lecture 8

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LaurenFleming
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156196
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lecture 8
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2012-05-28 22:49:16
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respriatory
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  1. Hypoventilation
    –Leads to hypercapnia and hypoxemia

    –Caused by certain drugs, disorders such as obesity, myasthenia gravis, chest wall damage, or paralysis of respiratory muscles

    the delivery of air to the alveoli is insufficient this deficieny leads to hypercapnia (increase CO2 in blood) and hypoemia (decrease in O2 in blood)

    Your not blowing out CO2 so it builds up the increase in alveolar CO2 displaces the O2, contributed to obesity

    Myasthenia gravis: a breakdown of the motor end plate of the muscle is gone lossing muscle control causeing hypoventilation
  2. Hyperventilation
    –Leads to hypocapnia

    –Caused by hypoxia, pain, fever, or anxiety
  3. Hypoxemia
    decrease O2 in blood

    –Caused by high altitude, hypoventilation, and airway obstruction
  4. Hypoxia
    decreased O2 in tissues

    –Caused by high altitude, hypoventilation, and airway obstruction
  5. Acute Respriatory Failure
    –Disturbed gas exchange resulting in abnormal arterial blood gas levels

    –Hypoxemia develops because of mismatched perfusion and ventilation

    • –Hypercapnia develops due to
    • inadequate alveolar ventilation
  6. Manifestations of Acute respiratory failure
    pt becomes confuesed not enough o2 to brain, dizziness, depressed conciousness, tremors, pt will attempt to take in O2 àtachypnea, increased HR, whenever you have decreased O2 tension àvasodilation àhypotension
  7. Pulmonary hypertension
    occurs with any condition that increases the resistance of the pulmonary vasulature also related to cardio genic
  8. Primary pulmonary Hypertension
    Idopathic not sure what causes it but associated with it are serosis of the liver, appetite supresive drugs, seen in HIV, rapid progression and prognosis poor, more common in women
  9. Secondary Pulmonary Hypertension
    Most commonly due to increased airway resistance, as in chronic bronchitis and advanced emphysema
  10. Pulmonary Venous Thromboembolism
    coming from DVT and increase in pulmonary pressure -->right sided HF

    • PE: pts will presetn with tachycardia and pnea, severe chest pain may or may not occuring with very large PE,
    • SOB -->very anxious and restlessness, symptoms of RHF (kussmals sign-disteneded superficial jugular vein, peripheral edema, spleenomeglia)
  11. Four major types of carcinomas
    • Squamous cell carcinomas
    • Adenocarcinoma
    • Large cell carcinoma
    • Smalle cell carcinoma
  12. Squamous cell carcinoma
    Metastasizes to regional lymph nodes

    • common can b detected by ctyological examination of
    • sputum. Propensity to mestastisize to regional lymph nodes

    develop in bronchial tree
  13. Adenocarcinoma
    Metastasis occurs in distant organs

    located in the perphery of the lungs no easily detected

    causes increased sputum

    develops in parenchyma
  14. Large cell carcinoma
    Metastasis occurs in distant organs

    develops in parenchyma
  15. small Cell carcinoma
    worst type and resistant to treatment, grows rapidly

    widespread metastasis is common

    mutates a lot causing more and more resistance to the intervention used

    develops in the bronchial tree
  16. Obstructive Pulmonary disorder
    Obstruction from conditions of the wall of the lumen
  17. Asthma
    Most common chronic disease in childhood

    Lung disease characterized by

    -Airway obstruction, usually reversible

    -Airway inflammation

    -Increased airway responsiveness to stimuli
  18. Exercise induced asthma
    common in children often related to heat loss and water loss more common in winter lack of humidity
  19. Drug induced Asthma
    associated with aspirin (affects the cygooxynase cycle so that gets kicked out to ipooxygenase pathwayà increase din leukitrine production, NSAIDs,
  20. Asthma episode may range in severity from
    mild to life threatening depending on the degree of airway obstruction
  21. Acute Bronchitis
    • Acute inflammation of trachea and bronchi, typically caused by viruses (influenza virus A or B, parainfluenza virus, rhinovirus, etc.) and bacteria (Streptococcus
    • pneumoniae, Haemophilus influenza, etc.)

    Heat, smoke inhalation, inhalation of irritant chemicals, and allergic reactions can also induce acute bronchitis

    Cough and a low grade fever, bronchi and trachea bc obstructed complaining of dyspnea and chest pain

    Considered more dangerous in children bc of the smallness of their airways and a smaller diameter but evquivelant response
  22. With Acute Bronchitis airways can be inflammed causing it bo become narrow in 4 diff ways
    • 1. capillary dilation
    • 2. increased exudation of fluid
    • 3. increased mucus secreations
    • 4. loss of mucilary cilliary esculator
  23. Chronic Bronchitis (Type B COPD)
    • Presistent narrowing of the airways, due to chronic inflammation, excessicve mucsous production (lining
    • the bronchi) leading to poor ventilation and poor gas defrusion

    Major cause is cigarette smoking (paralyzing mucous cilliary esculator à> repeated airway infection

    Remaining cause is inhalation of chemical irritants

    Key is chronic obstruction
  24. Clincal manifestations of chronic bronchitis
    • excess body fluid (edemal plethora)
    • Chronic cough
    • SOB on exertion
    • increased sputum
    • cyanosis (late sign)

    "blue bloaters"
  25. Alveolar hypoxia leads to
    generalized pulmonary vasoconstriciton, pulmonary hypertension and right ventrivular hypertrophy (cor pulmonale)

    right sided HF may occur bc of the high pulmonary resistance
  26. Emphysema Type A COPD characterized by
    by destructive changes of the alveolar walls and abnormal enlargement of the distant air sacs

    Cigarette smoking is a major cause of emphysema
  27. emphysema develops over a ...
    long period and is seen more frequently in persons older than 50
  28. Pathologic changes of emphysema are characterized by
    alveolardestruction associated with the release of proteolytic enzymes from inflammatory cells (neutrophils and macrophages)
  29. Pathologic changes of emphysema are characterized by
    alveolar destruction associated with the release of proteolytic enzymes from inflammatory cells (neutrophils and macrophages)
  30. With the loss of alveolar wall, in emphysema there is a marked
    reduction in the pulmonary capillary bed and a decrease in overall gas exchange
  31. Emphysema is due to ...
    due to alastic in alveolar walls in broken down when inhale there is no elastic in there to bring it back to normal size resulting in abnormal size in lungs


    • Elsatic fibers also keep the small airways open, when lungs expand the lungs stretch and expands and the
    • elastic fibers are pulled in all direction and small airways are collapsed à the obstruction is they cant get the air out staying in the lungs, lost radial traction and that’s what keeps the small airways open
  32. Clincal manifestations of Emphysema
    • use of accessory muscles to breath
    • pursed lip breathing
    • minimal or absent cough
    • leaning forward to breathe
    • barrel chest
    • digital clubbing
    • dyspnea on exertion
  33. Bronchiectasis
    Characterized by recurrent infection and inflammation of bronchial walls, leading to persistent dilation of medium-sized bronchi and bronchioles

    recurrent infection inflammation --> a lot of purulent exudate (puss and foul smell yellow greenish)à airway obstruction
  34. Bronchiolotis
    wide spread inflammation of bronchials, due to respiratory sincidial virus or influenza virus,

    • what happens is the obstruction is due to inflammation associated with a inflammatory exudateà releaseing inflammatiory mediateorsà broncho constriction and
    • fibrosis

    • -obstruction typically takes place in the
    • smallest broncials
  35. Cystic Fibrosis (CF)
    Autosomal recessive disorder of exocrine glands

    CF gene on chromosome 7, mutation in gene for transmembrane conductance regulator, which is involved in Chloride ion transport
  36. what does CF affect
    • CF affects lungs (hypersecretion of thickened mucus), intestinal tract (excessive mucus secretions),
    • sweat glands (high salt content in sweat) and pancreas (decreased production of pancreatic enzymes)

    Heart-lung or lung transplantation is the only definitive treatment

    first sign in children is said to have a salty kiss (bc chloride isnt working)
  37. Acute Tracheobroncial Obstruction
    Requires immediate treatment

    Causes include aspiration of a foreign body, laryngospasm, trauma, epiglottitis, swelling from smoke inhalation, etc.

    can be complete or partial
  38. Acute tracheobronchial obstruction Complete happens in the
    trachea or larnex
  39. Actue trachobronchial obstruction Partial or incomplete occurs in the
    typically in bronchi usually one bronchi often times the right bronchus
  40. Epiglottitis
    • Rapidly progressive cellulitis of the epiglottis
    • and adjacent tissues

    Typically caused by H. influenzae

    Most often seen in children 2 to 4 years of age

    Difficulty swallowing saliva with evidence of drooling is common
  41. Croup Syndrome
    A number of acute viral inflammatory diseases of the larynx

    Typically occur in late fall and early winter and affect children from 6 months to 3 years of age

    typically present w/ a barking cough and stridor

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