Pathoma - Pulmonary HTN and RDS Flashcards Preview

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Flashcards in Pathoma - Pulmonary HTN and RDS Deck (21)
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1

Normal pressure in the pulmonary circuit compared to what is considered high pressure

Normal is about 10mmHg
High pressure is > 25mmHg

2

pulmonary HTN is characterized by what?

Atherosclerosis of the pulmonary trunk

Smooth muscle hypertrophy of pulmonary arteries

Intimal fibrosis

Plexiform lesions

3

Pulmonary HTN leads to ______

Right ventricular hypertrophy/right sided heart failure

4

Presentation of pulmonary HTN

Exertional dyspnea, especially in younger women

5

Primary pulmonary HTN

Seen in young adult females unknown etiology

6

Genetic correlation with primary pulmonary HTN

Familial forms are related to inactivating mutations of BMPR2, which leads to proliferation of vascular smooth muscle

7

Secondary Pulmonary HTN is caused by what

Arises from hypoxemia (like in COPD and ILD) or increased volume in the pulmonary circuit (like in congenital heart disease)

May also arise with recurrent pulmonary embolism

8

Acute Respiratory Distress Syndrome (ARDS)

Damage to alveolar capillary interface in the alveolar sacs leads to leaking of protein rich fluid that builds up a hyaline membrane diffusely in the lung.

9

Histology of ARDS

Alveolar sacks with hyaline rings around the inside

10

Problems with ARDS

1. Exchange barrier in alveolar sacs leads to cyanosis

2. Membranes are sticky, causing pressure on the sacs to collapse.

Overall: Hypoxemia and cyanosis with respiratory Distress

11

CXR of ARDS

White out diffusely

12

Cause of ARDS

Many.

Sepsis, infection, shock, car accident, pancreatitis, etc.

Activation of neutrophils induces protease mediated and FR damage of Type I and type II pneumocytes

13

Treatment of ARDS

Addressss underlying cause...

Ventilation with positive and expiratory pressure (PEEP)

Recovery may be complicated by insterstitial fibrosis

14

Why do we get fibrosis?

Problem with pneumocyte type II, which is the regeneration stem cell of the lung. Without this, you have to do repair instead of regeneration, leading to the interstitial fibrosis

15

Neonatal respiratory distress syndrome

Respiratory distress due to inadequate surfactant levels

16

____ pneumocytes produce surfactant which _____

Type II pneumocyte

Reduces surface tension of the lungs so the alveolar sacs don't collapse

17

Clinical features of neonatal respiratory distress syndrome

1. Increasing respiratory effort after birth, tachypnea with use of accessory muscles, and grunting

2. Hypoxemia with cyanosis

3. Diffuse granularity ofl ung on CXR

18

Neonatal respiratory distress syndrome is associated with what 3 things?

1. Prematurity which we can screen with L:S (>2) ratio to screen for surfactant levels (Lethicin (AKA phosphatidylcholine) and sphingomyelin make surfactant)

2. C-section delivery

3. Maternal diabetes

19

How is maternal diabetes related to neonatal respiratory distress syndrome?

Mom makes too much sugar and sends it to baby who has an ormal pancreas that dishes out insulin. The insulin breaks down surfactant

20

Complications of neonatal respiratory distress syndrome

1. Hypoxemia - increases risk for persistence of patent ductus arteriosus and necrotizing enterocolitis

2. Supplemental oxygen increases risk for free radical injury

21

Supplemental oxygen, which increases risk for free radical injury, can lead to what?

- Blindness
- Damage to lungs during earlyl ung development