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Diseases of the Respiratory System. Lung Volumes & Capacities. Forced vital capacity (FVC) amount of air expelled from maximum inspiration to maximum expiration regardless of time Forced expiratory volume (FEV 1 ) amount of air expelled from maximum inspiration in the first second of effort

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Diseases of the Respiratory System

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Diseases of the respiratory system l.jpg

Diseases of the Respiratory System


Lung volumes capacities l.jpg

Lung Volumes & Capacities

  • Forced vital capacity (FVC)

    • amount of air expelled from maximum inspiration to maximum expiration regardless of time

  • Forced expiratory volume (FEV1)

    • amount of air expelled from maximum inspiration in the first second of effort

  • FEV1/FVC ratio is critical in separating obstructive & restrictive lung disease


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Obstructive Lung Disease

  • Limitation of airflow

  • Rate of expiration is slowed

  • Volume usually normal


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Restrictive Lung Disease

  • Limitation of lung expansion

  • Limit to both volume & flow rate


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Major Determinants of Disease

  • Diseases of one lung compartment tend to affect the others

  • The lungs are open to the environment, exposing them to infectious agents, allergens, irritants, & carcinogens

  • Most lung disease is caused by inhalation of material; the most common exception is autoimmune lung disease

  • Lost pulmonary membrane is not recoverable

  • Smoking is a major cause of lung disease

  • The heart & lungs are a functional unit; lung disease usually affects the heart; & heart disease usually affects the lungs


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Upper Respiratory Infections

  • Allergic rhinitis

    • “hay fever”

    • nasal mucosal edema

    • nasal discharge

    • sneezing

    • allergic conjunctivitis

  • “Colds”

    • transmitted through respiratory droplets

    • clear nasal discharge

    • low grade fever

    • if nasal discharge becomes colorful, it is an indication of secondary bacterial infection

  • Acute pharyngitis

    • “sore throat”

    • usually viral

    • bacterial infections more serious

    • red, swollen tonsils


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Carcinoma of the Larynx

  • Common

  • Mostly in male smokers over 40

  • Alcohol abuse increases the risk

  • Presents with

    • hoarseness

    • pain

    • cough

    • dysphagia

    • hemoptysis


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Atelectasis

  • Collapse of a lung or part of a lung

  • Resorption

    • bronchial obstruction

    • air below obstruction completely absorbed

    • obstructions are

      • mucous plug

      • asthma

      • bronchitis

      • tumors

  • Compression

    • pressure exerted from pleural space or upward pressure on diaphragm

  • Contraction

    • scars cause constriction & collapse

    • TB


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Asthma

  • Chronic inflammatory disease of small bronchi & bronchioles

  • Characterized by bronchospasm & air trapping

  • Airflow out is impaired

  • Triggered by inhaled irritants & classified by irritant

  • Allergic

    • type I hypersensitivity

  • Occupational

  • Exercise-induced

  • Infectious

  • Others

    • drug reactions

    • emotional stress

    • severe air pollution

  • Hyperplastic mucous glands in bronchi, hypertrophied smooth muscle, edema, & marked inflammation


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Chronic Obstructive Pulmonary Disease (COPD)

  • Related diseases

  • Chronic bronchial outflow obstruction

  • Overlapping features


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Emphysema

  • Destruction of alveolar walls, alveoli merge to form large air spaces

  • Loss of surface area affects diffusion

  • 90% of cases are smokers


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  • Cigarette smoke irritates lung & causes inflammation

  • Inflammatory cells release digestive enzymes

  • These enzymes normally inhibited by alpha-1 antitrypsin

  • AAT inhibited by smoke & so enzymes digest lung tissue


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  • Shortness of breath

  • Wheezing & coughing

  • Weight loss

  • Barrel-chested

  • Exhibits “tripoding”


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Chronic Bronchitis

  • Chronic cough that produces sputum for 3 consecutive months 2 years in a row

  • Primary cause is cigarette smoking

  • Chronic inflammation of bronchi

  • Simple chronic bronchitis

  • Chronic asthmatic bronchitis

  • Obstructive chronic bronchitis


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  • Most patients have chronic bronchitis & emphysema in varying degrees

  • “pink puffers”

    • emphysema

    • usually thin

    • barrel-chested

    • short of breath but well oxygenated

  • “blue bloaters”

    • obstructive chronic bronchitis

    • wheezing, coughing

    • sputum production

    • cyanotic

    • no lost pulmonary membrane

  • All at risk of chronic hypoxia


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Bronchiectasis

  • Marked, permanent dilation of small bronchi

  • Destruction of smooth muscle & elastic supporting tissue

  • Must have obstruction & infection

    • obstruction causes mucus retention

    • infection damages bronchial walls which causes excess mucus production

  • Not a primary condition

  • Typically involves lower lobes

  • Persistent cough


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Restrictive Lung Disease

  • Chronic inflammation making lungs stiff & inelastic

  • Affects diffusion

  • Scar tissue accumulates in the interstitium

  • Mostly cause is unknown

  • Equal decline in FEV1 & FVC

  • Usually presents with shortness of breath

  • Can lead to pulmonary HTN


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Interstitial Fibrosis without Granulomatous Inflammation

  • Usually middle-aged men at time of diagnosis

  • Shortness of breath; may progress to cor pulmonale, hypoxia

  • Pneumoconioses

    • black lung disease

    • silicosis

      • most common chronic occupational disease

    • asbestosis

      • mesothelioma


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Interstitial Fibrosis with Granulomatous Inflammation

  • Sarcoidosis

    • cause unknown

    • affects many tissues but mostly lungs

    • present with shortness of breath, cough, chest pain, hemoptysis


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Pulmonary Edema

  • Fluid in alveoli

  • Increased BP in lung

    • normal is 25/8 mmHg with average at 15 mmHg

  • Microvascular injury

    • due to

      • toxic fumes

      • hot gases

      • septicemia

      • IV drug abuse

  • Main symptom is SOB


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Pulmonary Thromboembolism

  • About 50,000 deaths annually

  • Mostly from DVT

  • Inflammation predisposes you to it

  • Promoted by

    • CHF

    • pregnancy

    • birth control pills

    • prolonged bed rest

    • metastatic cancer

    • genetics

  • Most associated with no symptoms but some

    • cause lung infarcts

    • chest pain & dyspnea

    • death


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Pulmonary Hypertension

  • Sustained systolic pressure over 30 mmHg or average in excess of 25 mmHg

  • Vicious cycle

  • Most common cause is increased pulmonary vascular resistance

  • Usually secondary to

    • COPD

    • heart disease

    • collagen vascular diseases

    • recurrent pulmonary thromboemboli

  • With R heart failure is cor pulmonale

  • Thickening of arteriolar walls

  • SOB

    • chest pain

    • fatigue


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Adult Respiratory Distress Syndrome

  • ARDS

  • Alveolar or pulmonary capillary damage

  • Pathogenesis

    • injury to endothelium or alveoli

    • neutrophils infiltrate

    • protein-rich fluid exudes into alveolar space

    • SOB occurs with rapid breathing which dries the fluid into a thick membrane

    • stiffens lungs

    • limits airflow & interferes with diffusion

    • hypoxia

  • 50% fatality

  • Causes

    • sepsis

    • smoke inhalation

    • near drowning

    • O2 toxicity

    • burns

    • DIC

    • fat embolism

    • endotoxic shock


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Pneumonia

  • Inflammation of the lungs

  • Usually caused by bacteria

  • 80,000 deaths/yr

  • Alveolar pneumonia

    • usually acute

    • fill with inflammatory exudate

    • most common


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  • Bronchopneumonia

    • patchy inflammation

    • involves alveoli of more than 1 lobe

    • usually in basilar parts

  • Lobar pneumonia

    • consolidation of an entire lobe

    • almost always caused by S. pneumoniae


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Interstitial Pneumonia

  • Inflammation in septa

  • Diffuse & bilateral

  • Usually viral


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Etiology

mostly bacterial

S. pneumoniae

Haemophilus influenzae

Staph

E. coli

Pseudomonas

Pathogenesis

inhalation of droplets, aspiration of gastric contents, blood-borne spread

those susceptible include

immune deficiency

decreased cough reflex

impaired cilia

accumulated secretions

pulmonary congestion


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Community-acquired

acute pneumonia

bronchopneumonia

lobar pneumonia

Legionnaire’s disease

atypical pneumonia

Mycoplasma

Nosocomial

Commonly S. aureus & E.coli

Seen in

People with severe disease

Prolonged antibiotic therapy

People with internal mechanical devices

Aspiration

Inflammatory reaction due to corrosive effects

Those who are comatose or those with a stroke

Hi mortality rate


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  • Seen mostly in the young & the elderly

  • Hypoxia & death

  • Bacterial

    • high fever & chills

    • purulent sputum

    • increased neutrophils

    • cough

    • SOB

  • Interstitial

    • less severe

    • increased lymphocytes

    • cough

    • SOB


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Lung Abscess

  • Purulent inflammation with tissue necrosis & liquefaction

  • Usually have several types of bacteria with anaerobic

  • Most commonly due to aspiration of gastric contents

  • Foul-smelling sputum


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Tuberculosis

  • Mycobacterium tuberculosis

  • Chronic granulomatous inflammation with caseous necrosis


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Pathogenesis


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  • Affects about 2 billion worldwide

  • Kills about 2 million/yr

  • 2nd only to AIDS

  • Associated with poverty, crowding, malnourishment, & chronic disease

  • PPD


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  • Low-grade fever

  • Night sweats

  • Malaise

  • Weight loss anorexia


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Mycoses

  • Histoplasmosis

  • Coccidiomycosis

  • Cryptococcus


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Lung Neoplasms

  • Mostly due to metastasis

  • Bronchogenic carcinoma is the most common

    • most common of all cancers

    • #1 cancer death

    • about 90% are cigarette smokers


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Bronchogenic Carcinoma

  • Mostly caused by cigarettes

    • Direct relationship between incidence of cancer & number of cigarettes smoked

    • Direct relationship between precancerous changes in bronchial mucosa & number of cigarettes smoked


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Small cell carcinoma

20% of cases

arise from specialized neuroendocrine cells of the bronchus

strongest relationship to cigarettes

aggressively malignant

Squamous cell carcinoma

30% of cases

bronchial epithelium that has undergone metaplasia

arises centrally

most common in men who smoke

grows slower so better prognosis

Adenocarcinomas

30% of cases

most well-differentiated

somewhat better prognosis

more peripheral in smaller bronchi

less associated with smoking

Large cell carcinoma

15% of cases

poor prognosis

metastasizes early


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Bronchial Carcinoid Tumor

  • 5% of lung cancers

  • Arise from bronchial neuroendocrine cells

  • Much less aggressive

  • Grows slow


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Pneumothorax

  • Air in pleural space

  • Causes atelectasis

  • May occur spontaneously

  • More frequent in people with emphysema who have large blebs near pleura

  • Traumatic penetration

  • Can be fatal

  • Tension pneumothorax

    • air in but not out


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Pleural Effusion

  • Fluid in pleural space

  • Transudate from CHF most common

  • If blood, called hemothorax


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Pleuritis

  • Inflammation

  • Pleurisy with each breath

  • Mostly caused by pneumonia


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