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Pathophysiology of ill-health > Pneumonia > Flashcards

Pneumonia Flashcards

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1
Q

Relevance

A

0.5-1% of adults in UK affected each year

16% of all deaths in children under 5, 808,694 in 2017 (WHO)

USA - most common cause of hosp admission except birth

**Common cause of sepsis and septic chock, causing 50% OF EPISODES

Pregnant women at risk - leading cause of death in maternity settings

Adult literature relevant to MH

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2
Q

Hospital Acquired Pneumonia - relevance

A

Increases hospital stay by 7-9 days per patient

Second most common hospital acquired infection other than UTI’s - significant mortality association

LD - respiratory conditions are major contributor to death amongst cohort

Chronic health conditions - MH population high, pneumonia risk is significant

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3
Q

Causes

A

Genetics, underlying medical and lifestyle conditions, determine pneumonia susceptibility

  • babies and young children
  • people over 65 - poor immune system - less cilia
  • people who smoke - fewer cilia
  • people with otehr health conditions such as asthma, cystic fibrosis, kidney, liver, HIV, anything which affects immune system - malnourished, post surgery,
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4
Q

Definition / Classification

A

No definition - too many types

Bacterial, Viral, Fungal - organism

Part of lung affected - lobar, bronchial

Location - Community-acquired or Hospital-acquired pneumonia

Mycoplasma pneumonia - ‘walking pneumonia’

Aspiration pneumonia - esp if laying- acid in lungs

Atypical pneumonia

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5
Q

Most common causes

A

Streptococcus pneumoniae - especially children

Hameophilus influenzae

Respiratry syncytial virus

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6
Q

Describe

A

Air sacs fill with puss and may become solid. Inflammation may affect one lung or both (double v single)

Inflammatory process

Purulent respiratory secretions, pyrexia and chest x-ray changes associated with the area of infection

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7
Q

Characteristics - describe

A

Inflammation and infection in the terminal bronchioles and alveoli, leading to engorgement of the capillaries and subsequently stasis of blood and also causing conslidation

21% oxygen in

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8
Q

Consolidation

A

Region of normally compressible lung tissue that has filled with liquid(fluid/exudate) instead of air

Shadowing on chest x-ray - can be detected on auscultation

Heavy fluid - pressure on the alveoli - can cause atelectasis (airway collapse)

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9
Q

Consolidation

A

Region of normally compressible lung tissue that has filled with liqui(fluid/exidate) instead of air

Shadowing on chest x-ray - can be detected on auscultation

Heavy fluid - pressure on the alveoli - can cause atelectasis (airway collapse)

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10
Q

Air journey - respiratory system

A

Oxygen in 21% in to down trachea, to bification of tracea (charina) - divide into right and left bronchiole tree, travels down via brionchioles, terminal brionchiles, alveoli - capillary interface, into circulation

Prevented at capillary interface

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11
Q

Respiratory Auscultation - what do you find?

A

Wheezing

Rales (upper airways) - popping crackling

Rhonchi - fluid - assoc. with heart failure and pneumonia - deep sea sounds

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12
Q

Atelectasis

A

airway collapse due to fluid in alveoli

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13
Q

Diagnosing pneumonia

A

Clinical symptoms - malaise, lethargy, fever, persistent cough, pleuritic pain

Dyspnoea - difficult / laboured breathing

Cough - sputum yellow green, rusty

Accompanied by pyrexia, chest x-ray changes and leucocytosis - elevated WBC count

Auscultation - rales, rhonchi

Send off lab sample - streptococcus pneumoniae?

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14
Q

Leucocytosis

A

Elevated WBC count

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15
Q

Dyspnoea

A

Shortness of breath - difficulty breathing

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16
Q

Classic diagnostic?

A

Start with chest x-ray

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17
Q

Inflammation

A

Th2 cells - white cells involved in inflammatory response

Th2 cells are activated by virus, bacteria, fungus

Release of cytokines

Get inflammatory response - symptoms (consolidation)

Helper type Th2 cell is a distinct type of T cell that secretes IL-4,5,9,11,13,17,25 (inflammatory mediators / cytokines)

Other cytokines produced by Th2 cells stimulate eosinophil activation and survival (IL-5) or promote mast cell activation (IL-9)

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18
Q

Inflammatory response:

A
  1. VASODILATION, INCREASED PERMEABILITY of blood vessels
  2. Emigration of phagocytes from the blood into the area of injury
  3. Tissue repair
  4. In pneumonia this presents as consolidation
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19
Q

Symptoms

A 
Muscular aches
Respiratory system
Fever, 
Low BP
Fast HR
Nausea vomiting

Can hear it with stethoscope

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20
Q

Lobes of lungs

A

3 lobes on Right side (superior, middle, inferior)

2 on Left side (superior, lower)

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21
Q

Most common for pneumonia?

A

Right bronchus - as higher, more vertical, bigger

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22
Q

Cell walls - humans?

Study These Flashcards
A

NO - bacteria, plants

Humans have cell membranes

Virus’ don’t have cell walls

23
Q

Laboratory sample

Study These Flashcards
A

streptococcus comes back green

24
Q

Clinical presentation - ‘way in’ logical thinking

Study These Flashcards
A

‘Advanced investigations’

Systemic - high fever, chills

Temperature 36.0-37,5

AIRWAY:

Respiratory rate depth and pattern - 12-20 breaths per minute normal depth

Oxygen - not delivered, cells respire anaerobically, make lactic acid, pH starts to fall, chemoreceptor, medulla olongata, phrenic nerve, increased resp

Cyanosis - lungs full of fluid - can’t get oxygen from respiratory to circulatory system

Pulse and BP

Pyrexia mega principle

25
Pyrexia in pneumonia
Pyrexia inhibits bacterial growth, mobilises immune defences, damage membranes of body and bacteria cells Any human cell that's damaged releases PYROGENS More damage, more pyrogens Pyrogens travel to HYPOTHALAMUS, act directly or via prostoglandins, change the set point of thypothalamus, body then perceived to be too cold, activate nervous system, start to shiver which brings your temperature up
26
Examples of pyrogen
IL-1 - acts directly on hypothalamus (pyrogen and cyctokine) Tumour Necrosis Factor - the principle cytokine that mediates acute inflammation TNF - acts directly on hypothalamus AND stimulates other white cells to release IL-6, IL-8 (more cytokines) More cytokines, more neutrophils
27
TNF Tumour Necrosis Factor stimulates production of?
Interleukin 6 = proinflammatory cytokine, stimulates liver to produce acute phase proteins, STIMULATES THE PRODUCTION OF NEUTROPHILS Interleukin 8 = PRODUCED BY MACROPHAGES IN THE ALVEOLI AND ATTRACTS NEUTROPHILS TO THE SITE OF INFLAMMATION
28
What are the products of cellular aerobic respiration?
Carbon dioxide, heat, ATP, water
29
What causes increase in heat?
Increase muscle use heart beating faster liver working hard fighting infection - IL-1 and TNF on hypothalamus TNF - IL1 & Aerobic resp - metabolic rate goes up
30
Excessive high temperatures:
Swell mitochondria | Change cell permeability
31
Temperature leads to....
Sweating Leads to dehydration - lost a lot? circulatory volume is reduce, BP can fall
32
Why does HR go up if BP falls?
If BP falls (e.g. due to sweating) Baroreceptors in neck - measure BP Connected to Medulla Oblongata Connected to heart via vagus nerve Break taken off vagus nerve, HR speeds up BUT - also stress - adrenaline
33
Why sputum green?
neutrophils have 'respiratory burst' - they produce free radicals enzymes in the white cells, made of iron, cause change in colour Live neutrophils stain yellow - eosinophils Iron enzymes + sputum = green
34
Raised white blood cell count?
Leukocytosis neutrophils - tend to rise with bacterial infections lymphocytes - viral infection monocytes - chronic cancer eosinophiles - parasitic infections basophils - anaphalyxis
35
End point - impact on funtioning
Lungs - oxygen in co2 out requires - large surface area, thin membrane for gaseous exchange, good blood supply, concentration gradient, adaptable consolidation impedes process o2 cant move down bronchiole tree into circulatory system ...becoming...HYPOXIC (asthma, pneumonia - can both cause) reduction of available oxygen systemically for cells, tissues and organs less oxygen in arteriole blood
36
Tissue Hypoxia
Starved of oxygen for 4 minutes - brain, kidney, heart Tissue becomes necrotic Clot - anything downstream is starved of oxygen
37
Alveoli filled with fluid =
Oxygen can't reach the bloodstream
38
Normal pH of blood Normal lactate Normal carbon dioxide Normal oxygen
blood: 7.35 - 7.45 lactate: 0.5 - 1 carbon dioxide: 4-6.5 kilapascals oxygen: 11-14 killapascals low oxygen - hypoxia
39
Types of hypoxia
5 x types Anaemic hypoxia - decreased haemoglobin Hypoxic hypoxia - asthma, choke and pneumonia Ischaemic hypoxia - arteriolar obstruction or vasoconstriction Oxygen affinity hypoxia - e.g carbon monoxide poisoning Stagnant hypoxia - very low blood pressure
40
Types of hypoxia
5 x types Anaemic hypoxia - decreased haemoglobin Hypoxic hypoxia - asthma, choke and pneumonia Ischaemic hypoxia - arteriolar obstruction or vasoconstriction Oxygen affinity hypoxia - e.g carbon monoxide poisoning Stagnant hypoxia - very low blood pressure
41
What happens if deprived of oxygen?
Switch from aerobic to anaerobic respiration in 21%, out 16.5% oxygen - I use 25% of oxygen breathed in binds to haemoglobin - oxyhaemoglobin,
42
Oxygen journey Respiration
``` Nasophayryx, orapharynx, lyn trachea bhronchos bhroncioles diffuses axcross thin membrane to bloodstream binds to haemoglobin forms oxyhaemoglobin, then pumped to tissues ``` when red cells arrive in capillary bed, xygen diffuses through capillary wall, through interstitial space that surrounds cell, through membrane and into the cytoplasm oxygen is combined with glucose 1. Glycolysis 2. Krebs cycle 3. Electron transport phosphorylation - make 36 ATP's
43
Unable to get oxygen? what happens?
Switch to Anaerobic respiration Glycolysis - Glucose -> 2 x ATP & Pyruvic Acid -> Lactic Acid & Lactate lactate levels start to climb, ph starts to fall Become more acidic - 7.35 -> 6.8= death
44
Consequences of anaerobic respiration?
Reduced ATP, disrupted sodium potassium pump Decrease in pH Increase in lactate Compromised cell membrane and cell organelle activity
45
Cell membrane disruption pathway 1
ATP dependent sodium potassium pump relies on ionic gradient Sodium accumulates in cell, oedema Calcium accumulates Potassium leaks out of cell (always leaks from acidotic cells) Leads to fluid and electrolyte imbalance Oedema and alectroltye imbalance disrupt the function of key cell organelles leading to irreverible damage and death
46
Cell membrane disruption pathway 2
Lysosome - An organelle involved in breaking down proteins & carbohydrates Thick organelle cell wall full of digestive enzymes Due to lack of ATP, cell membrane eaten away by enzymes inside lysosome Once cell walls become permeable, lysosomal enzymes self digest resulting in cell death
47
2 x major reasons for cell death
1. water movement, ph imbalance, electrolyte disturbance 2. Lysosomal enzyme activation caused by lack of oxygen, ph imbalance and failure of sodium potassium pump ACID
48
Assessment of pneumonia Resuscitation council recommend...
Assess area for safety, think about an early call for help, PPE, privacy and dignity Try to illicit response ``` A - If responding, airway open. Look listen and feel B - look listen and feel C - D - consciousness, blood glucose E - ```
49
Airway
Chest and abdominal movements, accessory muscle use, presence o Green (iron) or yellow (wbc live) sputum Cyanosis - purple/blue, grey assoc. with sat <85% changes between 3-5 g / decilitre
50
Breathing
Look Listen Feel ``` Respiratory distress Fast respiratory rate* Using accessory muscles* Speech interrupted due to strained breathing Rales, rhonchi with stethoscope Hypoxia ```
51
Circulation
Temperature up -> dehydration Dehydration can cause low BP, increased HR BP falls - baroreceptors in neck, medulla oblongata, vagus nerve, heat beats faster Delayed capillary refill, over 2 sec Perfusion to kidney low, urine output reduced Perfusion to stomach low, feel sick or vomit
52
Disability
``` Altered level of consciousness due to lack of oxygen to brain - hypoxic confusion A C V P U ``` Blood sugar - elevated due to stress response
53
Exposure
Maintain privacy and dignity Minimise heat loss Check for rashes fractures and breathing hot to the touch expected in pneumonia Baseline observations need to be considered Asthma, pneumonia - ABCDE Outside of ABCDE... Pneumonia - changes in chest x-ray, white cell count
54
Assessment tools for pneumonia
British Thoracic society - CURB 65 ``` C - new mental confusion due to hypoxia U - urea due to dehydration R - fast respiratory rate B - blood pressure systolic <90, diastolic <60 65 - 65 years or older? ``` Critique - 12-20 is norm (RCUK) BTS - above 30 is a worry RCUK - say 25 is a worry

Pathophysiology of ill-health (16 decks)

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