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Pathophysiology > Final: Ch 23 Disorders of Ventilation & Gas Exchange > Flashcards

Final: Ch 23 Disorders of Ventilation & Gas Exchange Flashcards

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1
Q

what is ventilation

A

movement of air into the lungs

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2
Q

what is perfusion

A

circulation of blood through pulmonary vessels

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3
Q

what is diffusion

A

oxygen and CO2 x respiratory membrane

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4
Q

what is hypoxemia

A

low arterial PO2

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5
Q

symptoms of hypoxemia

A

mental confusion, restlessness, agitation, combativeness

cyanosis when deoxygenated Hb > 5g/dl

SNS activation

PA vasoconstriction and polycythemia when chronic

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6
Q

diagnosis and treatment of hypoxemia

A

diagnosis: ABG, pulse oximeter
treatment: correct the cause – give O2 and/or ventilate

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7
Q

hypercapnea, symptoms, treatment

A

High CO2 in blood

hypoventilation or severe V/Q mismatch

symptoms: acidosis
treatment: mechanical support to improve ventilation

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8
Q

how to distinguish between cardiac and respiratory pain?

A

taking a deep breath doesn’t increase cardiac pain, but does increase respiratory pain

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9
Q

types of pleura

A

visceral pleura: covers lung

parietal pleura: lines chest cavity

pleural space inbetween - fluid

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10
Q

is there normally negative pressure in the lung system?

A

yes

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11
Q

pleuritis

A

inflammation of the pleura (localized) - acute pain

worse with deep breathing/coughing

may need analgesics, NSAIDS

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12
Q

pleural effusion

A

abnormal collection of fluid in the pleural cavity

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13
Q

causes of pleural effusion

A

negative intrapleural pressure (atelectasis)

high capillary pressure (HF)

high capillary permeability (infection)

low lymph drainage (mediastinal cancer)

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14
Q

symptoms of pleural effusion, diagnosis, treatment

A

symptoms: dyspnea, low breath sounds, hypoxia

Dx: chest x-ray, CT scan

treatment: thoracentesis

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15
Q

what is transudate

A

serous fluid - HF

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16
Q

what is exudate

A

fluid with protein or LDH

inflammatory process

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17
Q

what is empyema

A

pus in the pleural cavity

rupture of an abscess

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18
Q

what is chylothorax

A

lymph in the pleural cavity

trauma, inflammation, malignancy

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19
Q

what is hemothorax

A

blood in the pleural cavity

trauma, aneurysm, malignancy

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20
Q

pneumothorax

A

air in the pleural cavity causing partial or complete lung collapse

spontaneous or traumatic

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21
Q

spontaneous pneumothorax is caused by what, and types (primary/secondary)

A

caused by the rupture of a bleb

primary: no known cause (common in tall men + smokers)
secondary: asthma, TB, CF, lung cancer

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22
Q

spontaneous pneumothorax leak

A

lung collapse can seal the leak

otherwise, the leak continues until a negative intrapleural pressure is abolished

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23
Q

traumatic pneumothorax

A

caused by a rib fracture or penetrating external wound

may be accompanied by other traumatic injuries like a hemothorax

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24
Q

tension pneumothorax (life-threatening)

A

opening from pleural space covered by flap valve

air enters during inspiration but can’t leave

pleural pressure > atmospheric

mediastinum shifty and other lung and great vessels compromised

type of traumatic pneumothorax

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25
symptoms of pneumothorax
depends on size respiratory distress and hypoxemia asymmetry of the chest tension pneumo can cause cardiovascular collapse
26
diagnosis of pneumothorax
chest x-ray CT ABG pulse oximetry
27
treatment of pneumothorax
a small spontaneous one may resolve itself needle aspiration or chest tube and closed drainage tension pneumo - emergency chest tube cover sucking chest wounds with an airtight dressing
28
on a CXR what does a collapsed lung look like
an empty, dark space
29
what is atelectasis and what are the types
incomplete expansion of part of the lung caused by a blockage of airway, compression, or lack of surfactant primary or acquired
30
primary atelectasis
infant's lung fails to expand at birth seen in premature and high risk infants
31
acquired atelectasis
caused by bronchial obstruction or external compression (tumor, pleural effusion, mucus plug) once bronchus becomes obstructed, air is absorbed from alveoli leading to the atelectasis seen post op: pain, anesthesia, immobilization --> retention of secretions
32
symptoms of atelectasis
tachypnea tachycardia dyspnea cyanosis low breath sounds fever
33
diagnosis and treatment of atelectasis
Dx: CXR, CT Rx: mobilization and cough/deep breath for post op patients (produces neg pressure) may require bronchoscopy
34
what is obstructive airway disease
caused by an obstruction that limits expiration reversible (asthma), or not (COPD) bronchial smooth muscle plays a role SNS dilates and PNS constricts bronchi
35
bronchial asthma
bronchospasm and activation of inflammatory cells always hyper-responsive wheezing, cough, SOB
36
asthma acute phase (10-20 min) response
immediate bronchoconstriction (SMC activation) to antigen or irritant sensitized mast cells release histamine mucus membranes are permeable to cells/antigen increased vascular permeability causes mucosal edema
37
what reverses the acute phase of asthma
beta2-agonists dilators
38
asthma late phase (4-8hrs) response
sensitized mast cells release histamine strong inflammatory response multiple types of leukocytes recruited cholinergic nerves activated
39
are early childhood infections preventative of asthma?
can be
40
extrinsic causes of asthma
airborne allergens familial pattern
41
intrinsic causes of asthma
respiratory infection inhaled irritants NSAIDS, beta-blockers emotional trigger GE reflux exercise
42
VE
minute ventilation VE = Vt x RR
43
FRC
fractional residual capacity
44
FVC
forced vital capacity
45
Vt - Vd
dead space
46
VE =
VT x f (500ml/breath x 12 breaths/min) = 6L/min
47
symptoms of asthma
wheezing, chest tightness prolonged expiration, air trapping (high RV, low FVC) alveolar ventilation less effective --> V/Q mismatch (shunt) --> hypoxia
48
symptoms of mild asthma attacks
chest tightness wheezing cough
49
symptoms of severe asthma attacks
distant breath sounds loud wheezing inaudible breath sounds and wheezing signals onset of respiratory failure
50
FEV1
forced expiratory volume in 1 second how much was breathed out in 1 second?
51
diagnosis of asthma
H&P spirometry FEV1/FVC low, PEF low peak expiratory flow (PEF) meter methacholine challenge to trigger attack see if bronchodilators reverse
52
treatment of asthma
education and desensitization to allergens
53
short-term meds for asthma
beta-agonists (albuterol, terbutaline) by inhaler anti-cholinergics by inhaler systemic steroids
54
long-term meds for asthma
steroids mast cell stabilizers long-acting beta-agonists SMC relaxers leukotriene modifiers (block synthesis/receptors) Xolair: monoclonal Ab against IgE
55
how is asthma classified
by severity allows proper treatment and identification at those at risk for complications
56
severe asthma
virtually constant symptoms and requires frequent use of steroids deterioration can be rapid - don't delay treatment
57
chronic obstructive pulmonary disease: COPD
a group of diseases that produce chronic obstruction of air flow 4th leading cause of death in US
58
what causes COPD
smoking alpha1-antitrypsin deficiency
59
when do you get symptoms of COPD?
when the disease is advanced
60
in COPD, the airway can be obstructed by... 3 things
fibrosis with hypertrophy of bronchial wall inflammation with hyper-secretion of mucus destruction of elastic fibers
61
progression of COPD
destruction of alveoli decreases gas exchange area destruction of elastic fibers causes airway collapse V/Q mismatch = wasted effort and hypoxia low elastic recoil causes airway collapse and air trapping
62
2 types of COPD
emphysema - enlarged airspaces chronic bronchitis - small airway obstructions
63
emphysema
loss of lung tissue (elastic, alveolar walls destroyed) airspaces enlarged lungs hyperinflated high TLC
64
_______ is the leading cause of emphysema
smoking
65
smoking and emphysema
activates macrophages and neutrophils to release elastases decreases antitrypsin activity (inhibits elastases) elastin fibers destroyed
66
genetics of alpha1 antitrypsin deficiency
PI (protein inhibitor) genes produce alpha1 antitrypsin PIZ mutation most severe 5% of population homozygotes have 1/5 or less of normal enzyme activity
67
if emphysema in a person less than 40 YOA then cause is likely...
alpha1 antitrypsin deficiency
68
2 types of emphysema
centriacinar paracinar
69
centriacinar emphysema
bronchioles in central lung affected 1st alveoli initially normal common in male smokers
70
paracinar emphysema
peripheral alveoli affected 1st bronchioles initially normal common in alpha1-antitrypsin deficiency
71
chronic bronchitis cause
caused by inflammation of airways (hyperplasia and a lot of mucus production) middle aged males that smoke (multiple infections) bacterial/viral infection
72
diagnosis of chronic bronchitis
cough for 3 months consecutively fo 2 years
73
progression of COPD
from cough to severe respiratory distress
74
older terminology for COPD
pink puffer: emphysema blue bloater: chronic bronchitis most people with COPD have some of both
75
emphysema causes loss of both _________ & _________
ventilation & perfusion
76
emphysema causes hypoxia when
late in disease
77
chronic bronchitis leads to _______ obstruction, and low V/Q areas lead to _______
airway, hypoxia
78
symptoms of emphysema
dyspnea with use of accessory muscles seated position at night barrel chest from air trapping pursed lip breathing
79
symptoms of chronic bronchitis
dyspnea exercise intolerance hypoxia & hypercapnea polycythemia --> HTN + Rt HF
80
death from COPD occurs from
exacerbation from infection eventually respiratory failure
81
diagnosis of COPD
CXR - shower hyperinflation PFT's: FEV1 and FEV1/FVC are low TLC & RV high if FEV1/FVC less than 50% -- severe disease exercise tolerance test blood gases
82
CXR of a COPD patient
hyperinflation seen as: increased lung volume low flat diaphragm increased retrosternal air
83
treatment of COPD
stop smoking prevent respiratory infection increase physical/psychosocial function O2 therapy when hypoxia present (PO2 to 60)
84
drugs for COPD
beta-agonists anti-cholinergics theophylline steroids
85
bronchiectasis
uncommon, but serious type of COPD (airway obstruction) 2ndary to persistent infection/inflammation (TB)
86
symptoms of bronchiectasis
productive cough purulent sputum hemoptasis anemia weight loss
87
diagnosis/treatment of bronchiectasis
H&P, CXT, CT postural drainage, chest PT, treat infection

Pathophysiology (24 decks)

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