Clin Med: Respiratory system & Circulatory system

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Bethalex88
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154838
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Clin Med: Respiratory system & Circulatory system
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2012-05-20 12:22:21
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Respiratory circulatory diseaes
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Respiratory diseases
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  1. Hypoplasia
    • Any condition that impedes the development of the thoracic cavity
    • May lead to unilateral or bilateral underdevelopment of the lungs
  2. Diaphragmal Hernia
    • Partial or total absence of the diaphragm
    • May result in herniation of abdomen into thoracic cavity
  3. Bronchogenic cysts
    • Peribronchial cysts
    • Lined by bronchial epithelium
    • May contain air or mucoid material
    • May lead to abcess formation
    • May rupture into bronchi or pleural cavity
  4. Bronchopulmonary Sequestration
    • Lung tissue w/ no connection to bronchial system
    • Extralobar: outside visceral pleura w/ its own
    • Intralobar: within visceral pleuro
  5. Atelectasis
    • Incomplete expansion of alveoli; collapse
    • Primary: failure of ventilation @ birth
    • Secondary: insufficient surfactant, loss of negative pressure, obstruction, direct pressure on lungs
  6. Bronchiectasis
    • Dilation of bronchi & bronchioles
    • B/c of destruction of muscle & elastic supporting tissue
    • Result of: chronic necrotizing infections, or mechanical obstruction of bronchi
  7. Viral Pneumonia
    • Lesions: peribronchiolar & within alveolar walls
    • Walls widened by edema
    • Persistent non-productive cough
    • Rare chest pain
    • Dyspnea
  8. Bacterial Pneumonia
    Inflammation & solidification of pulm parynchyma
  9. Bronchopneumonia
    • Bacterial
    • Inflammatory consolidation
    • Patchy distribution
    • Usually LOWER lobe
  10. Lobar Pneumonia
    • Bacterial
    • Inflammatory consolidation
    • Involves ENTIRE lobe
    • Streptococcus Pneumoniae
  11. Pneumococcal Pneumonia development
    • Congestion: Bacterial proliferation & inflammatory response & serous exudation into alveolar space
    • Red Hepatization: neutrophils & fibrin into alveolar space; produced consistency like the liver
    • Gray hepatization: disintegration of neutrophils & erythrocytes, w/ fibrin accumulation
    • Resolution: Digestion & reabsorption of exudate & restoration of pulm parenchyma to normal
  12. Fungal infections
    • Weak antigens
    • Cause tissue damage via hypersensitivity reactions
  13. Lung Abscess
    • Localized suppuration
    • Liquefaction necrosis of lung parenchyma
    • Due to aspiration of foreign material
    • From altered consiousness
    • Usually on RIGHT side b/c of shallow angle of right bronchus
    • Cough w/ foul smelling sputum
  14. Obstructive disease
    • Incr. in resistance to air flow from partial or complete obstruction @ any level of lung
    • Normal total lung capacity
    • Decreased expiratory flow rate
    • Anatomic airway narrowing or loss of elastic recoil
    • Ex: asthma, empysema, chonic bronchitis, bronchiectasis
  15. Restrictive Disease
    • Reduced expansion of lung parenchyma
    • Decreased total lung capacity
    • Reduced compliance
    • Normal expiratory rate
  16. Asthma
    • Episodic, reversible bronchocontriction
    • Increased responsiveness to chronic inflammation of tracheobronchial tree
    • Dyspnea, cough, wheezing, (during expiration)
  17. Emphysema
    • Chronic obstructive
    • Increase in size of air space distal to terminal bronchiole
  18. Sleep apnea
    • Absence of breath during sleep
    • Inspiratory obstruction--> relaxed walls of the pharynx
    • Relieved with strong inspiratory efforts
  19. Bronchogenic carcinoma
    • 90% of primary malignant tumors of lung
    • Begin in hilar regions
    • Metastases to regional lymph nodes & distant organs
    • Squamous cell carcinoma
    • Adenocarcinoma
    • Bronchoalveolar
    • Small cell carcinoma
  20. Atherosclerosis
    • Accumulation of cholesterol-rich fat in the INTIMA of arteries
    • Occlude arteries
    • Cause: ischemic heart disease, myocardial infarction, stroke & gangrene of extremities
    • Vascular smooth muscle has receptors for LDL
  21. Risk factors for atherosclerosis
    • High LDL level- hereditary, diet, exercise
    • Cigarette Smoking- oxidizes LDL
    • High Blood Pressure- damage to intima
    • Lack of exercise- change in lipoprotein receptor count
    • Hereditary- hypercholesterolemia
    • Low HDL levels
  22. Hypertension
    • Systolic blood pressure over 160 mmHg
    • Diastolic blood pressure over 90 mmHg
    • Result from imbalance b/n:
    • Cardiac output
    • Renal function
    • Peripheral resistance
    • Sodium homeostasis
  23. Vasculitis
    • Inflammation & necrosis of blood vessels
    • Raynaud phenomenon
    • Polyarteritis nodosa
    • Thromboangitis obliterans- Buerger disease
  24. Aneurysms
    • Abnormal dilation of arteries or veins
    • Saccular type or disecting type
    • Weakening of the wall- tunica media
    • Frequently in the aorta
  25. Dissecting Aneurysm
    • Type A: ascending part of aorta
    • Type B: decending part of aorta
    • Berry type: @ base of skill; imp cause of intracranial bleeding in young patients
  26. Pseudoaneurysms
    • Injury to an arterial wall allows escape of blood to form a hematoma confined by arterial adventitia
    • Usually from penetrating trauma
  27. Varicose Veins
    Abnormally dilated veins caused by increased vessel intraluminal pressure
  28. Deep Vein thrombosis
    • Thrombophlebitis
    • Usually in legs
    • Associated with prolonged bed rest
    • May lead to embolization to the lung
    • May or may not be associated with infection
  29. Hemangioma
    • Benign
    • In blood vessel in skin usually
    • can be in internal organs
    • Tumors have capillary-like channels filled with blood.
  30. Hemangiosarcoma
    • Highly malignant
    • Begins as as a small, painless red nodule located in skin, liver
  31. Congenital Heart Disease:
    Right to left shunt
    • Blood contains:
    • reduced hemoglobin away from pulm circuit into systemic circuit
    • Less O2 saturation
    • Results in cyanosis
    • Ex: Tetralogy of Fallot
    • 1) Pulmonary stenosis
    • 2) Ventricular septal defect
    • 3) Dextroposition of aorta
    • 4) Right ventricular hypertrophy
  32. Congenital Heart Disease:
    Left to right shunt
    • Oxygenated blood diverts from systemic circuit into pulm
    • Deprives systemic tissues of oxygen
    • Increased blood --> increased demand on right side --> Hypertrophy of pulmoary arrteriol walls -> incr pulm hypertension --> right ventricular hypertrophy --> possible shunt reversal
  33. Coarctation of aorta
    • Local constriction
    • Upper extremities show higher blood pressure, left ventricular hypertrophy
    • Lower extremities show decreased blood pressure, lower peripheral pulses, coldness, intermittent claudications in calves
  34. Congestive Heart Failure
    • Heart is no longer able to supply enough blood to tissues for norm metabolism
    • Related to:
    • Loss of myocardial contractility
    • Increased resistance
    • Inadequate ventricular filling
    • Increased ventricular blood volume
  35. Congestive heart Failure:
    Compensatory mechanisms
    • Increased heart rate
    • Increased contractility
    • Hypertrophy of muscles
    • Dilation of ventricles
    • Heart later decompesates b/c of additional burden
  36. Left-sided heart failure
    • Insufficient cardiac output
    • Due to:
    • Ischemic heart disease & systemic hypertension
    • Result:
    • Hypertrophy and/or dilation of left ventricle
    • Increased hydrostatic pressure in pulm circulation
    • Pulm edema
    • Dyspnea
    • Orthopnea
    • Cough
  37. Right-sided Heart Failure
    • Right side unable to overcome increased pulm arterial pressure
    • Pulm hypertension may be due to parenchymal or vascular disease (pulm emboli)
    • Presents:
    • Distention of neck veins
    • Congestion of liver & ascites
    • Pitting edema
  38. Ischemic heart disease
    • Result of atherosclerosis of coronary arteries
    • Blood flow is inadequate for O2 demands of the heart
  39. Angina pectoris
    • Due to transient ichemic myocardial injury
    • Discomfort/pain in chest, may extend to neck, left jaw, left shoulder, left arm
    • 3 types:
    • Stable: from physical activity, use beta blockers
    • Unstable: from stress (at rest), coronary artery vasospasm, use Calcium ch blockers
    • Variant: Thrombosis is coronary artery
  40. Acute myocardial infarction
    • Irreversible myocardial damage
    • Inadequate oxygenation of heart
    • Occulded coronary artery & reduced blood flow
    • Associated with: high cholesterol level, hypertension, smoking
    • Severe persistent chest pain
  41. Acute myocardial infarction:
    Transmural infarct
    Occulusion of coronary artery incolving full thickness of ventricular wall (left)
  42. Acute myocardial infarction:
    Subendocardial infarct
    • Hypoperfusion,
    • partial thickness
    • not associated with regional thrombosis
    • 1/3 to 1/2 of left ventricle
  43. Complications of myocardial infarction
    • Cardiac arrhythmia
    • Left ventricular dysfunction
    • Myocardial rupture
    • Ventricular aneurysm
  44. Rheumatic heart disease:
    Acute rheumatic fever
    • Systemic
    • Immuno response
    • Symptoms 2 weeks after strept infection:
    • Polyarthritis
    • Carditis in all 3 heart layers (myocardium, pericardium, endocardium)
    • Erithema
  45. Valvular Heart Disease
    • Calcific aortic stenosis
    • Mitral valve prolapse
    • Endocarditis
    • Lupus
    • May result in: failure of valve to open for fwd flow, or inability of valve to close causing back flow
  46. Myocardial Heart Disease:
    Myocarditis
    • Inflammation involving the myocardium
    • Associated with necrosis of myocytes
  47. Myocardial Heart Disease:
    Cardiomyopathy
    • One of 3:
    • Dilated (congestive): dilation & hypertrophy of heart
    • Hypertrophic (obstructive): hypertrophied myocardium w/ mitral insufficiency
    • Restrictive cardiomyopathy: restriction of ventricular filling
  48. Pericardial Heart Disease
    • Pericarditis, with appearance 1 of 4 ways:
    • Serous- from bacteria or virus w/ inflammation
    • fibrinous- from infarct or trauma
    • purulent- from infection
    • hemorrhagic- from injury, TB or neoplasm
  49. Cardiac neoplasm
    Myoxomas- most frequent, left atrium, may cause valve obstruction

    Angiosarcoma- most common malignant, but rare

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