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29 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Diseases grouped by "Chronic obstructive pulmonary disease"
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Chronic Bronchitis
Emphysema Asthma Bronchiectasis Confusing Term/Don't Use It |
Four
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COPD Diseases
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Chronic Bronchitis
Emphysema |
Two
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Cause of obstruction in COPD
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Chronic Bronchitis - edema, necrosis, firbrosis due to infection in bronchial tree
Emphysema - loss of lung's elastic recoil, small airways collapse during forced expiration |
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COPD Causes
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Cigarettes & alpha-1 antitrypsin deficiency (may also show liver cirrhosis)
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What's in a smoker's lungs?
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Tobacco & carbon pigments, Loss of ciliary motion, Goblet cell proliferation,
Thickened basement membrane, Increased macrophages with impaired abilities, Increased elastase production, Squamous metaplasia, Destruction of alveolar walls |
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Emphysema Diagnosis
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PFTs with prolonged time required for full forced exhalation in absence of asthma
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Forms of Emphysema
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Centrilobar & Panlobar, all look the same by the time its symptomatic
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Two
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Emphysema Pathogenesis
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PMNs, monocytes, & pancrease?, create elastases. Cigarette smoking brings lots of PMNs to lungs, Elastase damages elastic fibers of lungs
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Pink Puffer vs. Blue Bloater
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Pink Puffer - Hypercarbic drive, struggles, keeps some air in to keep lungs from collapsing, puffs chest out (barrel chested), small breaths, purses lips, puts muscle into it, emphysema
Blue Bloater - Lost hypercarbic drive, cyanotic, happier, doesn't struggle, cor pulmonale, much sputum production, chronic bronchitis |
Puffer is Buffer
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Blebs
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Bullous emphysema, little or no lung tissue, may rupture causing pneumothorax
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Other forms of emphysema*
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Paraseptal
Compensatory - misnomer, after removal of lung lobe Irregular/Tractional - misnomer, after scarring Senile - old age Interstitial Emphysema - air pushed into fibrous tissues, listen for MILKMAN's CRUNCH |
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"Reid Index"
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Ratio of thickness of submucosal mucous glands to entire submucosa, Normal up to .4, increased in chronic bronchitis
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Chronic Bronchitis Findings
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Tolerance for hypercarbia, copious secretions even in absence of pneumonia
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Why is there smooth muscle in bronchi?
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To help get irritants out. Cough!
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Bronchial Asthma smooth muscle effect
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Small bronchi are abnormally responsive to stimuli causing contriction OR inflamed OR both
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What STD may be related to asthma?
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Chlamydia
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Mast Cell factors affecting bronchoconstriction
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histamine, bradykinin, leukotrienes, prostaglandins
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Asthmatic triggers
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Type I hypersensitivity IgE
Viral Infections Pollution Cigarette smoke Inhaling heroin Strong odors Aspirin (and other NSAIDS) Stress Exercise (especially in cold) Gastric acid reflux |
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Allergic Asthma
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IgE mediated hypersensitivity, Leukotrienes effect important here
Often have "Charcot-Leyden" crystals in sputum & Curschman's spirals |
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Idiosyncratic asthma
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due to ASA, tartrazine yellow, COX inhibitors
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Asthma remodeling
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Thickened basement membrane
Smooth Muscle hyperplasia Increased goblet cells |
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Asthma treatment
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Mainstay - inhaled glucocorticoids, which prevent pathology and cause eosinophil apoptosis
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Bronchiectasis Definition and Bronchial Effect
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Permanent cylindrical dilation and ulceration of the bronchial tree, as ulcer heals, it scars, scar contracts and pulls bronchi wide
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Clincial symptoms Brochiectasis
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Chronic cough, lots of sputum
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Bronchiectasis causes
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following infection (whooping cough)
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Sleep Apnea Cause and Symptoms
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Uvula blocks airway of sleeping patient, patient snores, may be overweight or drink a lot, may have a thick neck, sleeps in supine position
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Sleep Apnea Clinical Presentation
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Deterioration of patient (hypothyroidism & down's syndrome)
Morning headaches Patient believes he/she is getting 8 hours of sleep "narcolepsy" |
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Sleep Apnea Treatment and Diagnosis
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Sleep clinic - polysomnography
Sleep on side Protriptyline - drug Remove uvula/tonsils CPAP Tracheostomy |
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Pickwickian Syndrome
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Severe sleep apnea resulting in loss of hypercarbic drive, obese patients
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