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SWC Heep Respiratory

Respiratory System, Survey Western Clinical Sciences, Heep, Bastyr

Describe the Basic anatomy of the Respiratory System: Thoracic cavity Mediastinum Lungs: Right lung has 3 lobes Left has 2 lobes Pleura: Parietal pleura and visceral pleura
What are the Respiratory muscles? internal and external intercostals, diaphragm, SCM and scalene, trapezius, abdominal muscles.
What comprises the Upper Airway? Nasal passages Mouth Pharynx Larynx, vocal cords and epiglottis
What comprises the Lower Airway Trachea Main bronchi Bronchioles Alveolar ducts Alveolar sacs (alveoli/alveolus)
Functions of Conductive portion of lung: Transports air Warms, moisturizes and filters air Mucociliary system
Functions of Respiratory portion: (includes some bronchioles, alveolar ducts and sacs) Gas exchange
Types of cells Cells in the Alveolus: Type I – exchange gas Type II – produce surfactant Macrophages
What is spirometry: Ability to measure lung volumes
what are Normal Lung volumes: Tidal Volume 500 ml Inspiratory reserve volume 3000 ml Expiratory reserve volume 1100 ml Residual volume 1200 ml VC (4600 ml) and TLC (5800 ml) Spirometer
What is the normal pH of the blood: Neutral
Describe Metabolic vs. respiratory pH balance: Respiratory acidosis / alkalosis: change of pH is caused by breathing Metabolic acidosis / alkalosis: change of pH is caused by internal factors
Describe Respiratory acidosis / alkalosis: change of pH is caused by breathing
Describe Metabolic acidosis / alkalosis: change of pH is caused by internal factors
Describe effects of Temperature and Oxygen transfer: Shift to right due to high temp/ high CO2 and low pH Shift to left due to low temp / low CO2 and high pH
Define Bradypnea: slow respiration rate < 12 bpm
Define Tachypnea: rapid (shallow) breathing >18 bpm
Define Apnea: no breathing
Define Hyperpnea: increase in rate and depth of breathing Hyperventilation
Define Dyspnea: shortness of breath (SOB), difficulty breathing or painful breathing.
Define Cheyne-Stokes breathing: periodic apnea
What are the complications of Cheyne Stokes breathing: Congestive heart failure CNS lesion, stroke Normal, adaptation to high altitude
Describe age Ranges and Bradypnea: Age 0-1 year < 30 bpm Age 1-3 years < 25 bpm Age 3-12 years < 20 bpm Age 12 and older < 12 bpm
What is an RTI? Respiratory Tract Infection.
What is an URI? Upper respiratory Infection
What is an LRI? Lower Respiratory tract infection
Describe RTI’s Mostly viruses: self limited common cold to life-threatening pneumonia. Affects upper and lower respiratory tract. URI LRI Some diseases (measles and chicken pox) are contagious through respiration though no presentation in respiratory system.
Complications of RTI’s Can lead to secondary bacterial infection
Common pathogens in Respiratory system: Viral: Rhinovirus, RSV, influenza, adenovirus Bacteria: Staph., Pneumococci Mycobacteria: TB Fungi: Histoplasmosis, blastomycosis Opportunistic organisms: Pneumocystis carinii
Describe common cold: Viral Infection – in cold seasons.
Sx of Common Cold: URI: starts with dryness and stuffiness in nasopharynx, sore throat, ear plugging. Clear watery nose/eye secretion. Fever, chills, body ache, erythema in throat. Usually self-limited (if no bacterial super-infection) – up to 7 days.
Tx of common cold: Tx: no ABx needed, rest, water, steam inhalation, OTC meds.
Describe OTC meds for common cold: Antipyretic Antihistamines: can cause dryness, more cough Decongestant: can cause systemic vasoconstriction – increase BP Use with caution in HTN, Hyperthyroidism, DM.
Viruses involved in common cold: Rhinovirus in cold seasons RSV in winter and spring Para-influenza type 1, 2, 3 Adenovirus and coronavirus: epidemic in winter and spring
Describe Sinusitis: Inflammation/infection of the sinuses. Mostly viral, sometimes bacterial or fungal
Describe acute to chronic sinusitis: Acute (<4 weeks), sub-acute (4 -12 weeks) chronic (> 3 months), recurrent acute (4+/yr)
Sx of Sinusitis: Nasal congestion Purulent nasal discharge Tooth discomfort Facial pain/pressure worse bending forward
DDX for acute sinusitis: Allergic rhinitis and common cold
DDX for chronic sinusitis, more dull pain, HA, PND, chronic cough and bad breath.
Tx for Sinusitis: ABX (antibiotics) treatment, decongestant, expectorants, steaming and saline nasal wash.
Complications of Sinusitis: Facial edema Eye involvement, swelling, pain, pressure Cellulitis: infection of interstitial space Meningitis Intracranial abscess
Describe Influenza: Flu is a viral infection (RNA virus); types A, B
Describe Type A Influenza: Type A is most common and most severe. Can cause epidemics
DDX of Influenza: : common cold, but influenza is a much more severe disease.
Is the onset of the Flu Rapid? Onset very rapid, within 1-3 days.
Complications of Influenza: sinusitis, otitis media, bronchitis, viral/bacterial pneumonia. Can cause URI or LRI. Can progress rapidly to bacterial super-infection and pneumonia, specially in immune deficient and elderly patients and become LRI and pneumonia.
Can Influenza cause death? Can cause death in people > 65 years old.
Sx of Influenza: Fever, sore throat, myalgia, HA, cough, malaise and weakness. Other symptoms like other viral URIs
Is nausea and vomiting a symptom of the Flu? Although nausea and vomiting can be produced, especially in children, these symptoms are more characteristic of the unrelated gastroenteritis, which is sometimes called "stomach flu" or "24-hour flu."
Tx of Influenza: Rest Keep warm Lots of liquid Refer, need antibiotics and life support.
Describe Bronchitis: inflammation of the bronchi or airways, mostly medium sized airways.
Acute Bronchitis is: viral, bacterial
Chronic Bronchitis could be: COPD, caused by smoking or other irritants
Sx of Bronchitis: cough, sputum, SOB, wheezing, occasional fever and fatigue
Describe Pneumonia: lung parenchyma alveoli are inflamed and filled with fluid. Hard to exchange gas
Etiology of Pneumonia: Can be due to: Bacteria, Virus, Fungal, Parasite Idiopathic Chemicals, irritants
Define Pneumonia: Inflammation of the parenchymal structure of the lungs.
What causes Non-infectious pneumonia: fumes and irritants
Types of Infectious pneumonia: Bacterial (typical pneumonia): Strep. pneumoniae Bacterial (atypical pneumonia): Mycoplasma pneumoniae, (atypical bacteria) Other: Candida, viruses, Pneumocystis carinii
Predisposing factors of Pneumonia: Smoking , damage to the ciliated endothelium of the respiratory tract Loss of cough reflex Low immunity
Symptoms of pneumonia: Previous URI/influenza High fever and chills, productive cough, sputum, chest pain and dyspnea, body ache, nausea, fatigue. Feeling of heaviness and consolidation in the chest (lungs).
Sx of viral and mycoplasma pneumonia: cough is dry, hacking and non-productive.
Body defense against pneumonias: Cellular, the macrophages Immunoglobulins: IgA and IgG
Difference of Community acquired vs. hospital acquired pneumonia S. pneumonia = community aquired legionella pneumophilia (gram-negative bacillus). = hospital aquired
Describe pneumocystis jirovecii: PCP. Fungal infection, intracellular in lung cells
Who si susceptible to pneumocystis jirovecii: immunodeficient individuals. Common in AIDS, immunodeficient patients like cancer, radiation, chemotherapy…
Sx of pneumocystis jirovecii High fever, shortness of breath, nonproductive cough, cyanosis. REFERRAL Been treated with ABx: Trimethoprim-sulfamethoxazole (Bactrim) Pentamidine
Describe tuberculosis: Aerobe acid-fast bacillus, called Mycobacterium tuberculinum.
Major forms of TB: 2 major forms of the bacillus: 1) M.T hominis – through airborne droplet nuclei 2) M.T bovis – from cow milk Also Atypical Mycobacterium in north America: M. kansasii M. avium, opportunistic in AIDS
Describe Pathogenesis of TB: Exposure  Primary infection  granuloma Reactivation  Secondary infection Mostly self-limited in the primary stage, forming granuloma in lung.
Effects of TB: Evokes a “hypersensitivity” response in body Tuberculin test (PPD) becomes positive
Sx of TB: If low immunity or reactive: low grade fever, cough, night sweats, anorexia, weight loss.
Describ chain of events of TB exposure: 1) Exposure  primary infection: low grade fever, chest pain, sometimes flu like illness, formation of granuloma 2) Reactivation, d/t stress, illness, etc  insidious onset of cough, weight loss, fatigue, fever and night sweats, chest pain, hemoptysis
Describe fungal infections of the lung: Histoplasmosis, blastomycosis and coccidiomycosis Are common but seldom serious Similar symptoms to pneumonia and tuberculosis.
Describe Lung Cancer: Leading cause of cancer death in USA 25% of all cancer death due to lung cancer
Risk factors of lung cancer: Smoking (10-30 fold increased risk) Industrial material such as asbestos
Describe diagnosis and prognosis of lung cancer: Usually diagnosed in advanced stage Poor prognosis – 5 year survival is about 15%
What are the most common types of lung cancer? 90% are: Non-small cell lung carcinoma (NSLC) Squamous cell carcinoma Large cell carcinoma Adenocarcinoma Small cell carcinoma (SCLC): 15% Smokers only Invasive, poor prognosis Paraneoplastic properties
Describe Manifestations of lung cancer: Slow growing. Present as chronic bronchitis, or smoking side effects; weight loss, night sweats. Local involvement: pressure or secretionMetastasis: brain, bone and liver Can manifest 6 months to 4 years before tumor detected
Describe Paraneoplastic disorders: Hypercalcemia due to high PTH like peptide Cushing’s syndrome due to ACTH secretion
What are the Tools to detect Lung Cancer: Medical history Imaging: XRay, MRI, CTscan, ultrasound, bronchoscopy. CEA for follow up
What are the categories of pulmonary disorders? Disorders of lung inflation Obstructive Airway Disorders Restrictive Airway Disorders Pulmonary Vascular Disorders Breathing Disorders
What physical tests can diagnose Lung cancer, (or at least find something abnormal)? Breath Sounds: Resonance is Hyper-resonance or Dullness Increased Tactile Fremitus Percussion
What are disorders of lung inflation: Pleural disorders Pleuritis Pneumothorax Pleural effusion Atelectasis
Describe the pleura of the lungs: Double layer membrane: visceral and parietal Pleural cavity/space and serous fluid
Describe the negative pressure of the pleura? Negative pressure in pleural cavity compared to alveolar pressure. This negative pressure keeps the lungs open and resists lung collapse.
Causes of Inflammation of the pleura: viral respiratory infection, pneumonia, direct trauma
Sx of Inflammation of the pleura: Unilateral pain, usually lateral and lower part of chest Pain is stabbing and worse with deep breathing
DDx of Inflammation of the pleura: Musculoskeletal, MI (Myocardial Infarction)
Tx of Inflammation of the pleura: Mostly self limited NSAIDs
What are the 3 kinds of Pneumothorax: Spontaneous Traumatic Tension
Symptoms of Pneumothorax: Acute chest pain, dyspnea
Signs of Pneumothorax: RR increases, HR increases Shallow breathing Asymmetry of chest during breathing Decrease tactile fremitus, absent lung sounds, hyperresonance on percussion
Describe causes of Pneumothorax: Lung diseases - Air enters the pleural space via damaged alveoli. COPD, asthma Pneumonia TB Cancer, metastasis Trauma: Acupuncture, rib fracture
What is a pleural effusion? Accumulation of fluid in the pleural cavity
Causes of Pleural effusion: Due to local or systemic conditions:Trauma to chest, lung cancer, infections like pneumonia or lung abscess, autoimmune conditions (RA and SLE), kidney problems, heart problems (CHF), liver problems.
Sx of Pleural effusion: dyspnea and shifting of the trachea and mediastinum (unilateral).
Signs of Pleural effusion: decreased breath sounds, dullness on percussion, decreased tactile fremitus
Define Atelectasis: Incomplete expansion of the lung. Will cause collapse of lung partial or total. Complication of pneumothorax and pleural effusion.
Who is most likely to have Atelectasis: Primary: in premature infants Secondary or acquired Obstruction of airways or pressure from outside like tumor or pleural effusion or pneumothorax.
Symptoms of atelectasis: reduced lung capacity and pleural inflammation can be present.
What are some obstructive airway disorders: Bronchial Asthma Chronic Obstructive Pulmonary Disease (COPD) Emphysema Chronic bronchitis Bronchiectasis Cystic fibrosis
Describe the transition in terms of anatomy of Upper airways to lower airways: – reduction in the cartilage that supports the wall and increase in smooth muscle.
Describe the interaction of the Autonomic nervous system: Parasympathetic: vagus nerve (CN X), ACh receptors constriction of the airways. Sympathetic and β2-adrenergic receptors dilation of airways. Histamines and IgE  constriction
Describe Bronchial Asthma: Chronic inflammation and narrowing of the airways & hyperresponsiveness. Incidence is increasing worldwide
Describe the acute and chronic stage of Bronchial Asthma: Acute stage entails constriction of the airways. Chronic stage entails inflammation and mucus production.
Describe pneumohemothorax: The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the pneumothorax, creating a pneumohemothorax.
Etiology of Non allergic Bronchial Asthma: irritants, infections especially viruses, cold air, exercise, drugs and medication, emotions.
Etiology of Allergic Bronchial Asthma: usually with other allergic symptoms such as GI and skin allergic problems – starts younger age (childhood asthma). Eczema and asthma pattern. Medications:
Medications for Acute bronchial asthma: β2 adrenergic agonist – stimulate β2 receptors and mimic sympathetic bronchodilation (albuterol). Anticholinergics – antagonist of the parasympathetic (ipratropium).
Medications for chronic bronchial asthma: Anti-inflammatory – reduce the inflammation in airways (↓ hyperresponsiveness) Cromolyn and nedocromil stabilize the allergy cells (mast cells); less production of IgE. Steroids – potent antiinflammatory action
Describe Asthmatic attack: acute episode of bronchospasm and constriction. Expiration more difficult than inspiration resulting in air trapped in lungs.
Symptoms of Asthmatic attack: Wheezing and tightness in the chest Cough Dyspnea Exhaustion
Signs of Asthmatic attack: Respiratory distress Cyanosis Drop in BP
Describe COPD: Group of respiratory disorders characterized by chronic and recurrent obstruction of airflow
What is the most common cause of COPD: Most common cause for it is smoking, clinical findings usually absent during early stages, when present disease is already advanced.
What are Other risk factors of COPD: Inhaled toxins Congenital α1-antitripsin deficiency
Types of COPD: Emphysema and chronic bronchitis, asthma
Describe Emphysema: Loss of lung elasticity and abnormal permanent enlargement of air spaces and hyperinflation of lungs.
Etiology of Emphysema: smoking, “α1-antitrypsin” deficiency This is an enzyme that inhibits elastase; which is the enzyme that digests proteins (Elastin) in the lung. (more elastase  less Elastin)
Describe bronchitis: Excess mucus excretion into the bronchial tree Simple bronchitis Chronic obstructive bronchitis
Sx of Bronchitis: History of 3 months of cough in 2 consecutive years in the absence of other reasons.
Risk factors of Bronchitis: middle aged men, smoking and recurrent lung infections.
Symptoms of Bronchitis: Cough, respiratory distress, impaired gas exchange, imbalance of perfusion and ventilation leading to hypoxemia.
Describe Bronchiectasis: Thickening and dilation of the major bronchi/bronchioles due damage of the wall secondary to recurrent infection.
Describe Cystic Firrosis: Autosomal recessive genetic disorder Abnormal transport of Cl- and Na+  thick, viscous mucus production
Symptoms of Cystic Fibrosis: Chronic lung disease: thick mucus, productive cough, recurrent infections, COPD Pancreatic exocrine deficiency: digestive problems Elevation of sodium chloride in the sweat
Describe Interstitial Lung Disease: Inflammation and fibrosis in the lungs, resulting in decrease of lung compliance. Affects the supportive collagen and elastic tissue in lungs
Describe Sarcoidosis: An immune system disorder characterized by small inflammatory nodules (granuloma) formation in lungs.
Who is most likely to aquire Sarcoidosis: Most commonly arises in young adults. The cause of the disease is still unknown.
What organs can be affected by Sarcoidosis: Virtually any organ can be affected
Symptoms of Sarcoidosis: Commonly Asx (found on CXR), insidious or acute. Cough, dyspnea, chest pain Fatigue, fever, weight loss
What are pulmonary vascular diseases: Pulmonary embolism Pulmonary hypertension Cor pulmonale
Describe Pulmonary embolism: A blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow. (embolus) Thrombus, air or fat can be embolus
Describe Cor pulmonale: Right heart failure due to primary pulmonary disease.
Describe Obstructive Sleep Apnea (OSA): Reduced airway size & ↓ neural input  airway collapse. Cessation of airflow (apnea) though nose and mouth for ≥ 10 seconds. 5-30 episodes per hour Risk factors for OSA:
Symptoms of OSA: daytime sleepiness, noisy snoring, insomnia, abnormal moving during sleep, morning headache, erectile dysfunction, HTN
Describe Hyperventilation syndrome: Over-breathing and reduction in PCo2 resulting in respiratory alkalosis due to organic problems, drug effects, CNS problems, heat, exercise and emotional states.
Sx of Hyperventilation syndrome: Headache, dizziness, lightheadedness, tingling and numbness in fingers and syncope.
Describe Occupational lung disease: lung diseases due to toxic drugs and radiation and lung diseases of unknown origin as such as sarcoidosis.
Created by: bastyr41