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Patho Test 3

Terms in this set (46)

Restrictive pulmonary disorders usually result from what?
Decreased lung expansion
Acute (Adult) respiratory distress (ARDS)
Inflammation, fibrosis and fluid accumulation in the alveoli
-Caused by trauma, sepsis (>40%), shock, aspiration of gastric acid, fat emboli syndrome
[Very low O2!]
ARDS is caused by what three pathologic processes?
-Noncardiogenic pulmonary edema associated with "leaky" pulmonary capilaries
-Atelectasis associated with lack of surfactant
-Fibrossis
Severe hypoxemia in ARDS is caused by what?
Intrapulmonary shunting of blood
In a patient with ARDS what would you see on an x-ray?
"Whiteout"
Does atelectasis occur with ARDS?
Yes
Treatment for ARDS
-Block system inflammatory cells
-Identify underlying cause
-Anti SNS drugs
-PEEP (Positive end-expiratory pressure)[to move fluid out of the way]
Infants Respiratory Distress Syndrome (IRDS)
-Primary cause is lack of surfactant
-Hyaline membrane disease
-It's similar to ARDS
Occupational lung diseases
-Pneumoconiosis (Permanent fibrosis in the lung tissue) - caused by infalation of inorganic dust particles
-Anthracosis "coal miner's lung" or "black lung"
-Silicosis - silica inhalation
-Asbestosis - asbestos inhalation
Pathogenesis of Occupational lung diseases
-Pollutants interfere and paralyze cilia, interfere with ciliary action
-Alveolar macrophages try to engulf and remove
-Secretion of lysozyme to control foreign particle activity
Pleural space disorders (Restrictive disorders)
-Pneumothorax
-Pleural effusion
Pneuymothorax
Accumulation of air in the pleural space.
-Can lead to decrease in venous return and cardiac output
TLC (Total lung capacity) GOES DOWN
Primary pneumothorax (Air comes from outside)
Spontaneous
(Smoking increases risk)
-TRAUMA is also a primary cause
Secondary pneumothorax (Air comes from inside)
Results from preexisting pulmonary disease
-Asthma, emphysema, cystic fibrosis, infectious disease (pneumonia, Tb)
Catamenia Pneumothorax
Associated with menstruation
-Primarily right hemothorax
-Associated with endometriosis
Tension pneumothorax
Traumatic origin
-Results from penetrating or non penetration injury
Open "sucking" chest wound
Air enters during inspiration but cannot escape during expiration
-Leads to shift in mediastinum
Clinical findings of pneumothorax
Tachycardia
Decreased or absent breath sounds on affected side
Sudden chest pain on affected side
dyspnea
FOR SEVERE:
-tracheal shift to contralateral side
-neck vein distention
-hyperresonanace
Pleural effusion
Collection of FLUID or PUS in pleural cavity as result of another disease process
-Normaly 5-15mL of serous fluid is contains in pleural space
5 major types of pleural effusion
-Transudates
-Exudates
-Empyema (due to infection in the plural space)
-Hemothorax
-Chylothorax or lymphatic (nastiest, has lipids)
Obstructive Pulmonary disorders
Asthma
Chronic Bronchitis
Emphysema (COPD)
-Acute tracheobronchial obstruction
COPD leads to what
Cor Polmonae
3 Types of ventilation-perfusion imbalances
High Va/Q
Low Va/Q
True Shunt
Airway resistance in obstructive pulmonary diseases develops in localized regions why?
-Obstruction of airways from increased sputum production
-mucosal hypertrophy and edema
-loss of structural integrity of the airway
-narrowing of the airway from bronchial smooth muscle contraction, when there is hyperactivity in the airways
High Va/Q
Related to physiologic dead space
-High ventilation, almost no perfusion. Ex. Trachea or Apex(top) of lungs
4L/2L
Low Va/Q
Related to lower O2 (hypoxemia)
-Poor ventilation/undeventilated
2L/5L
[This is responsive to O2 therapy] {Unlike true shunt that is not responsive to it at all}
True shunt
Right to left shunting of unoxygenation blood through pulmonary circulation. Contributes to lowering of O2. (Found in pts with ARF)

-Not responsive to O2 therapy because the alveoli are collapsed or consolidated and oxygen can not regain entry to them
Normal Va/Q
Found at base of lungs
4L/5L
Pulmonary function tests
Demonstrates abnormality of airflow in lungs
Uses FEV1/FVC

FEV1: volume exhaled in 1st second
FVC (forced vital capacity): Total volume of air exhaled
Pulmonary function tests: OBSTRUCTIVE
FEV1= 1.0L
FVC= 4.0L
FEV1/FVC = 25%
Pulmonary function tests: RESTRICTIVE
FEV1= 2.5L
FVC= 3.0L
FEV1/FVC = 83%
Pulmonary function tests: NORMAL
FEV1= 3.0L
FVC= 4.0L
FEV1/FVC = 75% (usually 80%)
Positive bronchodilator response
FEV1 IMPROVES >15% = positive bronchodilator response
Asthma
Type I Hypersensitiviety
-IGE
-Mast cells release histamine

-Bronchoconstriction

(Additionally, Metaplasia [replacing] of epithelium is replaced by goblet cells which release mucus)

REMEMBER: Because Asthma is obstructive the FEV1/FVC will be decreased. <75%
Respiratory alkalosis or acidosis with Asthma?
Respiratory Alkalosis AND hypoxemia
Chronic Bronchitis (Type B COPD) "Blue bloater"
INFLAMMATION + HYPOXIA
Pulmonary HTN will lead to R sided heart failure
(Females have a high occurrence)
Pathogenesis of Chronic Bronchitis
-Chronic inflammation and swelling of the bronchial mucosa resulting in scarring
-Hyperplaia of bronchial mucous gland/goblet cells
-Increased Bronchial wall thickness [smooth muscle contraction]
-Pulmonary HTN
-Excessive local hypoxia leads to vessel constriction

RIGHT SIDED HEART FAILURE MAY OCCUR R/T HIGH PULMONARY RESISTANCE KNOWN AS COR PULMONALE
Why don't we give Chronic bronchitis pts ghit doses of O2?
To prevent free radicals as well as avoiding shutting off hypoxic drive
Emphysema
INFLAMMATION + DESTRUCTION OF ALVEOLI

Type A COPD "pink puffer"
*Low a1-antitrypsin
(Essentially, d/t low a1-antitrypsin or deficiency in it, it can not control elastase from getting rid of elastin, so there will be a lack of elastin which causes lack of elasticity in alveoli and lungs)

-Decrease in surface area
-Airway collapse d/t loss of radial traction
-Airway collapse is greater on expiration resulting in air trapping and hyperinflation

Residual volume (RV) will go up because of trapped air.

-Barrel chest

-Increased RV
-Increased TLC
-Decreased FEV
-Decreased FVC

Low dose O2 therapy
Why do people with Emphysema have normal PaCO2 levels for the most part?
They are compensating and also from accessory muscle usage
pleural effusion
High protein or low protein
Hemothorax Treatment
...
Restrictive pulmonary diseases
High O2 volume
Obstructive pulmonary diseases
Low O2 treatment
Restictive
FEV1 LOW
FVC LOW
VC LOWEST YOU ARE
...
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