Chapter 22: Emphysema

Question 1

Etiology of Emphysema

Answer 1

• Type A COPD (pink puffer)
• destructive changes of aveolar walls without fibrosis
• abnormal enlargement of the distal air sacs
• Damage is irreversible
• Associated with chronic bronchitis

Question 2

Causes of Emphysema

Answer 2

• smoking > 70 packs a year
• air pollution
• certain occupations such as mining, welding, and working with or near asbestos
• alpha 1 Antitrypsin deficiency (protein needed for preventing the breakdown of tissue in inflammation)

Question 3

Pathogenesis of Emphysema

Answer 3

• groups of genes
• release of proteolytic enzymes from neutrophils and macrophages leading to alveolar damage
• smoking caused alveolar damage
• reduction in pulmonary capillary bed
• loss of elastic tissue
• Air becomes trapped in distal Alveoli
• Loss of alveolar wall and air trapping with leads to bullae formation (large, thin-walled cysts in the lung)

Question 4

Pathogenesis of Emphysema (smoking caused alveolar damage)

Answer 4

• inflammation leads to release of proteolytic enzymes

- inactivates alpha 1 - antitrypsin which normally protects lung parenchyma

Question 5

Pathogenesis of Emphysema (Reduction in pulmonary capillary bed)

Answer 5

• exchange of O2 and CO2 between alveolar and capillary blood is impaired

Question 6

Pathogenesis of Emphysema (loss of elastic tissue in lung)

Answer 6

• Results in loss of radial traction (this normally holds the airway open

Question 7

Classifications of Emphysema

Answer 7

• Centriacinar/centriobular (associated with smoking and chronic bronchitis, destroys respiratory bronchioles)
• Panacinar/panlobular (destroys the alveoli)
• paraseptal (affects the peripheral lobules)

Question 8

Clinical Manifestations of Emphysema

Answer 8

• progressive, exertional dyspnea
• Thin (related to increased respiratory effect, increased caloric expenditure, and decreased ability to consume adequate calories
• Use of accessory muscles
• Pursed lip breathing (natural response to try and stall end expiration)
• cough (minimal or absent)
• Digital clubbing (fingernails that look like drumsticks)
• Barrel Chest

Question 9

Diagnosis of Emphysema

Answer 9

• PFTs, Chest x-ray, ECG, ABG, Patient History, and Common physical findings

Question 10

Diagnosis of Emphysema (PFT)

Answer 10

• increased residual capacity
• increased RV, and TLC (because big inflammed lungs)
• Decreased FEV1, FVC

Question 11

Diagnosis of Emphysema (Chest x-ray)

Answer 11

• hyperventilation
• low, flat diaphragm
• presence of blebs or bullae
• Narrow mediastinum
• normal or small “vertical” heart

Question 12

Diagnosis of Emphysema (ECG)

Answer 12

• normal, show tall p waves
• Sinus tachycardia (first sign of decreased oxygenation)
• Supraventricular arrhythmias
• Ventricular Irregularities

Question 13

Diagnosis of Emphysema (ABG)

Answer 13

• Mild decrease in PaO2

- Normal PaCO2 (elevated in the late stages)

Question 14

Diagnosis of Emphysema (common physical findings)

Answer 14

• thin, wasted individual hunched forward
• using accessory muscles
• decreased breath sounds, lack of crackles and rhonchi (no mucous)
• Prolonged expiration
• Decreased heart sounds
• Hyperresonance
• Decreased diaphragmatic excursion
• chronic morning cough

Question 15

Treatment of Emphysema

Answer 15

• O2 therapy
• smoking cessation
• Medications, which include Inhaled short acting B2 antagonists, inhaled anticholegic bronchodilators, cough suppressants, antimicrobial agents, inhaled/oral corticosteroids, and theophylline products