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Respiratory Pathophysiology

Terms in this set (60)

Pneumonia
-Infection and inflammation of lung parenchyma tissue
-Primarily caused by bacteria, but also viral, fungal, protozoan and parasites.
-Pathogens can reach lungs by inhalation, aspiration, or hematologic spread.
Pneumonia Manifestations
-High fever, chills, fatigue/weakness
-Bronchial inflammation, productive cough, sputum rusty (bacterial) or yellow or green.
-Shortness of breath, tachypnea
-Tachycardia
-Nausea, diarrhea, vomiting
Associated with left sided heart failure
Pneumonia Treatment
-Fluids and electrolytes
-Antibiotics for bacterial pneumonia
-Antiviral medications for viral pneumonia
-Fever reducing medications
-Cough medications
-Cortiocosteroids
-Oxygen, ventilation, humidified air
What are some complications from pneumonia?
-Pleuritis, pleural effusion
-Lung abscesses
-Sepsis
Pulmonary Tuberculosis (TB)
-a bacterial infectious disease caused by M. tuberculosis
-spread by air-borne particles in respiratory fluids of individuals with active TB.
Primary TB
-Largely asymptomatic
-Develops in people who are previously unexposed (unsensitized)
-Develop a latent TB infection, organism is walled-off in granulomas (tubercles)
-Rarely, individuals can progress to progressive primary TB
Progressive (secondary) or active TB
Can develop from a reinfection via respiratory droplets or reactivation from previous lesions
Small Cell Lung Cancer
-Cells appear small and arise from central bronchi
-Highly associated with smoking
-Paraneoplastic effect is common
Non-Small Cell Lung Cancer
-Cells appear larger
-3 types of non-small cell lung cancer
Adenocarcinoma
-Begins in peripheral edges of lungs and just beneath lining of bronchi
-Most common type of lung cancer
-Associated with non-smokers
-Non-small cell
Squamous-Cell Carcinoma
-Men are at higher risk
-Highly associated with smoking
-Begins in bronchi
-Non-small cell
Lung Cancer Manifestations
-Persistent cough, blood-tinged sputum
-Chest pain, referred pain in upper back
-Recurrent attacks of pneumonia and/or bronchitis
Fatigue
-Radiated pain
Pleural Effusion/Edema
abnormal accumulation of fluid in the pleural cavity
Exudative Pleural Effusion
pleuritis, bacterial pneumonia, viral infections, pulmonary infarction, tumors. (empyema)
Hemothorax
pleural effusion characterized by presence of blood
Chylothorax
effusion of lymph fluid in to the pleural cavity
Pleuritis (pleurisy):
inflammation of the pleural membranes
Pleuritis Etiologies
viral and bacterial infections, pneumonia
Pleuritis Manifestations
-Pain in thorax, sometimes referred to shoulder (abrupt, made worse with deep breathing and coughing)
-Empyema and sometimes hemothorax
Pneumothorax
presence of air/gas in the pleural space that leads to a partial or complete collapse of affected lung lobe/s due to idiopathic reasons or direct injuries/disease.
Open Pneumothorax
air moves in and out from an external environment
Tension Pneumothorax
due to increased pressure in the pleural cavity resulting in a one-way entry of air, life-threatening
Spontaneous Pneumothorax
(idiopathic) rupture of an air-filled bleb or blister on the surface of lungs
Secondary Pneumothorax
occurs in people with lung diseases
Traumatic Pneumothorax
caused by chest injuries
Atelectasis
incomplete expansion or collapse of lung tissue
Atelectasis Etiologies
airway obstruction or lung compression, pneumothorax, pleural effusion, respiratory complication at birth or neonatal period.
Compression Ateletasis
caused by external pressure
Absorption Atelectasis
can occur when alveoli collapse because most of the gas inside alveoli are absorbed into pulmonary blood (ex. If given 100% oxygen)
Obstructive Airway Disease
-disorders characterized by airway obstruction
-Asthma, COPD, emphysema, bronchiectasis, cystic fibrosis
Asthma
-Acute and reversible inflammatory disease of bronchial tubes (most people have both types)
-Type I: hypersensitivity type 1
-Type II: non-hypersensitivity causes such as respiratory tract infection, smoke/lung irritants, emotional upset
Asthma Manifestations
-Wheezing and cough, shortness of breath, prolonged and painful expiration
-Chest tightness
-Increased respiratory rate
-Fatigue
-Moist skin
-Anxiety
What are the events during an asthma attack?
-Narrowing of airways due to bronchospasm
-Expiration is elongated because of airway obstruction due to edema and excessive mucus production.
-If attack continues, accessory breathing muscles are used to help with breathing. Air becomes trapped behind the obstruction causing a hyperinflation of the lungs.
-There is a mismatching of ventilation and perfusion leading to hypercapnia and hypoxemia, increased pulmonary hypertension, increased work of the right side of the heart, could eventually lead to respiratory failure. (these last two things will be presented with COPD)
Asthma Treatment
-Recognition and avoidance of triggers
-Short-term relief medications: short-acting beta agonists, immediate bronchodilators, oral and IV corticosteroids
-Long-term relief medications: inhaled corticosteroids, leukotriene modifiers, long-acting beta agonists, combination inhalers, bronchodilators
Chronic Obstructive Pulmonary Disease (COPD):
A catch-all clinical term used for lung diseases characterized by chronic airway obstruction. The most common etiology for COPD is smoking.
COPD Blue Bloaters
chronic bronchitis is the primary problem. They suffer from hypoxemia and hypercapnia (tend to be more cyanotic than emphysemia, so "Blue"). Because of increasing obstruction, their residual lung volume increases so "bloating")
COPD Pink Puffers
Emphysema is the primary problem, compensation involves excessive hyperventilation ("puffer"). They have less hypoxemia and the neck/chest muscles are overworking with pursed-lip breathing so appear "pink."
Emphysema
-Chronic inflammatory lung disease in which there is a loss of elasticity of lung alveoli and enlargement of air spaces past the terminal bronchioles.
-Eventually alveoli wall and capillaries are damaged.
-Lungs become hyperinflated with increased total lung capacity.
Emphysema Etiologies
-Injury to lung tissue from smoking
-Inherited deficiency of alpha-trypsin (an anti-protease enzyme that protects lung tissue)
Centriacinar Emphysema
begins in bronchioles of the upper lobes and spreads into the peripheral alveoli
Pancinar Emphysema
begins in the lower lobes in the peripheral alveoli and spreads to the bronchioles.
Chronic Bronchitis
-Chronic bronchial inflammation characterized by excessive mucus production that obstructs major and smaller airways.
-Hypersecretion of mucus in bronchi
-Hypertrophy of submucosal glands lining trachea and bronchi
-Increased number of goblet cells, inflammatory infiltration, fibrosis of the bronchial walls (in smaller airways)
Bronchiectasis
- A rare type of COPD characterized by a permanent dilation of the bronchi and bronchioles caused by destruction of muscle and elastic supporting tissue.
-Characterized by cycles of infection and inflammation.
Cystic Fibrosis
-An autosomal recessive disorder that causes severe damage to the lungs and the digestive and reproductive systems.
-Major cause of chronic respiratory disease in children
-It is caused by a dysfunctional gene that encodes for a membrane protein that functions as a chloride channel protein in epithelial membranes. The altered protein makes epithelial cell membranes. mostly impermeable to chloride.
Ventilation/Perfusion Mismatch
-Is a mismatch between the movement of air into and out of the alveoli (ventilation) and the blood supply to alveolar capillaries (perfusion).
-If the ratio is too high in a part of the lung (that is ventilation without enough perfusion) that lung behaves as a dead space.
-If the ratio is too low (perfusion with not enough ventilation) the area behaves as a shunt.
Ventilation
movement of air into and out of the alveoli
Perfusion
the blood supply to alveolar capillaries
COPD Treatment
-Bronchodilator drugs (inhaled adrenergic and anticholinergic agents) and inhaled corticosteroids.
-Oxygen therapy when there is significant hypoxemia (continuous, low flow oxygen).
-Lung reduction surgery (emphysema).
-Quit smoking and avoid other airway irritants.
-Prescribed exercise.
-Antibiotics for infections (particularly with chronic bronchitis).
-Avoidance of large crowds.
Chronic Interstitial (restrictive) Lung Disease
-Characterized by stiff lungs and chest
-Inability to get air into lungs because lungs and/or chest can't expand properly due to decreased lung tissue elasticity and recoil. This leads to reduced lung volume.
Chronic Interstitial (restrictive) Lung Disease Etiologies
scar tissue from pneumona, black lung, brown lung, sarcoidosis, pulmonary fibrosis
Chest Wall Restriction Etiologies
-Substances or injuries that affect the respiratory centers in the brain
-Problems with the phrenic nerve
-Disorders of neuromuscular junction (myasthenia gravis)
-Problems with the lung cavity (obesity, rib fractures, pleurisy, pneumothorax, flail chest, kyphosis)
Pulmonary Embolism
occlusion of a pulmonary artery or arterioles
Pulmonary Embolism Etiologies
Deep venous thrombosis (DVT) and hypercoagulability problems
What are some consequences of a pulmonary embolism?
pulmonary blood flow causes backup, pulmonary edema, could lead to right-sided heart failure and hypoxic organs/tissues.
Pulmonary Hypertension
involves the elevation of arterial pressure in pulmonary circulation which increases resistance to blood flow putting extra work on the right heart.
Cor Pulmonale
right-sided heart failure due to pulmonary vasoconstriction. Normally, hypoxic tissue causes blood vessels to dilate, only pulmonary blood vessels in the lungs will vasoconstrict when hypoxic.
Acute Respiratory Distress Syndrome
A clinical term used to describe changes that occur in the lungs. Lungs become heavy, filled with fluid and "airless."
Acute Respiratory Distress Syndrome Etiologies
shock, trauma, burns, acute cardiac failure, pneumonia, toxic lung injury, aspiration of fluids, premature lungs
Acute Respiratory Failure Manifestations
-Rapid onset
-Increased respiratory rate, respiratory distress in infants
-Hypoxemia
-Complications can lead to respiratory failure and multiple organ failure
Acute Respiratory Failure Treatment
-Oxygen
-Fluids and electrolytes
-Supportive care until lungs can recover
-Treat underlying disorder
-Pain medication
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