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Ch 19 Thorax and Lungs Abnormal Findings
Terms in this set (28)
a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.
sunken sternum and adjacent cartilages
a chest that protrudes like the keel of a ship
lateral S-shaped curvature of the thoracic and lumbar spine
excessive outward curvature of the spine, causing hunching of the back.
(rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration
loud, bubbly noise heard during inspiration; not cleared by a cough
Sounds like fine crackles but do not last and are not pathologic; disappear after first few breaths
pleural friction rub
continuous, dry grating sound caused by inflammation of pleural surfaces and loss of lubricating pleural fluid
high-pitched, musical, squeaking adventitious lung sound
predominate in expiration
high pitch, musical, sounds like a squeak; tightly constricted airways
Sonorous wheezes (rhonchi)
Low-pitched, loud, coarse, snoring sounds. (Often heard on expiration.)
strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx
collapsed lung; incomplete expansion of alveoli
Infection in lung parenchyma; bacteria, debris, & fluid replace alveolar air leading to hypoxemia. Inspect: increased resp rate. lag on infected side. Palpate: chest expansion on affected side. Tactile fremitus increased if bronchus patent, decreased if bronchus obstructed. Percuss: dull over lobar pneumonia. Asucultate: louder breath sounds w patent bronchus. Adventitious sounds: crackles fine - medium.
alveoli consolidated with fluid, bacteria, RBCs, WBCs
an acute infection of the trachea and larger bronchi characterized by cough, lasting up to 3 weeks
90% are viral
epithelium of bronchi are inflamed and damaged. releasing proinflammatory mediators
large airways are narrowed from capillary dilation, increased mucus production, loss of cilia function, swelling of epithelium.
More cases occur with smokers, aging adults, children and in winter months
proliferation of mucus glands in the passageways resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. Secretions of lung distal to obstruction may be deflated. Bronchitis may be acute or chronic with recurrent productive cough. Usually caused by cigarette smoking
caused by destruction of pulmonary connective tissue (elastin, collagen). characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. This increases airway resistance, especially on expiration, producing a hyperinflated lung and an increase in lung volume. Cigarette smoking accounts for 80-90% of these cases.
Asthma (reactive airway disease)
allergic hypersensitivity causing inflamm/edema in walls of bronchioles. Inspect: severe attack, wheeze, labored. Palpate: tactile fremitus decreased. Percuss: Resonant. Auscultate: diminished air movement. Adventitious sounds: bilateral wheezing.
Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. May contain watery capillary fluid (transudative), protein (exudative), purulent matter (empyemic), blood (hemothorax), or milky lymphatic fluid (chylothorax).
Gravity settles fluid in dependent areas of thorax. Most common cause is heart failure, also infection and cancer
pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries
Dependent air sacs deflated. Pulmonary capillaries engorged. Bronchial mucosa may be swollen.
inhalation of tubercule bacilli into the alveolar wall starts:
1-initial complex is acute inflammatory response- macrophages engulf bacilli but do not kill them. tubercle forms around bacilli.
2- Scar tissue forms, lesion calcifies and shows on x-ray
3- reactivation of previously healed lesion. dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue (cheese like)
4- extensive destruction as lesion erodes into bronchus, forming air-filled cavity
free air in pleural space causes partial or complete lung collapse
air in pleural space neutralizes the usual negative pressure present- thus lung collaspes. usually unilateral.
Pneumocystis jiroveci (P. carinii) Pneumonia
This virulent form of pneumonia is a protozoal infection associated with AIDS. The parasite P. jiroveci (P. carinii) is common in the United States and harmless to most people, except to the immunocompromised, in whom a diffuse interstitial pneumonitis ensues. Cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid.
Inspection Anxiety, SOB, dyspnea on exertion, malaise are common; also tachypnea; fever; a dry, nonproductive cough; intercostal retractions in children; cyanosis.
Palpation Decreased chest expansion.
Percussion Dull over areas of diffuse infiltrate.
Auscultation Breath sounds may be diminished.
Adventitious Sounds Crackles may be present but often are absent.
Undissolved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels.
Over 95% arise from DVT in LE as a result of stais of blood, vessel injury or hyper coagulability
Pulmonary occlusion results in ischemia in downstream lung tissue, increased PA pressure, decreased CO, and hypoxia
embolus in bifurcation of PAs leads to sudden death from hypoxia
acute respiratory distress syndrome (ARDS)
An acute pulmonary insult (trauma, gastric acid aspiration, shock, sepsis) damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema.
the most fatal of malignancies. major cause is cigarette smoking.
squamous cell usually starts in bronchi near the hilus, adenocarcinoma usually starts in periphery and escapes early detection.
large cell also starts in periphery with tumors arranged as clusters
small cell (oat cell) compresses and narrows central bronchi
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