Pulmonary Pathology: COPD/COLD Flashcards Preview

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Flashcards in Pulmonary Pathology: COPD/COLD Deck (51):
1

Bullae

-large dilated airspaces bulging from beneath pleura

2

Polycythemia

-increased RBC production
-more viscous

3

Obstructive

trouble getting air out

4

Primary problem center on obstruction to airflow

-increased resistance through decreased sized airways
-loss of elastic recoil
-tendency of airways to collapse

5

differences in obstructive

-cause of obstruction
-reversibility/prognosis of disease
-location of obstruction

6

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

7

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

8

Common Symptoms of Obstructive

-chronic cough
-productive cough
-abnormal/adventitious breath sounds
-dyspnea on exertion

9

Pediatric Obstructive Lung Diseases

-bronchopulmonary dysplasia
-cystic fibrosis
-asthma
-bronchiectasis

10

Adult Obstructive Lung Diseases

-chronic bronchitis
-emphysema
-asthma
-bronchiectasis

11

Asthma Etiology

-chronic inflam disease of airways
-heightened bronchial activivty to stimuli
-irritants cause bronchospasm-->wheezing

12

Asthma stimuli

-allergies
-Exercise
-infections
-stress

13

Intrinsic Asthma

-begins after age 35
-more severe
-year round
-related to viral infection

14

Extrinsic Asthma

-usually children, young adults
-hayfever, allergies
-fall/spring
-1/2 grow out of it

15

Asthma Treatment

-bronchodilators
-avoid irritants
-pt/family edu
-exercise goals

16

BPD pathophysiology

-damage to alveoli by mechanical ventilator-->inflammation, pulmonary edema and fibrosis

17

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

18

BPD Etiology

-neonates who have been mechanically ventilated or treated with high O2 levels as result of RDS

19

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

20

BPD Treatment

-Bronchodilators
-Diuretics
-K+ supplement
-Nutritional Support
-Antibiotics

21

Emphysema

-abnormal permanent enlargement of air spaces distal to terminal bronchiole, w/ destruction of their walls
-"pink puffer"

22

2 Types of Emphysema

-centrilobar
-panlobar

23

Panlobar Emphysema

--->enlargment of destruction of alveoli
-affects lower lobes (worse prognosis)
-Alpha1-Antitripsin deficiency
-affects alveoli more

24

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

25

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

26

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

27

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

28

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

29

Emphysema Treatment

-irreversible
-stop smoking to stop further destruction
-no effective Tx
-PT

30

PT Management of Emphysema

-pursed lip breathing to increase lung efficiency and decrease collapse of airways

31

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

32

Bronchiectasis Prognosis

-with use of antibiotics as needed, can live into 70's & 80's

33

Bronchiectasis Etiology

-abnormal permanent dilation of medium-sized bronchi that extends distally
-areas filled with secretions are swollen/inflamed & can be ulcerated

34

Types of Bronchiectasis

-cylindrical/longitudinal
-varicose
-saccular/cystic

35

Cylindrical/Longitudinal Bronchiectasis

-most common
-uniform dilation of airways

36

Varicose Bronchiectasis

-greater dilation than cylindrical
-bronchial walls look like varicose veins & irregular

37

Saccular/Cystic Bronchiectasis

-balloon shaped

38

Bronchiectasis Treatment

-antibiotics
-pulmonary hygiene
-hydration
-immunizations to prevent flu & pneumonia
-surgical resections of segments

39

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

40

CF Treatment

-chest PT
-Antibiotics
-Mucolytics (increase hydration)
-Bronchodilators
-Nutrition (pancreatic enzyme replacement)
-Single/double lung or heart transplant

41

CF Prognosis

-median survival 35 years
-cause of death usually respiratory

42

CF Vent-Perf Mismatching Causes

-arterial hypoxemia-->dyspnea
-Pulm HTN-->cor pulmonale-->R ventricle failure
-Increased CO2
-Respiratory Acidosis

43

CF:
Bacterial Infections

-pseudomonas aeruginosa most common
-staph aureus
-haemophilus influenza
-burkholderia cepacia

44

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

45

CF:
Pancreatic Insufficiency

-destruction by mucous secretions-->
-enzymes trapped in ducts-->
-autodestruction pancreas-->
-decreased ability to absorb nutrients

46

CF:
Meconium Ileus

-obstruction of intestines by meconium stools due to lack of trypsin & other pancreatic enzymes

47

CF:
Salty Sweat

-Cl- imbalance & exocrine glands clogged by mucus
-excess Cl- can't be reabsorbed in sweat ducts so goes out to skin

48

Chronic Bronchitis Pathology

-due to chronic inflam of tracheobronchial tree-->
-hyper-secretion of mucus-->
-damage to cilia-->
-mucus collects-->
-place for infection and inflam

49

chronic bronchitis etiology

-#1 cause is smoking
-pollution

50

Chronic Bronchitis Diagnosis

-productive cough (>100 ml/day) for 3 months of the year for 2 consecutive years
-"blue bloaters"

51

Chronic Bronchitis Treatment

-quit smoking
-can improve if before blue and bloated stage & only has cough
-IV antibiotics if infection
-bronchodilators/O2
-chest PT