Patho: Respiratory System Disorders

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Patho: Respiratory System Disorders
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2012-11-11 18:57:43
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Patho Respiratory System Disorders Pathophysiology
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Patho: Respiratory System Disorders Pathophysiology
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  1. pneumonia
    • An acute or chronic disease marked by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms and sometimes by physical and chemical irritants.
    • a risk following any aspiration, when fluids pool or defense mchanisms such as cilia are reduced
  2. Lobar pneumonia
    • definition: pneumonia affecting one or more lobes of the lung; commonly due to streptococcal infection
    • pathophysiology: • inflammation of alveolar wall and leakage of cells, fibrin, and fluid into alveoli causing consolidation • pleura may be inflamed
    • Onset signs: Sudden and acute • high fever and chills • dyspnea, tachypnea, tachycardia • productive cough with rusty sputum • rales progressing to absence of breath sounds in affected lobes • metabolic acidosis • dehydration from high fever, hyperventilation, and inadequate fluid intake
    • Treatment: antibacterial medications such as penicillin
  3. Interstitial Pneumonia
    • aka Primary Atypical Pneumonia, PAP
    • chronic lung disease affecting the interstitial tissue of the lungS
    • Distribution: scattered small patches
    • Cause: influenza virus, Mycoplasma
    • Pathophysiology: interstitial inflammation around alveoli • necrosis of bronchial epithelium
    • Onset Signs: Variable • sore throat, variable fever, headache, aching muscles, nonproductive hacking cough
  4. Bronchopneumonia
    • A pneumonia involving inflammation of the lungs that spreads from and after infection of the bronchi.
    • Distribution: scattered small patches
    • Cause: multiple bacteria
    • Pathophysiology: inflammation and purulent exudate in alveoli often arising from prior pooled secretions or irritation
    • Onset signs: Insidious • mild fever • productive cough with yellow-green sputum • dyspnea • rales
  5. Legionnaires' disease
    • a pneumonia caused by a gram-negative bacteria, legionella pneumophila
    • pathophysiology: found in pulmonary macrophages
    • Onset signs: fever, chills, and a cough, which may be dry or may produce sputum. Some patients also have muscle aches, headache, tiredness, loss of appetite, loss of coordination (ataxia), and occasionally diarrhea and vomiting.
  6. Severe Acute Respiratory Syndrome
    • SARS
    • Distribution: spreading patchy areas of interstitial congestion
    • Cause: RNA coronavirus SARS-CoV transmitted by respiratory droplets during close contact
    • Pathophysiology: 1st stage presents flulike syndrome 3-7 days. 2nd stage interstital congestion and increasing hypoxia. Lymphopenia and thrmobocytopenia, elevated liver enzymes from damaged liver. 3rd Stage: severe/fatal respiratory distress
  7. Pathophysiology of Tuberculosis
    • a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans.
    • usually attacks the lungs but can also affect other parts of the body.
    • It is spread through the air when people who have the disease cough, sneeze, or spit. A disease of poverty and crowding
    • Two stages: Primary Infection and Secondary Infection or Reinfection
  8. Primary Infection of TB
    • occurs when the microorganisms first enter the lungs, are engulfed by macrophages--> inflammatory response + delayed hypersensitivity reaction.
    • High resistance-->tubercle formation: caseation necrosis and granuloma • organisms walled off (Ghon complex)--> bacilli may remain viable in dormant state, possibly for years-->asymptomatic
    • Low resistance--> active infection-->spread to lungs and other organs
  9. Secondary or Reinfection of TB
    • the stage of active infection
    • often arises years after primary infection, usually due to decreased host resistance
    • cavitation and necrosis with large open area in the lunch and erosion into the bronchi and BVs
    • hemoptysis
  10. cystic fibrosis
    • CF or mucoviscidosis
    • a hereditary chronic disease of the exocrine glands, characterized by the production of viscid mucus that obstructs the pancreatic ducts and bronchi, leading to infection and fibrosis.
  11. Pathophysiology of CF
    • several mutations to the CFTR gene on 7th chromosome and relate to a protein involved in Cl ion transport in the cell membrane that causes abnormally thick secretions by exocrine glands
    • In the lungs: mucus obstructs airflow in the bronchioles and small bronchi, causing airtrapping or atelectasis with perm. damage to bronchial walls • infections are common--> destruction of lung tissue--> respiratory failure or cor pulmonale develops
    • In the pancreas: the ducts become blocked--> deficit of pancreatic enzymes in intestine--> malabsorption + malnutrition + dehydration  • backup of secretions--> damage to pancreatic tissue--> diabete mellitus
  12. CF in newborns
    first indication of abnormality may be meconium ileus, in which the small instestine of the neonate is blocked by mucus at birth, preventing excretion of meconium shortly after birth
  13. Cause of CF
    • mutated CFTR gene for CF on seventh chromosome
    • autosomal recessive disorder
  14. Signs and Symptoms of CF
    • meconium ileus may appear at birth
    • salty skin (noticed by mother)
    • malabsorption noticed in 1st year, with steatorrhea, abdominal distention, and failure to gain weight
    • chronic cough and frequent respiratory infections--> hypoxia, fatigue, exercise intolerance
    • failure to meet normal growth milestones
  15. Pathophysiology of Lung Cancer
    • 1st change: metaplasia, usually reversible if irritant ceases (smoking)
    • Second change: dysplasia or carcinoma in situ develops. Difficult to detect. Stages determined based on tumor size. Common sites of metastases include brain, bone, and liver.
    • Effects of tumors of the lungs: obstruction of airflow • inflammation surrounding tumor stimulates a cough and predisposes to secondary infection • pleural effusion, hemothorax, pneumothorax or combo • paraneoplastic syndrome ADH ACTH--> neuromuscular disturbances or DIC
  16. paraneoplastic syndrome
    • a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.
    • mediated by hormones or cytokines excreted by tumor cells or by an immune response against the tumor.
    • Paraneoplastic syndromes are typical among middle aged to older patients, and they most commonly present with cancers of the lung, breast, ovaries or lymphatic system.
    • their symptoms sometimes show even before the diagnosis of a malignancy.
  17. Signs and Symptoms of Lung Cancer
    • Early: persistent productive cough, dyspnea, and wheezing • detection on x-ray • hemoptysis • pleural involvement • chest pain • hoarseness, facial or arm edema and headache (compression of superior vena cava), dysphagia (compression of esophogus), atelectasis
    • Systemic Signs: weight loss, anemia, fatigue
    • Paraneoplastic syndrome
    • Signs of metastases depend on site
  18. Aspiration
    • the entry of secretions or foreign material into the trachea and lungs
    • As the right main bronchus is more vertical and of slightly wider lumen than the left, aspirated material is more likely to end up in this branch or one of its subsequent bifurcations.
  19. Emphysema
    • Etiology: smoking • genetic
    • Location: alveoli
    • Pathophysiology: destruction of alveolar walls, loss of elasticity, impaired expiration, barrel chest, hyperinflation
    • Cough, Dyspnea: some coughing • marked dyspnea
    • Sputum: Little
    • cyanosis: No
    • Infections: Some
    • Cor pulmonale: perhaps late
  20. Chronic Bronchitis
    • Etiology: smoking • genetic
    • Location: bronchi
    • Pathophysiology: increased mucous glands and secretion, inflammation, infection, obstruction
    • Cough, Dyspnea: early, constant cough • some dyspnea
    • Sputum: large amount, purulent
    • Cyanosis: Yes
    • Infections: Frequent
    • Cor pulmonale: Common
  21. Asthma--Acute
    • Etiology: hypersensitivity type I, hyperresponsive tissue
    • Location: small bronchi, bronchioles
    • Pathophysiology: inflammation, broncho-constriction, increased mucus produced, obstructioon, repeat attaches lead to damage
    • Cough, Dyspnea: cough and dyspnea, wheezing
    • Sputum: thick tenacious mucus
    • Cyanosis: Yes if status asthmaticus
    • Infections: some
    • Cor pulmonale: rare
  22. Pathophysiology of  Pulmonary edema
    • fluids collects in the alveoli and interstitial area--> reduction in amount of O2 diffusing into blood and interferes with lung expansion--> reduction in O2--> severe hypoxemia
    • may develop when inflammation is present in lungs, increasing capillary permeability; plasma protein levels are low, decreasing plasma osmotic pressure; pulmonary hypertension develops
    • fluid interferes with surfactant action--> lung collapse
  23. Cause of Pulmonary Edema
    • CHF
    • hypoproteinema due to kidney or liver disease
    • inhalation of toxic gases--> inflammation--> increased capilliary permeability
    • blocked lymphatic drainage
    • idiopathically
    • secondary to untreated obstructive sleep apnea
  24. Signs and Symptoms of Pulmonary Edema
    • cough
    • orthopnea
    • rales
    • hemoptysis
    • frothy and blood-tinged sputum
    • labored breathing
    • drowning sensation
    • hypoxemia increase
    • cyanosis
    • paroxysmal nocturnal dyspnea during sleep period b/c of acute CHF
  25. pulmonary embolus
    • a blood clot or a mass of other material that obstructs the pulmonary artery or a branch of it, blocking the flow of blood through the lung tissue
    • most are thrombi originating from deep leg veins
    • leading cause of death in hospitals
  26. Pathophysiology of pulmonary embolus
    • usually cause respiratory impairment because fluid and blood fill the alveoli of involved area--> reflex vasocontriction--> increase in pressure
    • large emboli cause right-sided heart failure and decreased cardiac ouput/shock--> sudden death
  27. Cause of pulmonary embolus
    • deep vein thrombi breaking off
    • fat emboli from bone emboli
    • amniotic fluid emboli from placental tears from labor + delivery
    • tumor cell emboli
    • air embolus injected into vein
  28. Signs and symptoms of pulmonary embolus
    • small emboli: transient chest pain, cough, or dyspnea
    • large emboli: chest pain that increases with coughing or deep breathing,sudden tachpnea + dyspnea, hemoptysis and fever
    • hypoxia-->sympathetic response with anxiety and restlessness, pallor, tachycardia
    • Massive emboli: crushing chest pain, low BP, rapid weak pulse, loss of consciousness
    • Fat emboli: distinguished by development of acute respiratory distress, a petechial rash on the trunk, and neurologic signs such as confusion and disorientation
  29. Pneumothorax
    • a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall.
    • may occur spontaneously in people without chronic lung conditions ("primary") as well as in those with lung disease ("secondary"), and many pneumothoraces occur after physical trauma to the chest, blast injury, or as a complication of medical treatment.[1][2]
  30. Closed Pneumothorax
    • Cause: spontaneous, idiopathic • ruptured emphysematous bleb
    • Air entry: from inside lung through tear in visceral pleura
    • Effects: atelectasis • leak seals as lung collapses • one lung impaired • no additional cardiovascular effects
    • Signs: increased, labored respirations with dyspnea, tachycardia, pleural pain, and asymetrical chest movements • breath sounds absent • hypoxemia
  31. Open Pneumothorax
    • Cause: puncture wound through chest wall
    • Air entry: from outside body through opening in thorax and parietal pleura
    • Effects: atelectasis • air enters pleural cavity with each inspiration and leave with each expiration • unaffected lung compressed by mediastinal flutter impairs venous return to heart
    • Signs: increased, labored respirations with dyspnea, tachycardia, pleural pain, and asymetrical chest movements • sucking noise is large • tracheal swing • decreased BP • moderate hypoxemia
  32. Tension Pneumothorax
    • Cause: open--puncture through thorax • closed--tear in lung surface. Both with flap or one-way valve.
    • Air entry: through the thorax or tear in lung surface
    • Effects: atelectasis • air enters pleural cavity with each inspiration • flap closes with expiration and air pressure increases in pleural cavity pressure • unaffected lung increasingly compressed by mediastinal shift • mediastinal shoft reduces venous return to heart
    • Signs: increased, labored respirations with dyspnea, tachycardia, pleural pain, and asymetrical chest movements • breath sounds absent on affected side • tracheal deviation to unaffected side • increasing respiratory distress • shock, distended neck veins, cyanosis • severe hypoxemia
  33. Simple or Spontaneous pneumothorax
    • occurs when a tear on the surface of the lung allows air to escape from inside the lung through a bronchs and the visceral pleura into the pleural cavity
    • as the lung collapses, it seals off the leak
    • usually occurs in young men with no prior lung disease
    • following collapse, the mediastinum can shift toward the affected lung allowing the other lung to expand more

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