of the rectum
-Intestinal obstruction from thick, dry stool
How does CF affect musculoskeletal & Genitourinary (GU):
-Infertility is universal in men and common in women
-Decreased bone density
-Clinical presentation (malnutrition, resp compromise, etc)
-Sweat test (increase Na/Cl)
-Pancreatic enzyme test
-Pulmonary function test
-Variable depends on the systems involved
-rare birth condition characterized by the formation of a cyst in the middle of the chest, usually near the area where the trachea branches off (carina).
lined by respiratory epithelium
but no connection to bronchial tree
and limited by walls that contain muscle and cartilage.
commonly found in the middle mediastinum
is a bronchogenic cyst intrapulmonary or extrapulmonary?
Pathogenesis Bronchogenic Cyst:
-In the newborn, a bronchogenic cyst may compress a major artery and cause respiratory distress.
-Secondary infection of the cyst in older patients may lead to hemorrhage and perforation.
-Many bronchogenic cysts are
-a mass of lung tissue that is
not connected to the bronchial tree
and is located
outside the visceral pleura
arising from the aorta
, supplies the tissue.
Does an extralobar sequestration have alveoli?
Clinical Manifestation and Diagnosis Extralobar Sequestration
-50% cases recognized in the
first month of life.
-disorder usually manifests early as
dyspnea (difficult/laboured breathing) and cyanosis.
-older children may present with recurrent
-Treatment includes surgery.
-a mass of lung tissue
within the visceral pleura
-isolated from the tracheobronchial tree
-supplied by a systemic artery
Pathology Intralobar sequestration
-was thought to be congenital, but is now thought to be acquired.
chronic recurrent pneumonia
, end-stage fibrosis and
honeycomb cystic changes
-cysts range up to 5 cm in diameter
Does an intralobar sequestration have alveoli?
An acute, usually afebrile (not feverish), self-limiting viral infection of the upper respiratory tract. with excellent prognosis
and can be prevented by handwashing.
-"Scratchy" or sore throat
-Rhinorrhea (runny nose)
Aka - infectious rhinitis
What causes the common cold?
What Virus most commonly causes a common cold?
, Adenovirus, Parainfluenza virus)
Pathology of a common cold
-M/C during fall and spring, less in winter
-direct & indirect person to person contact, droplets (can survive for hours outside host)
Does cold temperature, health, nutrition or upper respiratory tract abnormalities affect susceptibility for a common cold?
-viral respiratory febrile (feverish) infection, coryza (mucus membrane inflammation), cough, headache, and malaise.
-occurring during fall & winter typically
-mortality is possible during epidemics, particularly among high-risk patients.
Cx: Influenza Virus
Risk factors: influenza?
How is influenza spread?
M/C airborne droplets
-contact with contaminated items
Sx with influenza
-Common cold, Cough
-Prostration (can't get out of bed)
-Aches and pain, Headache
-Coryza (inflammation of mucous membrane in nose)
-Nausea, Vomiting, Abdominal pain
Possible complications of influenza:
-Encephalitis (brain inflammation)
-Myocarditis (heart mm inflammation)
-Renal disease (kidney disease)
How to avoid the flu?
-acute, subacute, recurrent or chronic inflammation of the paranasal sinuses (sphenoid, frontal, ethmoid, maxillary, nasal):
4 different classifications of Sinusitis:
Clinical presentation sinusitis
-Pressure and pain
-Nasal congestion and irritation
-Tenderness, swelling, erythema
trachea and bronchi
that is of
SHORT DURATION & SELF LIMITING
with few pulmonary signs.
-No Major Damage to Parenchyma
-Can result from chemical irritation such as smoke, fumes, gas or may occur from viral infections such as influenza, measles, chickenpox, whooping cough or bacterial infection.
Does Acute Bronchitis result in damage to parenchyma of lung tissue?
Clinical manifestation acute bronchitis
Upper Respiratory Infection (URI)
Dry, irritating or
Sore throat, Chest pain, Wheezing
Cold, Fever, Constitutional symptoms
Complications/Mgmt acute bronchitis:
Prognosis: Usually good, Complications include
Treatment: Symptomatic, Vaccination
-Leading cause of death in US
-INFLAMMATION OF THE LUNGS
-Can be caused by infection, inhalation, aspiration (
lot's of causes
-Can be primary or secondary
-Can affect 1 x lobe, 1 x lung or both lungs
Most common cause of Pneumonia?
(50% of cases)
Most common means for which virus, bacteria, infection, etc... can gain access to lungs:
(inhalation of something that should not enter the lungs)
-Invading microorganisms cause
to release biochemical mediators
inflammatory response does not eliminate pathogen
-microorganisms multiply and release damaging toxins
-inflammatory and immune response
may lead to scarring and loss of function
Rx factors pneumonia:
-Acute respiratory infections, Chronic bronchitis
-Diabetes, Other Chronic or critical illness, Immune deficiency
-Elderly, Disabled, Bedridden (decreased sensation, aspiration)
-Periodontal disease (aspiration of bacteria)
-Difficulty swallowing (aspiration of sebum)
Name of position to place someone in so they avoid aspiration:
Classification Pneumonia (3):
M/C & community-acquired pneumonia cause:
M/C hospital-acquired pneumonia cause:
Is hospital-acquired pneumonia iatrogenic or nosocomial?
Nosocomial (hospital acquired)
Iatrogenic (due to medical procedure)
Contributing pathogens pneumonia:
-Upper respiratory flora: (Streptococcus, Staphylococcus, Haemophilus)
-Enteric (gut) Saprophytes: (Anaerobic bacteria as part of normal enteric flora, eg E. coli)
-Extraneous pathogens: (Mycobacterium tuberculosis, viruses)
-Pneumonia which involves alveoli
-focal diffuse and bacterial:
-Pneumonia which involves septa (alveolar septum separates adjacent alveoli in lung tissue)
-mycoplasma or virus:
Pneumonia limited to segmental bronchi:
Pneumonia which is widespread or diffuse:
Routes of infection pneumonia:
-Inhalation of pathogens in air droplets
-Aspiration of infected secretion from URT, e.g. Staph and Strep
-Aspiration of infected particles from GI, food or drinks, etc.
-Hematogenous spread - from
Clinical manifestation pneumonia:
-Upper Respiratory Infection (URI)
-Sudden sharp pleuritic chest pain
-Hacking, productive cough
-Rust or green-coloured sputum
-Dyspnea (difficult/laboured breathing), Tachypnea (rapid breathing)
-Cyanosis , Headache, Fatigue
-Aching, Myalgia (mm pain)
Complications of pneumonia:
-Chronic lung disease
-Leads to pleural effusion
Pus filled pleural cavity (pyothorax/empyema)
-Can be encapsulated with fibrous tissue
-Obliterates the pleural cavity → lungs cannot expand during inspiration →
restrictive lung disease
-From highly virulent bacteria, esp. staph.
-Destroys the lung parenchyma
-Pus causes destruction of walls → bronchial dilation (aka bronchiectasis)
When bronchial's are too wide causing a reduction in pressure and increase in dead air space:
-Pneumonia that is unresponsive to treatment
-End up with destruction of lung parenchyma and fibrosis → aka
Chronic lung disease
-A progressive, often fatal pneumonia
Risk factors: immunosuppression, chemotherapy, transplantation, malnutrition
-Clinical manifestation: fever,
impaired gas exchange
, progressive dyspnea, fatigue, weight loss, cough
-Diagnosis: lab tests
Pneumocystis Carinii Pneumonia (PCP)
What type of pneumonia are HIV/AIDS patients at increased risk of acquiring?
Pneumocystis Carinii Pneumonia (PCP)
-Rare infectious disease
massive consolidation and necrosis of lung parenchyma
-Also causes other severe symptoms including high fever, nausea, vomiting, headache, chills, disorientation, etc.
Cause (Etiology) of Legionnaire's Disease:
-Infectious, inflammatory systemic disease of the lungs that may disseminate to involve lymph nodes and other organs
-May be primary or secondary
- Primary infection is usually asymptomatic (chronic/latent)
- Secondary develops when the primary infection becomes active as a result of lowered resistance
Is latent or dormant tuberculosis infectious?
What is the M/C way for acquiring TB?
Inhalation of respiratory droplet nuclei containing M. Tuberculosis
Cause (Etiology) of TB:
What type of hypersensitivity disorder is TB?
Type IV (Delayed Type)
Pathogenesis of TB:
-Primary infection is usually asymptomatic (chronic or latent)
-Secondary develops when the primary infection becomes active as a result of lowered resistance
Pathogenesis of TB con't:
1. Involves inhalation of m. tuberculosis
2. macrophages and lymphocytes aggregate around organism
3. lymphocytes release cytokines
4. transforms macrophages into epithelioid cells
5. multinucleated giant cells cluster around to form granulomas with
How does TB become contagious?
-If the tubercle is contained by the immune system, the infection stays in the primary stage
-If the immune system becomes weakened, the tubercle may rupture and expectorate the bacteria
TB infection may leave ______ or _______ in lungs or lymph nodes:
What are particular areas of hematogenous spread of tubercle?
What is the most
extrapulmonary (outside lungs) presentation of TB?
What is the most
extrapulmonary (outside lungs) presentation of TB?
Meningitis (high mortality)
-Seen in Primary TB.
-Peripheral granulomatous lesions in the Middle or Lower Lung Lobes that can calcify.
-There is also the presence of hilar lymphadenopathy.
-Can be seen on X-Ray
(Anton Ghon: 1866-1936)
Risk factors TB:
-Low SE status
Clinical manifestation of TB:
-Delayed, insidious, non-specific
Diagnosis & Mgmt TB:
-Tuberculin skin test
-Localized accumulation of purulent exudate within the lung
-Usually develops as a complication of pneumonia
Etiology Lung Abscess:
-Aspiration of oral secretions by patients with
gingivitis or poor oral hygiene.
-Typically, patients have altered consciousness as a result of alcohol intoxication, illicit drugs, anesthesia, sedatives, etc.
-Older patients and those unable to handle their oral secretions, often because of neurologic disease, are also at risk. (same as pneumonia)
Most common cause of Lung Abscess?
(Can involve Aerobic as well)
bacteria to cause Lung Abscess:
Streptococci & Staphylococci
Immunocompromised patients with lung abscess may have infection with:
Mycobacteria or Fungi
Pathogenesis of Lung Abscess:
-Introduction of these pathogens into the lungs first causes inflammation, which leads to tissue necrosis and then abscess formation.
-The abscess usually ruptures into a bronchus, and its contents are expectorated, leaving an air- and fluid-filled cavity.
-Abscesses tend to connect with other airways and erode bronchial walls. Patients end up with
putrid malodorous expectorations.
Clinical manifestation of Lung Abscess:
What is a good massage Tx for Lung Abscess?
-Also: antibiotics, good nutrition
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