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What is acute resp. distress syndrome (ARDS)?
Diffuse alveolar damage
Decreased arterial oxygen pressure and lung compliance
Massive inflammation response in lungs
Is there l. heart failure with ARDS?
Development of diffuse pulmonary edema without l. heart failure.
What cells mediate the actual injury associated with ARDS?
Neutophils and macrophages are involved in mediating the injury in most cases.
Is ARDS an inspiratory or expiratory disease?
What are common conditions associated with ARDS?
Physical injury (near drowning, burns)
Inhaled irritants (smoke)
Hematologic conditions (multiple transfusions)
How does ARDS start? (i.e. the pathogenesis)
Can be either:
Injury to capillary endothelium (sepsis)
Injury to alveolar epithelium (viral/bacterial pneumonia)
Both! (damaging pulmonary burns)
What is the result of the massive inflammatory response that occurs with ARDS?
Formation of hyaline membranes in the alveoli
What are the clinical features of ARDS?
Symptoms os severs distress and dyspnea occur within 24 hours
X ray shows diffuse consolidation (leakage of fluid) of the lungs
Patients requrie ventilators
What is the mortality rate of ARDS?
1/3 die w/i days
1/3 die of penumonia and heart failure w/i weeks
1/3 recover with fibrosis of the lungs (contraction atelectasis)
Why are the lungs at risk for infections?
Constantly exposed to outside air
Nasopharyngeal flora regularly aspirated
Previous lungs disease make the lung more vulnerable
What are some of the lungs defenses against infection?
Mucus blanket and ciliated epithelium
IgA in upper resp. tract
Lymph node immune response
What are the 2 risk factors for pulmonary infection and examples for each?
Inhibition of mucociliary system caused by smoking, chronic bronchitis, or general anesthesia
Destruction of bronchial epithelium caused by aspiration of gastric contents, inhalation of toxins, or physical trauma
What is pneumonia?
An inflammation of alveoli, interstitial tissue, and/or bronchioles due to infection by pathogens or irritation by chemicals or other agents (sterile pneumonia).
How prevalent is pneumonia?
Occurs in 4 mill people a year
6th leading cause of death
Most common cause of death due to infection
What is sterile pneumonia?
Non infectious pneumonia
What are the 3 infectious subclassifications of penumonia?
What are the 2 differect radiological classifications of pneumonia?
Alveolar vs. Interstitial
What are the 2 etiological classifications of pneumonia?
Infectious vs. non infectious
What is alveolar pneumonia? What is it's origin?
Infection resulting from exudates in the lumen of the alveoli
May lead to consolidation (so full of shit it can't get oxygen)
Bacterial in origin
What is intersitial pneumonia and what is its origin?
Inflammation affects the alvolar septa
Diffuse and bilateral
What are the 2 types of alveolar penumonias?
Bronchopneumonia: patchy distribution affecting more than one lobe
Lobar pneumonia: part or all of one lobe filled with exudate
What are 3 unclassified pneumonias?
Aspiration: inhalation of gastric contents
Atypical: mycoplasma pneumoniae kills alveolar septa
Hypostatic: bacterial infection + pulonary edema (happens to bed-ridden)
What are 2 examples of bacterial pneumonias?
Legionnaire's Disease: problem with macrophage cytoplasm leads to massive consolidation and necrosis
Pneumococcal Pneumonia: inflammation leading to alveolar edema; bacteria like to live in the edema, leads to consolidation; try killing these bacteria and they release toxins
What is croup?
Usually occurs in children during the winter time
Marked by barking cough
Resolves w/i 24-48 hrs
What is tuberculosis?
Bacterial inflammation causing granulomas and tubercle formation that trap dormant organisms which can spread throughout the body if the immunity is impaired.
Describe the incidence rate of tuberculosis
Was low in the 50s and 80s but increased between 85-92.
Foreign born americans at 7x more risk
What is bronchogenic carcinoma?
95% of primary lung tumors, leading cause of cancer deaths in US
90% develop metastasis (bone, brain and liver)
Paransoplastic syndromes often occur
5 yr survival rate is only 13-15%
What are the 4 major bronchogenic carcinomas?
In order by prognosis:
Squamous cell lung carcinoma (25-40%)
Small cell (20-25%)
Large cell (10-15%)
Describe squamous cell carcinoma
Most commonly found in men
Associated with tobacco smoking
Easier to detect early
Most common in women and nonsmokers
Associated with scarring
Describe small cell carcinoma
Strongest correlation with tobacco smoking
Can't be completely removed
Paraneoplastic syndromes often seen
Describe large cell carcinoma
Most anaplastic and likely to metastasis
Why are liver disorders so serious?
Other organs are critically dependent on the metabolic function of the liver.
What is functional unit of the liver?
What 3 vessels make up the portal triad?
Describe the blood flow through the liver
Blood flows through the periphery though the sinusoids (wide leaky openings) toward the central vein
What are Kupffer's cells?
Macrophages of the liver
What are the 4 major functions of the liver
Excretion of bile
Metabolism of carbs, fats, and proteins
Storage of carbs and fats
Sythesis of albumin, coagulation, and transport proteins
What does hypoalbuminemia lead to?
Decreased albumin leads to hypoproteinemia which can lead to edema
What does the liver filter from circulation?
the liver removes from circulation, metabolizes, and detoxifies many drugs, hormones, and metabolites.
What is hepatotopism?
When certain viruses seek and destroy the liver
Describe liver cell regeneration
Liver cells can regenerate
These cells can giver rise tumors but are more often affected by metastasis.
Bile can form gallstones
What is cirrhosis?
Regeneration of liver cells is affected by fibrosis and nodules form instead of healthy tissue.
How is bilirubin created?
Lysis of old RBCs by Kupffer cells
Iron is removed and red pigment is lost for a yellow pigment
Bilirubin is released into the blood and binds to albumin (unconjugated (not water soluble))
Gets taken up by liver and conjugated (water soluble)
What is the primary function of bilirubin?
Conjugated bilirubin is excreted in bile into the intestine where it emulsifies fat.
What happens to bile salts throughout digestion?
Bile salts are nearly all reabsorbed and returned to the liver
What is jaundice?
A symptom, not disease, characterized by yellow disoloration of skin and mucosa
Caused by elevated bilirubin levels
What are normal bilirubin levels and when does jaundice occur?
Normal: < 1.2 mg/dl
Jaundice: > 2-3 mg/dl
What are the 3 classifications of jaundice?
Prehepatic (unconjugated hyperbilirubinemia)
Hepatic (mixed conjugations, viral, drugs, cirrhosis)
Posthepatic (conjugated hyperbilirubinemia, obstructive)
Describe jaundice in newborns
- Transient and benign during 1st week of life
- Mild unconjugated hyperbilirubinemia
- > 15 mg/dl
- Often need phototherapy
Multiple episodes of mild liver injury may have an ______ effect.
How is liver injury viewed histologically?
Necrosis of liver cells
What is liver failure?
Impairment of 90-90% of liver function.
What is viral hepatitis?
Diffuse inflammation throughout liver lobules
Associated with swelling and necrosis of liver cells
Can presenet itself with any combo of illness and jaundice
What are the 5 types of viral hepatitis?
A - infectious
B - serum
C - uh oh
D - Delta
E - Fecal-oral
What is HAV and its incubation period?
Self-limiting infection with available vaccine
Transmitted typucially through fecal contamination of food and water
Incubation: 2-6 weeks
What is HBV and its incubation period?
Usually eliminated but 10% become chronic carriers and may develop chronic hepatitis; available vaccine
Transmitted through blood and body fluids
Incubation: 6wk - 4mo
What is HCV and its incubation period?
Infection unabale to be eliminated and most become chronic carriers, develope chronic hepatitis and cirrhosis; no available vaccine
Transmitted through blood and body fluids
Incubation: 35-65 days
How can one get cirrhosis w/o ever touching a drink?
What is fatty liver?
Fat accumulation on liver cells that imparis function
Commonly caused by excessive alcohol and toxins
Reversible if injurious agent removed
What are 3 different forms of alcoholic liver disease?
Alcoholic fatty liver