Flashcards in Pulmonary Pathology: COPD/COLD Deck (51):
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Bullae
-large dilated airspaces bulging from beneath pleura
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Polycythemia
-increased RBC production
-more viscous
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Obstructive
trouble getting air out
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Primary problem center on obstruction to airflow
-increased resistance through decreased sized airways
-loss of elastic recoil
-tendency of airways to collapse
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differences in obstructive
-cause of obstruction
-reversibility/prognosis of disease
-location of obstruction
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common signs of obstructive lung diseases
-decr EFR
-incr residual volume
-incr WOB
-incr risk of DVT
-vent-perfusion mismatching
-polycythemia
-pulm HTN
-cor pulmonale (RVH)
-lung failure-->hypoxemia
-pump failure-->alveolar hypovent/hypercapnia
-expiratory Mm weakness
-Extrapulmonary effects
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Common Prognosis of Obstructive Lung Disease
-increase loss lung tissue if don't quit smoking
-chronic hypoxemia-->ishcemia in all organs
-most common cause of death=CHF, resp failure, pneumonia, bronchiolitis, PE
-LVRS in pt with emphysema=~5 year increase in benefits
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Common Symptoms of Obstructive
-chronic cough
-productive cough
-abnormal/adventitious breath sounds
-dyspnea on exertion
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Pediatric Obstructive Lung Diseases
-bronchopulmonary dysplasia
-cystic fibrosis
-asthma
-bronchiectasis
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Adult Obstructive Lung Diseases
-chronic bronchitis
-emphysema
-asthma
-bronchiectasis
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Asthma Etiology
-chronic inflam disease of airways
-heightened bronchial activivty to stimuli
-irritants cause bronchospasm-->wheezing
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Asthma stimuli
-allergies
-Exercise
-infections
-stress
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Intrinsic Asthma
-begins after age 35
-more severe
-year round
-related to viral infection
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Extrinsic Asthma
-usually children, young adults
-hayfever, allergies
-fall/spring
-1/2 grow out of it
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Asthma Treatment
-bronchodilators
-avoid irritants
-pt/family edu
-exercise goals
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BPD pathophysiology
-damage to alveoli by mechanical ventilator-->inflammation, pulmonary edema and fibrosis
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BPD Prognosis
-death by 1 year in some
-survivors have longterm problems with resp infections, hyperinflated lungs & bronchospasm
-resp symptoms into childhood
-some: decreased growth and increased neurodevelopmental sequelae
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BPD Etiology
-neonates who have been mechanically ventilated or treated with high O2 levels as result of RDS
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Factors leading to BPD
-born <12,000 grams at birth
-ventilated with continuous positive pressure
-O2 given at 60% or higher FIO2
-50+ hours on supplemental O2
-Birth mother is diabetic
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BPD Treatment
-Bronchodilators
-Diuretics
-K+ supplement
-Nutritional Support
-Antibiotics
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Emphysema
-abnormal permanent enlargement of air spaces distal to terminal bronchiole, w/ destruction of their walls
-"pink puffer"
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2 Types of Emphysema
-centrilobar
-panlobar
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Panlobar Emphysema
--->enlargment of destruction of alveoli
-affects lower lobes (worse prognosis)
-Alpha1-Antitripsin deficiency
-affects alveoli more
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Centrilobar Emphysema
-20x more common than panlobar
-affects bronchioles more
-->inflam, edema & thickening of bronchiole walls w/ destruction of respiratory bronchioles
-more affect upper segments and loves
-more common in men & pts with bronchitis
-rare in non-smokers
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Emphysema Etiology
-destruction of alveolar walls & elastic tissue distal to terminal bronchioles
-->abnormal permanent enlargement of gas exchange airways
-loss of elastin and cause collapse of airways
-due to imbalance between enzyme inhibitors and proteolytic enzymes
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Emphysema Pathophysiology
-SMOKING
-smoke particles in lungs-->neutrophils & macrophages move in to remove smoke-->release enzymes to destroy smoke-->some enzymes (protease) attack alveolar walls & (elastase) destroy elastin
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Emphysema:
Enzyme/Inhibitor Imbalance
-Proteolytic Enzymes: break down tissue
-Enzyme inhib: control enzymes
-Alpha1-Antitripsin Deficiency-->decreased proteolytic enzyme inhib
-Smokers have too many proteolytic enzymes
so lung tissue gets destroyed
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Emphysema:
Alpha1-Antritripsin Deficiency
-inherited
-symptoms around age 40-55
-cause liver disease; children @ risk for hepatitis and cirrhosis
-->inability to inhibit neutrophil elastase enqume and breaks down lung tissue
-Treatment: Alpha1-Antitripsin Injections
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Emphysema Treatment
-irreversible
-stop smoking to stop further destruction
-no effective Tx
-PT
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PT Management of Emphysema
-pursed lip breathing to increase lung efficiency and decrease collapse of airways
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Bronchiectasis Pathology
-a reaction to having something else
-result of infection
-usually localized to a few segments
-airways become dilated, fibrotic, lined with hyperplastic nonciliated, mucus secreting cells
-decr cilia-->incr mucus accum-->infection risk incr
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Bronchiectasis Prognosis
-with use of antibiotics as needed, can live into 70's & 80's
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Bronchiectasis Etiology
-abnormal permanent dilation of medium-sized bronchi that extends distally
-areas filled with secretions are swollen/inflamed & can be ulcerated
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Types of Bronchiectasis
-cylindrical/longitudinal
-varicose
-saccular/cystic
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Cylindrical/Longitudinal Bronchiectasis
-most common
-uniform dilation of airways
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Varicose Bronchiectasis
-greater dilation than cylindrical
-bronchial walls look like varicose veins & irregular
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Saccular/Cystic Bronchiectasis
-balloon shaped
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Bronchiectasis Treatment
-antibiotics
-pulmonary hygiene
-hydration
-immunizations to prevent flu & pneumonia
-surgical resections of segments
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CF Etiology
-autosomal recessive gene disorder
-probs affect cystic fibrosis transmembrane regulator (protein channel for Cl- transport)
-unable to resorb Cl- in sweat glands=salty sweat
-progressive obstruction of exocrine glands by increase mucous secretions
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CF Treatment
-chest PT
-Antibiotics
-Mucolytics (increase hydration)
-Bronchodilators
-Nutrition (pancreatic enzyme replacement)
-Single/double lung or heart transplant
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CF Prognosis
-median survival 35 years
-cause of death usually respiratory
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CF Vent-Perf Mismatching Causes
-arterial hypoxemia-->dyspnea
-Pulm HTN-->cor pulmonale-->R ventricle failure
-Increased CO2
-Respiratory Acidosis
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CF:
Bacterial Infections
-pseudomonas aeruginosa most common
-staph aureus
-haemophilus influenza
-burkholderia cepacia
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CF:
Obstructive Pulmonary Disease
-small airways inflam & infection-->
-incr mucus secretion-->
-incr infection-->
-neutrophils in airways-->
-accumulated micro-organisms destroy lung tissue-->
-fibrosis & vent-perf mismatching
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CF:
Pancreatic Insufficiency
-destruction by mucous secretions-->
-enzymes trapped in ducts-->
-autodestruction pancreas-->
-decreased ability to absorb nutrients
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CF:
Meconium Ileus
-obstruction of intestines by meconium stools due to lack of trypsin & other pancreatic enzymes
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CF:
Salty Sweat
-Cl- imbalance & exocrine glands clogged by mucus
-excess Cl- can't be reabsorbed in sweat ducts so goes out to skin
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Chronic Bronchitis Pathology
-due to chronic inflam of tracheobronchial tree-->
-hyper-secretion of mucus-->
-damage to cilia-->
-mucus collects-->
-place for infection and inflam
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chronic bronchitis etiology
-#1 cause is smoking
-pollution
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Chronic Bronchitis Diagnosis
-productive cough (>100 ml/day) for 3 months of the year for 2 consecutive years
-"blue bloaters"
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