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Patho Final-- Chapter 26
alterations in pulmonary function
70
Pathology
Undergraduate 2
12/12/2010

Additional Pathology Flashcards

 


 

Cards

Term
Asthma
Definition

- An obstructive disorder
- Features chronic inflammation of the airways and is characterized by recurrent episodes of:

wheezing

breathlessness

coughing and

chest tightness

Term
COPD
Definition

Chronic Obstructive Pulmonary Disorder--

 

Pathologic lung changes characteristic with Emphysema or Chronic Bronchitis

Term
Hemoptysis
Definition

coughing up of blood or bloody secretions;

 

(usually indicates local infecction or inflammation that damages bronchi or lung parenchima w/ rupture of pulmonary blood vessels)

 

Most common causes:

Bronchiectasis

Lung Cancer

Bronchitis

Pneumonia

Term
Cyanosis
Definition

Bluish discoloration of the skin and mucous membranes caused by increaing amounts of desaturated hemoglobin in the blood

 

Causes:

Low PaO2

Pulmonary/Cardiac right-to-left shunts

Decreased Cardiac Output

Cold Environments

Term
Clubbing
Definition

Bulbous enlargement of the end of a finger that is commonly associated with diseases that interfere with oxygenation

 

Conditions that manifest with clubbing:

lung cancer

bronchiectasis

cystic and pulmonary fibrosis

lung abscess

congenital heart disease

 

Term
Hypercapnia
Definition

increased CO2 in the arterial blood; PaCO2 > 45 mmHg

 

caused by hypoventilation-- usually result of decreased drive to breath or inadequate ability to respond to ventilatory stimulation.

Term
ABG
Definition

Arterial Blood Gas--

Measures:

PaO2

PaCO2

HCO3

pH

oxygen content & saturation

 

Term
Hypoxemia
Definition

reduced oxygenation in the arterial blood;

PaO2 < 80 mmHg at sea level

 

is caused by respiratory alterations

Term
4 main causes of Hypoxemia
Definition

↓ed PIO2

 

Hypoventilation

 

Alveolocapillary diffusion abnormality

 

V/Q mismatch ** (most important)

Term

Acute Respiratory Failure

 

Definition

inadequate gas exchange where PaO2 is less than or equal to 60 mmHg / PaCO2 is greater than or equal to 50 mmHg

 

Type I- (most common type) is called hypoxemic resp. failure and is characterized by a PaO2 <60 w/ a normal or low PaCO2; is the result of inadequate O2 exchange b/t alveoli and pulmonary capillaries

 

Type II- hypercapnic respiratory failure = PaCO2 > 50

Is the result of inadequate alveolar ventilation

Shows: ↓ PaO2 and pH

Term
Pulmonary Edema
Definition

excess water in the lung

 

3 main causes:

Heart disease (most common cause)

Capillary injury

Obstruction of lymphatic system

 

(I feel like it would be a good idea to look over Dolan's flowchart for the pathogenesis of pulmonary edema)

Term

Clinical Manifestations of pulmonary edema

 

Definition

dyspnea

orthopnea (dyspnea when lying down)

hypoxemia

increased work of breathing

Term
Aspiration
Definition

passage of fluid and solid particles into the lung;


clinical manifestations:

sudden onset of choking

cough w/ or w/o vomiting

dyspnea

wheezing

Term
Atelectasis
Definition

collapse of lung tissue

2 types:

compression- external pressure collapses alveoli

 

absorption- caused by removal of air from obstructed or hypoventilated alveoli or inhalation of concentrated oxygen or anesthetic agents

 

clinical manifestations=

dyspnea, cough, fever, leukocytosis

Term
Bronchiectasis
Definition

persistant abnormal dilation of the bronchi

 

is often assoc. with recurrent lower resp. tract infections (bronchitis) and has similar symptoms; coughing up of large amounts of sputum

 

Term
Bronchiolitis
Definition

inflammatory obstruction of the bronchioles; more common in children; usually accompanies chronic bronchitis in adults

 

clinical manifestations

wheezing d/t bronchospasm

tachypnea

use of assessory muscles

low-grade fever

nonproductive cough

hyperinflation

Term

Pneumothorax

 

Definition

presence of air/gas in the pleural space caused by a rupture of the visceral pleura or a rupture of the parietal pleura/chest wall; it removes fluid surface tension b/t the lungs and chest wall

 

types=

Traumatic; Tension; Spontaneous: primary or secondary

Term
Pleural Effusion
Definition

presence of fluid in the pleural space; can cause compression atelectasis

 

Types:

Transudative- watery fluid that diffuses out of capillaries beneath pleura

 

Exudative- fluid rich in proteins that migrates from capillaries

 

Hemothorax- hemorrhage into pleural space

Term
Empyema
Definition

infected pleural effusion (pus in pleural space)

 

pulmonary lymph vessels become blocked --> infection with debris accumulating in pleural space

Term
Pleurisy
Definition

inflammation of the pleura;

 

clinical manifestations: chills, fever, pain on inspiration

a pleural friction rub may be heard over affected area

 

pleurisy is usually preceded by an upper resp. infection

 

Term
Flail Chest
Definition

results from the fracture of several consecutive ribs in more than one place

 

causes paradox movement of the chest wall w/ inspiration and expiration

Term
Inhalation Disorders
Definition

are the result of exposure to toxic gases

 

Examples:

Pneumoconiosis

Allergic alveolitis

Term
Pneumoconiosis
Definition

disease of the lungs caused by habitual inhalation of inorganic dust particles

 

Deposition of particles --> chronic inflammation with scarring of the resp. membrane --> pulmonary fibrosis

 

disease frequently seen in miners or stonecutters (is an occupational disorder)

Term
Allergic alveolitis
Definition

allergic inflammatory response to inhalation of organic dust particles (grains, bird poop, silage)

 

can be acute or chronic-- with continued exposure, the disease becomes chronic --> pulmonary fibrosis

 

Term

Restrictive Diseases resulting from alterations in the

lung parenchyma

Definition

ARDS

 

IRDS

 

Pneumonia

 

 

Term

Restrictive diseases caused by changes in the:

a. pleura

b. chest wall

c. neuromuscular apparatus

Definition

a- pneumothorax

 

b- flail chest

 

c- myasthenia gravis

Term
Restrive Disorders
Definition

characterized by:

reduced lung volumes

reduced compliance

 

(reduced compliance representa and increase in overall stiffness of the lungs)

 

Term
ARDS
Definition

suddenly occuring, severe form of respiratory failure characterized by inflammation and diffuse alveolar-capillary injury

 

hallmark= hypoxemia that doesn't respond to supplemental oxygen therapy

Term
4 main pathological processes that go with ARDS
Definition

Noncardiogenic pulmonary edema

 

atelectasis

 

fibrosis

 

pulmonary hypertension

Term
ARDS: alterations in PFTs and Clinical Manifestations
Definition

PFTs- ↓ VC, ↓ FRC, ↓compliance, ↓tidal volume

 

Manifestations:

Tachypnea-- restrictive pattern

respiratory alkalosis

marked dyspnea

↓d lung compliance

refractory hypoxemia -- hypoxemia is unresponsive to Tx

diffuse alveolar infiltrates that are seen on X-ray

Term
Physiological importance of surfactant
Definition

it reduces the work of breathing by ↓ing surface tension-- less pressure is needed to inflate an alveolus to a given radius

 

it prevents the collapse of smaller alveoli-- allows surface tenstion to become reduces as lung volume decreases

Term
IRDS
Definition

caused by inadequate pulmonary surfactant- an L/S ratio <2.1 is assoc. with a higher risk of IRDS

 

In premature infant, lack of pulmonary surfactant causes:

atelectasis and increased work of breathing

 

end results of increased work of breathing and ↓d ventilation are:

progressive atelectasis

increased pulmonary vascular resistance

profound hypoxemia

acidosis

Term
Pulmonary Fibrosis
Definition

excessive amount of fibrous/connective tissue in the lung

 

is marked by a ↓d lung compliance

Term
Obstructive lung diseases
Definition

classified based on site of obstruction--

 

w/in luminal wall = asthma; chronic bronchitis

 

increased pressure around the outside of lumen= emphysema secondary to loss of lung tissue&elasticity

 

obstruction in airway lumen-= cystic fibrosis

Term
Asthma
Definition

one of the most common obstructive diseases; characterized by:

reversible obstruction

airway inflammaation

airway hyperresponsiveness

 

common triad that cause an episode: bronchoconstriction, excessive mucus prod., swelling of bronchial mucosa

 

common features of an episode: wheezing, breathlessness, chest tightness, coughing

Term
Types of Asthma
Definition

Intrinsic

Extrinsic

Exercised-induced

Occupational

Drug-induced

Term

Asthma spirometry

 

Asthma blood gases

Definition

↓d: Expiratory flow rate, FEV1, FVC, FEV1/FVC

 

Increased: FRC and TLC

 


blood gases show hypoxemia with early resp. alkalosis or late respiratory acidosis

Term
COPD
Definition

lung changes consistent with empysema or chronic bronchitis; 4th leading cause of death in US (prevalence and mortality have been increasing over past 30 yrs)

 

risk factors: primarily caused by cig. smoke, genetics, air pollution, occupational exposures

Term
Chronic Bronchitis
Definition

inflammatory disorder of the airways; most commonly results from long-term smoking; damage is irreversible

 

is a chronic productive cough that lasts at least 3 months of the year for at least 2 consecutive years

 

assoc. with persistent narrowing of the airways d/t chronic inflammation, scarring, and excessive mucus production-- is not d/t bronchospasm like asthma

 

 

Term
Clinical Manifestations of Chronic Bronchitis
Definition

↓d exercise tolerance

wheezing

SOB

productive cough

airway obstruction (seen by ↓d FEV1)

Term
Emphysema
Definition

results from destruction of alveoli and small airways (no obvious fibrosis); risk factor= smoking; marked by a loss in elastic recoil

 

Obstruction is d/t changes in the lung tissue, not changes d/t mucus production (like asthma/chronic bronchitis)

 

 

Term
Cystic Fibrosis
Definition

Autosomal recessive disorder of exocrine glands & mucus cells;

 

most common genetic lung disease in US

 in the disease, thick mucus secretions cause:

airway obstruction

atelectasis

air trapping

 

Typical features= mucus plugging, chronic inflam., and infection; progressive ↓ in functional lung tissue


Term
Pneumonia
Definition

inflammation of the lung; lower resp. tract infection;

may be bacterial or viral (coughing is nonproductive in viral pneumonia)

 

8th leading cause of death in US; most common cause of death d/t infectious disease;

Term
Risk factors for pneumonia
Definition

advanced age

immune deficiency

underlying lung disease

alcoholism, smoking

altered consciousness

malnutrition

endotracheal intubation

immobilization

Term
Types of Pneumonia
Definition

Community Acquired-- Streptococcus pneumonia is the most common pneumonia-causing bacteria; Mycoplasma is common in young people; Haemophilus influenzae is most common viral form in adults

 

Nosocomial

 

Immuno - compromised individuals

Term
Clinical Manifestations of pneumonia
Definition

upper resp. infection --> productive cough, dyspnea, fever

may have chills, malaise, and pleuritic chest pain

 

4 stages: congestion; red hepatization (from RBC in alveoli); gray hepatization (from WBC in alveoli); resolution

 

(hepatization = conversion of loose tissue into a firm mass)

Term
Tuberculosis
Definition

lung infection caused by Myobacterium tuberculosis

leading cause of death from a curable infectious disease in the world

Term
Acute Bronchitis
Definition

self limiting, acute infection/inflammation of the airways; most cases are caused by viruses

 

clinical manifestations:

fever, cough, chills, malaise

Term
Pulmonary embolism
Definition

obstruct BF through part of the pulmonary system; can cause right ventricular HF;

emboli may be compased of fat, air, amniotic fluid, or thrombi (thrombi are th emost common cause)

 

is suspected with sudden dyspnea and chest pain

dyspnea is the most common symptom

 

predisposing factors (Virchow triad):

venous stasis/slow BF (immobility, HF)

hypercoagulability (pregnancy, cancer, estrogen use)

damage to venous intima (trauma)

 

Term
Pulmonary Hypertension
Definition

a sustained increase in pulmonary arterial pressure

(>30 mmHg)

Primary: rare; no known cause; usually occurs in women aged 20-40

 

Secondary: caused by any respiratory/cardiovascular disorder that: increases the V or P entering pulm. arteries or narrows/obstructs the pulm. arteries

 

 

 

Term
4 main causes of secondary pulmonary HTN
Definition

1. elevated L ventricular filling pressures (CHF)


2. Increased BF through pulmonary circulation (right-to-left shunt)


3. obstruction of pulmonary vascular bed by embolus or by chronic destruction of alveolar wall (emphysema)


4. vasoconstriction of vascular bed (occurs w/ acidosis, hypoxemia, or a combo of the 2)


most common cause= hypoxic vasoconstriction seen in COPD

Term
Cor Pulmonale
Definition

right ventricular hypertrophy and dilation d/t pulmonary HTN-- caused by primary disorders of the lung parenchyma or vasculature

 

usually leads to R sided HF when pulmonary artery pressure =s sytemic BP

Term
4 types of lung cancer
Definition

Large cell carcinoma

 

small cell carcinoma

 

squamous cell carinoma

 

adenocarcinoma

Term
Lung Cancer
Definition

smoking is #1 cause

 

manifestations:

cough, hemoptysis, hoarseness,

chest pain, pleural effusion

Term
Cardiac causes of pulmonary edema
Definition
[image]

The hydrostatic pressure leads to fliud leakage into the pulmonary interstitiuim. The lymphatic system eventually loses the ability to remove the fluids and thus edema occurs
Term
[image]
Definition
lung with chronic bronchitis
Term
[image]
Definition
lung with emphysema
Term
[image]
Definition
lung with asthma
Term
Signs and symptoms of pulmonary disease
Definition
Abnormal breathing patterns (restrictive/obstructed pattern tachypnea, hyperpnea); abnormal sputum

Chest pain; cyanosis; clubbing; coughing

Dyspnea

hypoventilation/hyperventilation; hemoptysis
Term

Hypoxemia caused by decreased F1O2

Definition

high altitude

 

low O2 content of gas mixture

 

enclosed breathing spaces (suffocation)

Term
Hypoxemia caused by hypoventilation
Definition

lack of neuro stim. of the respiratory center

(oversedation; drug overdose; brain damage)

 

Diseases that restrict chest expansion

 

COPD

Term
Alveolocapillary diffusion abnormality
Definition

common clinical causes:

Emphysema

Fibrosis

Edema

Term
V(A)/Q mismatch: common clinical causes
Definition

Asthma; chronic bronchitis

Pulmonary edema

Pulmonary embolism

Pneumonia

ARDS/IRDS

Atelectasis

Term
4 main categories of Lung Diseases
Definition

Restrictive-- marked by a loss of lung compliance

ARDS/IRDS, pulmonary fibrosis, pneumonia, TB, pleural effusions, SARS, pneumothorax

 

Obstructive- marked by increase in resistance to airflow (Raw); airway obstruction that is worse with expiration; Asthma, chronic bronchitis, emphysema

 

Infectious- pneumonia, tuberculosis, acute bronchitis

 

Vascular- pulmonary HTN, pulmonary embolism, cor pulmonale

Term

Obstructive Disease

 

Definition

with this type of disease more force is required to expire a given volume of air, or emptying of the lungs is slowed, or both.

 

unifying sign of Obstructive disease= wheezing

unifying symptom= dyspnea

Term
How heart disease causes pulmonary edema
Definition

(most common cause)

1. L ventricular HF causes increased filling pressures on L side of heart --> increased pulmonary hydrostatic pressure

2. Fluid moves out of the pulm. capillaries into pulm. interstitium when pulm. hydrostatic pressure > oncotic pressure

3. fluid volume entering interstitium > lymph system's ability to remove it, causing Pulm. Edema

Term
How capillary injury causes Pulmonary Edema
Definition

1. injury increases capillary permeability

2. Plasma proteins leak out and increase the interstitial osmotic pressure

 

examples that involve capillary injury:

ARDS; inhalation of toxic gases

Term
OxyHb dissociation curve: factors causing increased affinity for O2
Definition

increased pH

decreased temperature and PCO2

carboxyHb

abnormal Hb

lower levels of 2,3 DPG

Term
OxyHb Dissociation Curve: factors decreasing Hb affinity for O2
Definition

Decreased pH

Increased temp and PCO2

High levels of 2,3 DPG

Abnormal Hb

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