Respiratory- CA, CF, Failure Flashcards Preview

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Flashcards in Respiratory- CA, CF, Failure Deck (21)
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Describe the Characteristics of Lung CA

(character and spread)

• 1* and 2*
• major cause of death
• aggressive, invasive, metastatic
• spreads to bone, liver and brain


Describe 4 types of Lung CA and incidence

o Adenocarcinomas (~30%)
o Squamous cell carcinoma (30%)
(Non-Small Cell Lung Cancer)
o Large cell carcinoma (~12%)
o Small cell carcinoma (~22%) SCLC


Etiology of lung CA (risks)

• Smoking (>80%)
• Toxins (eg asbestos)
• Genetic predisposition
(...HLA on 6 plus other familial connections)


Describe Adenocarcinoma

Peripheral origin
(Alveoli or bronchioles)

Common in women (not clear why) and in non smoker (not clear why)


Describe squamous cell carcinoma

o Arises in the central bronchi (hilum)
o Spreads to hilar nodes
o More common in men (no clear reason)
o Growth can effect external structures like the heart.


Describe Large cell carcinoma

o Peripheral origin
(Alveoli and bronchioles)
o Large and undifferentiated cells
o Early metastasis (Poor prognosis)


Describe Small cell carcinoma

o 99% in smokers
o Aggressive, invasive, early metastasis (esp brain)
o Small, oval cells
o Often metastasized by Dx
o Non-resectable
o Radiosensitive

plus paraneoplastic


Which type of CA is related to paraneoplastic syndrome?

Small cell carcinoma

Paraneoplastic refers to ectopic tumors we spoke of in endocrine

(eg SIADH, Cushings – cortico and ACTH excess)


MNFTS of lung CA

• Based on type and location (eg. Central or peripheral- bronchi, lungs, heart)
• Based on extent and metastasis
• Paraneoplastic syndromes

• For all types/locations
o Hemoptysis
o Pain


What sort of MNFTS are dependent of location of tumor in lung CA

If central -> impairs ventilation -> coughing, wheezing, dyspnea

Tumors on left side will result in cardiac MNFTS


Dx of Lung CA

• Hx, Px, US, CXR, MRI
• Bronchoscopy, needle biopsy
• Cytology (sputum or bronchial wash)

No adequate screen to pick up early lung cancer


Tx for Lung CA

• NSCLC: Sx, radiation and chemo
• SCLC: chemo and radiation
• Poor prognosis


What is Cystic Fibrosis

Hereditary exocrine disease

Defective Cl- channel in cell membrane leading to hypersecretion (or at least build up) of fluid


What systems does cystic fibrosis Affect?

Exocrine cells!

GI tract (pancreas, etc), reprod tract and resp system


Etiology of Cystic Fibrosis

•CFTR (cystic fibrosis transmembrane regulator) gene on Chr 7

(CFTR is the protein)

Autosomal recessive


Patho of Cystic Fibrosis

CFTR gene mutation leads to defective Cl channel on epith cells of resp tract (and elsewhere)

• Mutation makes cell impermeable to Cl-
leading to Impaired Cl- transport across cell membrane

• Abnormal secretion and also inc concentration of Cl- on outside of epithelial membrane

• High Cl- conc pulls h20 and Na from mucous in the resp. lumen

• Mucous becomes thick and viscous cannot be moved by cilia -> dec cilliary fx -> plugs airway -> dec fx (i.e gas exchange)

• Mucous is great spot for bact growth (recurrent bacterial infection.

• > 90% die from severe pulmonary disease


Dx of cystic Fibrosis

• Sweat test
• CF in a sibling
• Newborn (trypsinogen) = a precursor for trypsin
• GI and Resp tract MNFTS


Tx of Cystic Fibrosis?

• No cure, will succumb to respiratory failure (inflm and inf)

• DNAase (reduce mucus stickiness)
o DNA released by dead cells in mucus, help reduce strands making it easier to mobilize

• Control infection (they tend to be major and persistent)
o Prophylaxis, and abx tx, not easy
• Diet mod and pancreatic E supplement
• Anti inflm and gamma globulins indications)


What is Respiratory Failure?

•No gaseous exchange
o Hypoxemia and Hypercapnea


Tx of Respiratory Failure

• Restore gas exchange eg:
o 02
o Bronchodilators ?? (based on cause)
o Mech ventilation`
o Abx?? (based on cause)


MNFTS of Respiratory Failure

Hypercapnia ( over 45mmHG)
Hypoxemia (under 60mmHG)
Resp Acidosis
MNFTS of Cause