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Physiology > Pulmonary Pathophysiology > Flashcards

Pulmonary Pathophysiology Flashcards

1
Q

When is the most critical moment for an asthmatic during anesthesia?

A

During airway manipulation. Make sure you have an adequate anesthetic depth before proceeding.

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1
Q

What are the 4 components that lead to poor gas exchange and an increase in V/Q mismatching with COPD?

A
  1. Intrapulmonary shunt
  2. Increase in dead space ventilation
  3. Capillary destruction
  4. Alveolar destruction and formation of blebs
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1
Q

What is seen on a flow-volume loop in someone with a variable intrathroacic lesion?

A

Normal inspiration, blunted expiration

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2
Q

Describe a restrictive flow-volume loop.

A

Rightward shift, similar shape to normal curve, lower than normal flow rates.

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3
Q

What are some preoperative considerations for COPD patients?

A
  • Recent changes in symptoms (want them at baseline)
  • Chest X-ray, +/- PFT’s
  • Baseline ABG
  • Cardiac evaluaion
  • Infection control
  • Taking bronchodilators/steroids/anticholinergics
  • How long has it been since they’ve stopped smoking
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4
Q

T or F: Patients with COPD need a larger I:E ratio during controlled ventilation?

A

False:

Because it takes longer for these patients to exhale, they need a smaller I:E ratio. They need to spend more time during expiration to allow for adequate gas removal from alveoli and small airways.

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5
Q

Describe the typcial sequence of events during an untreated asthma attack.

A
  1. Bronchial smooth muscle hyperactivity
  2. Airflow limitations (primarily during exhalation)
  3. Inflammatory response (increase swelling and mucous)
  4. Continued or worsening bronchospasm
  5. Alveolar fluid extravasation (swelling)
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6
Q

What are 3 risk factors predisposing a patient to post-op pulmonary complications?

A
  1. Operation site (thoracic and upper abdominal)
  2. Duration of procedure
  3. Pre-op pulmonary dysfunction (dyspnea, smoking history, age, obesity)
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6
Q

What are important things to know about an asthmatic patient preoperatively?

A
  1. Baseline peak flows
  2. Severity of asthma (# of attacks, resolution of attacks)
  3. Clinical history (steroid use, intubation history, current wheezing status)
  4. Exacerbating factors
  5. Do you need to give a bronchodilator/glucocorticoids/supplemental 02 preoperatively to optimize patient status?
  6. Do you need to sedate to decrease anxiety?
  7. Do you need to give a stress dose of steroids?
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7
Q

What happens to the size of alveoli in someone with COPD?

A

They get larger.

Alveoli merge to form giant blebs. There is also a destruction in the capillary beds perfusing the alveoli.

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7
Q

T or F: It is beneficial for a patient to stop smoking any time before their surgery?

A

False:

You want them to quit 6-8 weeks before surgery. Any less than that you can have a hyperresponse and increase secretions.

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8
Q

Name 4 possible post-operative pulmonary complications.

A
  1. Atelectasis
  2. Pneumonia
  3. Pulmonary embolism
  4. Respiratory failure
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9
Q

What type of pulmonary disease is characterized by normal expiratory flows but difficulty during inspiration?

A

Restrictive lung disease

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10
Q

What is the most common pulmonary disorder?

A

COPD

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10
Q

T or F: There is a reversible component to the obstructive nature in patients with mild to moderate COPD?

A

True:

These patients often benefit from bronchodilators and secretion drying agents.

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11
Q

What are the three comon characteristics of asthma?

A
  1. Hyperreactive airways
  2. Bronchoconstriction
  3. Inflammatory response
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11
Q

T or F: In COPD, epithelial cells are destroyed and replaced by fibroblasts creating scar tissue in the lung parenchyma?

A

True

13
Q

What is the benefit of using epinephrine during an asthma attack?

A

It acts as a bronchodilator and blunts the inflammatory response.

14
Q

Define chronic bronchitis.

A

Patient must have a chronic productive cough most days lasting at lease 3 months for 2 years.

17
Q

T or F: All wheezing is caused by asthma?

A

False:

You could have mainstemmed during intubation, have light anesthesia, an allergic reaction, obstructed ETT, increased secretions, pulmonary edema, pulmonary embolism, pneumothorax

18
Q

List 4 preoperative interventions we can do to optimize conditions in patients with COPD.

A
  1. Correct hypoxemia
  2. Correct bronchospasm
  3. Mobilize/dry secretions
  4. Control infections
19
Q

Name 5 effects of chronic hypoxemia.

A
  1. Erythrocytosis
  2. Pulmonary HTN –> R heart failure
  3. CO2 retention resulting from an increased work of breathing
  4. Respiratory acidosis, increase bicarbonate production
  5. Blunted hypercapnic drive to breathe
20
Q

What is seen on a flow-volume loop in someone with a variable extrathoracic lesion?

A

Normal expiration, blunted inspiration

22
Q

What are common treatments for asthma?

A
  • Bronchodilators (B2 agonists)
  • Steroids (anti-inflammatory)
  • Anticholinergics (decrease secretions)
  • Methylxanthines (bronchodilator but NOT B2 agonist, ex. caffeine)
23
Q

Pursed lip breathing is common in what type of patients?

A

Patients with COPD.

This allows for back pressure to stent open alveoli making it easier for them to exhale.

24
Q

What type of pulmonary disease is categorized by limited lung expansion, decreased overall lung volumes and has increase resistance during inspiration?

A

Restrictive

25
Q

What is a normal FEV1?

What is the FEV1 in someone with obstructive pulmonary disease?

In restrictive pulmonary disease?

A

Normal = 70%

Obstructive < 70%

Restrictive > 70%

26
Q

Describe some types or causes of restrictive pulmonary diseases contained to the chest wall.

A
  • Thoracic spinal deformities (osteoporosis, kyphosis)
  • Severe chest burns (burn tissue is rigid and restrictive)
26
Q

What is seen on a flow-volume loop in someone with a fixed obstruction?

A

Decreased inspiration and expiration.

27
Q

T or F: A common characteristic of COPD is hyposecretion?

A

False:

People with COPD have hypersecretion production and can’t clear the mucous out of their lungs due to damaged cilia often resulting in infections such as pneumonia and chronic bronchitis.

28
Q

What are the 2 most common forms of obstructive lung disease?

A

Asthma an COPD

29
Q

What type of obstructive lung disease is characterized by a slow progression over time often caused by environmental stressors?

A

COPD

30
Q

Describe an obstructive flow-volume loop.

A

Left shift, lower peak expiratory flows, scalloped curve during expiration, smaller area under loop (less air movement)

32
Q

T or F: PaCO2 will decrease initially with an asthma attack?

A

True:

An increase in respiratory rate initially will decrease PaCO2. Eventually, the patient will tire from the increased work of breathing and will hypoventilate resulting in an increase in PaCO2.

33
Q

What type of pulmonary disease is categorized by a hyperinflation of lung volumes, increased FRC and makes it difficult to exhale?

A

Obstructive

35
Q

Why do we need to be cautious if an asthma response is initiated perioperatively?

A

Hours later, inflammatory mediators will still be present and can result in airway swelling and increased secretions. You might want to run a steroid course.

36
Q

T or F: Restrictive lung disease results in an overall decrease in compliance?

A

True:

It can be restricted to the chest wall or pulmonary parenchyma, but both result in a decrease in compliance.

38
Q

What are some common characteristics of chronic bronchitis?

A

Recurrent infections

Bronchospasms

Hypoxemia

Intrapulmonary shunting

39
Q

What are the two types of pulmonary disease categories?

A

Obstructive and Restrictive

40
Q

Describe some types or causes of restrictive pulmonary disease that involves the lung parenchyma.

A
  • Pulmonary edema
  • Pneumonia/Aspiration
  • Cystic and pulmonary fibrosis
  • Intersitial lung disease

Physiology (13 decks)

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