Pathophys Exam 2

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JennyH8
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39842
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Pathophys Exam 2
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2010-10-05 13:47:55
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Patho Exam
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Pulmonary, renal, flu, 3 cases
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  1. Atelectasis
    • Lack of gas exchange in the alveoli
    • "collapse of lung tissue"
    • Due to:
    • Compression-tumor, fluid, abdominal distention
    • Absorption: In obstucted or hypo-ventilated alveoli
  2. Hypoxemia
    Decrease in PaO2 in arterial blood
  3. Hypercapnia
    • Too much CO2 in the blood:
    • Caused by hypoventilation or lung disease
  4. Bronchiolitis
    • Inflammation of the bronchioles, the smallest air passages of the lungs.
    • Most common in children
    • Decrease V/Q
    • May have delayed respiratory distress
    • Usually caused by viruses/ toxic gases.
  5. Bronchiectasis
    • Causes: cystic fibrosis, obstructions, infection, bronchial wall weakness, autoimmune/AIDS
    • Abnormal dilation of bronchi = more weakened & more prone to collapse = causing local obstructions
    • Focal more common = due to infection
    • Diffuse = due to systemic illness (autoimmune)
  6. Pulmonary Disease S&S
    • Dyspnea
    • Abnormal Breathing
    • Cough
    • Clubbing
  7. Conditions caused by Pulmonary Disease
    • -Hypercapnia, hypoxemia
    • -Acute Respiratory failure
    • -Pulmonary Edema
    • -Aspiration
    • -Atelectasis, Bronchiectasis, Bronchiolitis
    • -Pleural Abnormalities
    • -Abscesses, fibrosis, restriction
    • -Inhalation disorders
    • -Systemic disorders
  8. Types o f Pulmonary Disease
    Acute vs chronic: bacteria vs COPD

    Obstructive vs. Restrictive: Cancer vs. Fibrous of Lung

    Infectious vs. noninfectious
  9. Overall lung Function
    • Gas exchange
    • Acid/base
    • Prevent infection
  10. Lung Anatomy
    • Surface Area
    • Compliance
    • Humidity
    • Blood flow change in lung and heart
  11. Physiology modifications of lungs
    • Modified by change in surface area (SA) and distance for diffusion
    • Obstructions modifiy SA
    • Changes in compliance and expandabilty and reduce filling capacity
    • -asthm
    • -COPD
    • -musculoskeletal defects: broken ribs, RA
    • -collapsed lung
    • -fibrosis
    • Fluids & inflammation in the lung can decrease both area and diffusion
  12. If pulmonary vascular resistance goes up, what happens to the right heart
    Right heart failure
  13. When lungs are injured or stressed, what happens?
    • -Hypoxia
    • -Acid-base abnormalities
    • -Infections
    • -Altered hemodynamics
  14. When can damage to other organs cause secondary damage to lungs?
    • Renal disease-metabolites damage lungs
    • Immune disorders
  15. Dyspnea
    • Subjective sense of uncomfortable breathing
    • Can't get enough air
    • Breathlessness, air hunger, SOB
  16. Causes of Dyspnea
    • -Diffuse & extensive pulmonary involvment
    • -Disturbances of ventilation &gas exchange

    • 1. Stimulation of receptors in respiratory muscles
    • -Increased airway resistance
    • -Decreased compliance

    • 2. Central & Peripheral chemoreceptors
    • -low pH
    • -hypercapnia
    • -hypoxemia

    • 3. Stimulation of afferent (vagal) receptors in lung
    • -Stretch R's (smooth muscles): decrease volume & vent. rate
    • -Irritant R's(epithelium esp. proximal airways): cause cough, bronchoconstriction, increased resp rate
    • -J-R's (juxtapulmonary capillary): stimulates rapid , shallow breathing, hypotension, and bradycardia
  17. Dyspnea signs
    • -Flaring of nostrils
    • -Use of accessory muscles of respiration
    • -Retraction of intercostal spaces
    • -Position: worse when lying down
    • -Paroxysmal nocturnal dyspnea (PND): problems with ventricular heart failure
  18. Eupnea
    • Normal breathing pattern
    • Tidal volume 400-800 ml
    • Breathing rate 8-16/min
    • Sigh breaths occuring ~ 10-12 hr
  19. Kussmaul respiration (hyperpnea)
    • Triggered by strenuous excercise or acidosis
    • Increased rate
    • Big increase tidal volume
    • No expiratory pause
    • All go up
  20. Labored/Obstructed respiration
    • COPD
    • Decrease rate
    • Increase tidal volume
    • Increase effort
    • Wheezing
    • Stridor (high-pitch)
  21. Restricted breathing pattern
    • Pulmonary fibrosis
    • Stiff lungs or chest wall & decreased compliance
    • Increase rate (tachypnea)
    • Decrease tidal volume
  22. Gasping
    • Seen in shock & severe cerebral hypoxia
    • Irregular
    • Quick inspirations
    • Expiratory pause
  23. Cheyne-Stokes breathing pattern
    Seen in brain stem damage or decreased blood flow to it

    • Alternating periods of deep & shallow breathing
    • Apnea 15-60 sec followed by ventilations that increase in volume until a peak is reached then decreasing to apnea again
  24. Hypoventilation
    Due to pulmonary or neurologic problems

    Causes hypercapnea (paco2 > 44mmHg)

    Respiratory acidosis b/c decrease in pH more H+ in blood

    Decreases minute volume
  25. Hyperventilation
    Causes hypocapnea

    Respiratory alkalosis b/c increase in pH

    • Due to:
    • -severe anxiety
    • -pain
    • -head injury
    • -conditions causing insufficient O2
  26. Hemoptysis
    Coughing up blood or bloody secretions

    Caused by bronchiectasis, lung cancer, bronchitis, pne, TB

    Red, alkaline pH, frothy
  27. Hematemesis
    Vomiting up blood

    Darker, acidic pH
  28. Cyanosis & clubbbing
    Bluish skin

    • Desaturated Hb ~ 5 g/dL (~1/3 of Hb total)
    • -If total Hb conc is 15 g/dl then to cause cyanosis

    • Due to low PaO2 due to:
    • -pulmonary or cardiac R-L shunts
    • -decreased CO
    • -cold, anxiety

    *Adult cyanosis may be difficult to detect until severe
  29. Pulmonary Pain
    • Plural pain is most common source
    • -sharp, stabbing
    • -pain when stretched (laugh,cough)

    • Audible pleural friction rub over painful area
    • -infection & inflammation
    • -pulmonary infarction from PE
    • -pulmonary hypertension during exercise
  30. Hypercapnea Causes
    • -decrease resp from drugs
    • -damage to medulla or spinal cord
    • -neuromuscular disease
    • -thoracic cage damage/deformity
    • -large airway obstuction
    • -increased work to breathe
  31. Hypercapnea problems
    • -acidosis = dyshythmias
    • -increased intracranial pressure due to CO2 vasodilation
  32. Hypoxia
    Decreased PaCO2 in tissues

    *Not always due to hypoxemia could be cyanide, low CO
  33. Hypoxemia causes
    • -Decreased O2 in air (high altitude, suffocation)
    • -Hypoventilation (COPD)
    • -Diffusion abnormalities (thickened aveolar membrane - edema, inflammation, fibrosis)
    • -Decrease in SA (emphysema)
    • -Abnormal ventilation perfersion ratios (V/Q normal 0.8 to 0.9)
    • -R-L shunts
  34. Low V/Q
    Due to asthma, PE, obstruction, ARDS, hyaline membrane disease

    Pco2 not affected

    Supplemental O2 doesn't help much
  35. High V/Q
    Pulmonary embolus, congenital heart disease, arterio-venous malformations, R-L shunts

    Adequate ventilation

    Poor perfusion of the lung
  36. Spirometry
    • -May be measured @ rest & exercise
    • -measures forced expiration
    • -detects restrictive (decrease in lung volume) or obstructive condition (decrease in gas flow)
  37. FVC
    Forced vital capacity
  38. FEV1
    Aka IRV, ERV, RV
    Forces expiratory volume in 1 second
  39. Arterial blood gases
    Measures acidemia (arterial blood) vs acidosis (mixed venous blood)

    Painful via pulmonary artery catheter
  40. Oximetry
    • Measures O2 once PaO2 has been measured
    • Not PaCO2 or pH
  41. Chest X-ray (CXR)
    • Sees:
    • -air trapping
    • -consolidation
    • -inflammation
    • -sturctures (tumors, calcification, TB cavitation)
  42. Normal lungs kept dry by:
    • -capillary hydrostatic & oncotic pressure
    • -lymphatic drainage
    • -surfactant
  43. Predisposing factors for pulmonary edema
    • -heart disease
    • -injury to pulmonary capillaries (toxic gases, ARDS)
    • -lympthatic obstruction (rare)
    • -plasma proteins leaking into lung = decreased oncotic pressure = edema
  44. Pulmonary Edema S&S
    • -dyspnea
    • -orthopnea (worse lying down)
    • -hypoxemia
    • -crackles & rales
    • -dullenss to percussion over the lung bases
    • -evidence of ventricular dilation
    • -pink frothy sputum
  45. Pulmonary Edema TX
    • -Remove from irritants
    • -Improve volume status
    • -Reduce volume overload (diuretics)
    • -CHF: try to improve cardiac fx (vasodilators)
    • -Mechanical ventilation
  46. Wedge pressure where pulmonary edema begins
    > 20 mm Hg
  47. Aspiration risks
    • -advanced age
    • -difficulty swallowing
    • -altered consciousness
    • -repeated vomiting
    • -smoking
    • -NG tube or intubation
    • -seizures
  48. Things that can be aspirated
    • -GI contents
    • -Large food particles
    • -Oral or pharyngeal secretions- risk of infection
    • -GERD & Asthma
  49. Bronchiectasis types
    • -Cylindrical: reversible & seen in PNA
    • -Saccular & varicose: bronchial division plugged
    • -Anastamoses may cause hemoptysis
  50. Pneumothorax
    • Air or gas in pleural space due to rupture of visceral pleura
    • Lungs recoil & collapse
  51. Pneumothorax types
    • -Open
    • -Tension: opening acts like one-way valve, preventing air exit: life threatening
    • S&S severe hypoxemia, dyspnea, hypotension

    • -Spontaneous: in healthy males 20-40, ruptures of blebs
    • S&S pleural pain, tachypnea, mild dyspnea

    -Secondary: rib fracture, stab, bullet, COPD, ventilation with positive pressure
  52. Pneumothorax treatment
    • Small: aspiration with small catheter
    • Large: chest tube with water-seal drainage tube
    • Persistent: pleurodesis- caustic into pleural space to scare it shut
  53. Transudate (hydrothorax)
    Fluid leads into pleural space due to CHF or hypoproteinemia
  54. Exudate
    • Fluid extended out of tissue or capillary
    • Due to inflammation, infection, malignancy
  55. Empyema
    • collection of pus in the space between the lung and the inside of the chest wall (pleural space).
    • May be caused by blocked lymphatics adjacent to PNA
    • S. aureus
  56. Hemothorax
    Hemorrhage into pleura space
  57. Lung consolidation
    Solidification into a firm, dense mass
  58. How abscess formation & cavitation formed
    Lung consolidation > necrosis & death > fluid, pus, debris > abscess formation > empties into bronchus > coughed up

    Caused by aspiration PNA due to staph & klebsiella

    TX: Antibiotics, percussion, postural drainage
  59. Chest wall restriction
    • -Musculoskeletal deformity
    • -Neuromuscular disease
    • -Immobilization
    • -Obesity
    • -Ankylosing spondylitis

    • Increase work of breathing and decrease tidal volume (hypoventilation & hypercapnia)
    • Increase risk PNA
  60. Inhalation Disorders
    • Toxic gases:
    • -Smoke
    • -Ammonia
    • -Hydrogen Chloride
    • -Sulfur Dioxide
    • -Chlorine
    • -Phosgene
    • -Oxygen
    • -Severe inflammatory response
  61. Pneumoconiosis (inhalation disorders)
    Causing inflammation and fibrosis
    • -Silcosis
    • -Coal
    • -Asbestosis
  62. Silcosis
    • -Inhaled free silica
    • -Causes chronic fibrosis
    • -Long-term onset - may be asymptomatic
    • -S&S:
    • cough, dyspnea, risk for PNA, bronchospasms & wheezing
    • -TX: nothing specific
  63. Coal (black lung)
    • -Inhaled coal, silica, & quartz
    • -Advanced = severe pulmonary fibrosis with productive cough
  64. Abestos
    • -Slow onset 15-30 years to see cancer
    • -Smoking & houses near mines increases risk
    • -Particles inhaled & permanently into lungs : body cant expel = scarring & fibrosis
    • -Long thin fibers worse

    • S&S
    • Non-malignant changes- lung parenchyma, pleura
    • Malignancies - lung cancers, mesothelioma
  65. Allergic Alveolitis
    Inhalation of organic dusts

    S&S: cough, dyspnea, chills a few hours resolving in 1-3 days if acute
  66. Systemic diseases affecting lungs
    • -granulomatous (sarcoidosis)
    • -connective tissue diseases (RA, SLE, cystic fibrosis, polyarteritis nodosa)
  67. Obstructive pulmonary diseases examples
    • -Asthma
    • -COPD
    • -Chronic bronchitis
    • -emphysema
  68. Acute Respiratory Distress Syndrome (ARDS)
    • Acute lung inflammation and diffuse alveocapillary injury = alveolar epithelium
    • Direct vs indirect (sepsis)
    • Respiratory insuffiency leading to cyanosis, arterial hypoxemia
    • Deadly and common
    • Absence of increase L atrial pressure
    • Pulmonary capillary wedge <18 mm Hg
    • Resistant to O2 TX
  69. ARDS causes
    • -Sepsis = common
    • -multiple trauma
    • -shock
    • -burns
    • -pancreatitis
    • -O2 toxicity
    • -radiation
    • -drowning
    • -altitude
    • -bypas surgery
    • -disseminated intravascular coagulation (DIC)
    • -PNA
    • -aspiration
    • -drugs/overdose

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