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36 Cards in this Set
- Front
- Back
What is the most common obstructive lung disease?
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emphysema
**alveoli clump together **raspberry (healthy) vs. a grape (not healthy) |
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What are the obstructive lung diseases?
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-asthma
-chronic bronchitis -emphysema |
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What's the definition of emphysema?
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the abnormal permanent enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls and loss of lung elasticity
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What's the patho of emphysema?
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-tobacco smoke/air pollution/or alpha 1 antitrypsin deficiency
-breakdown of elastin in connective tissue of lungs -emphysema: destruction of alveolar septa, airway instability -airway obstruction, air trapping, dyspnea, frequent infections -abnormal ventilation-perfusion ration, hypoxemia, hypoventilation, right heart failure |
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What are causes of emphysema?
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-alpha 1 antitrypsin deficiency
-identical to bronchitis, but older onset -smoking (main cause) -air pollution -toxins |
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What's antitrypsin?
What does the deficiency mean? |
-antitrypsin is a protein which inhibits action of proteolytic enzymes (that digest alveoli)
-the deficiency means tissue destruction related to circulating alveolar digesting enzymes |
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Clinical manifestations of emphysema
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-dyspnea on exertion (shortness of breath while walking)
-barrel chest (AP diameter of chest) *upon looking at side view. looks normal looking straight on -accessory muscle use -chest breather -pursed lip breathing -cough -weight loss -distant heart and lung sounds (more distance between heart and lungs due to barrel chest) -hyperresonance to percussion -tripod stance (hunched over trying to breath) -"pink puffer": related to increase work of breathing (use up all their energy because they're working so hard to breath) |
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What is restrictive pulmonary disease?
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-decreased lung expansion due to alterations in lung structure
-decrease in total lung capacity (taking less air in) -difficult in INSPIRATORY phase (breathing in phase) |
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what are the types of restrictive pulmonary diseases?
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-intrapulmonary: atlectasis
-extrapulmonary: pleural effusions, pneumothorax |
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Intrapulmonary restrictive pulmonary disease
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-intrapulmonary (within): atelectasis: restricitive disease that invovles collapse of previously expanded lung tissue
-airless state of alveoli -small segment or entire lung involved -collapse of alveoli=lower gas exchange |
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Types and causes of atlectasis
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-most commonly seen in post-operative patients
-absorption atlectasis -compression atlectasis |
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Absorption atlectasis
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-results from removal of air from obstruction or hypoventiated alveoli
-obstruction of airways leading to alveoli collapse -mucous, retained secretions ***air into alveoli, air gets stuck, gas slowly leaks out. alveoli collapse due to not refilling alveoli, gas reabsorbed by body |
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Compression atlectasis
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-external pressure exerted by tumor, fluid, or air in pleural space or abdominal distention
**something pushing against lung causes it to collapse |
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Absorption atlectasis vs compression atlectasis
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-atlectasis caused by airway obstruction and absorption of the air
-atelectasis caused by compression of lung tissue |
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Patho of atelectasis (collapse of alveoli)
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1. decreased alveolar ventilation
2. lack of surfactant 3. lack of nitrogen |
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Patho of atlectasis
-decreased alveolar ventilation |
1. trapped air diffuses into pulmonary circulation without being replaced = alveolar shrinking and collapse
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Patho of atlectasis
-lack of surfactant |
2. surfactant is secreted by type 2 cells in the alveolar lining.
-surfactant normally decreases surface tension which facilitates alveolar opening and ventilation (more lubricated=alveoli are more open) -surfactant normally decreases surface tension -lack of surfactant increases surface tension causing alveoli to collapse |
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Patho of atlectasis
-lack of nitrogen |
-nitrogen gas maintains alveoli open at end-expiration
-lack of nitrogen = collapse of alveoli -high O2 concentrations will decrease alveolar nitrogen levels |
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Clinical manifestations of atlectasis
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-hypoventilation
-tachypnea -dyspnea/cough -crackles in lungs -tachycardia -hypoxemia -fever |
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Extrapulmonary-pleural effusions
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-presence of excess fluid within the pleural space
-not a disease, caused by a disease process |
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Patho extrapulmonary pleural effusions
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-decreased plasma oncotic pressure, increased capillary permeability, increased plasma hydropressure
-third spacing in pleural space -compression atlectasis, decreased ventilation but perfusion OK |
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Causes of pleural effusions (extrapulmonary)
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-increased capillary permeability
-decreased plasma oncotic pressure (caused by proteins in the blood. draws fluid in vessel from outside) -increased hydrostatic pressure (pushes fluid out of blood vessels into interstitial space) |
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Types of fluid with pleural effusions (extrapulmonary)
-exudate -transudate |
-exudate: high protein, cloudy, high WBC, hemothroax: bloody fluid around sac of lung, chylothorax: milky white fluid that contains lymph and fat (normally found in small intestine), gets through via fistula (small intestine fluid surrounding lung sac), emphyema: infected pleural infusion
-transudate: low protein, watery, low WBC, aka hydrothorax, clear fluid around lung |
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Clinical maifestations of pleural effusions (enxtrapulmonary)
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-mild to sever dyspnea
-pleuritic chest pain (hurts to breath due to rubbing together of spaces) -pleural friction rub -dull/flat percussion -decreased or absent breath sounds -fever |
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Extrapulmonary - pneumothorax
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-accumulation of air or gas in the pleural space, caused by rupture in the visercal pleura or parietal pleura and chest wall
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3 types of extrapulmonary pneumonthorax
1. open (communicating or primary) 2. closed (simple or secondary) 3. tension |
1. open (communicating or primary): air drawn in and forced out during expiration. air pressure in pleural space = barometric (outside) pressure (causes collapse). collapse due to negative pressure. gun shot or stab wound
2. closed (simple or secondary): intact chest wall. air enters from lung into pleural space. cause-->bleb on lung (blister on lung that pops and causes a hole in the lung) **air into pleural space, only a hole in lung, not the sac 3. tension: life threatening: site of pleural rupture acts as a one way valve. air enters upon inspiration but can't escape upon expiration. clinical manifestations: mediastinal shift and tracheal deviation are life-threatening (shifts to healthy side) **air in, air trapped going out, builds up and shifts, pleural sac in injured, not the lung |
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Patho of pneumothorax (extrapulmonary)
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-intrapleural space has a negative pressure (-5), helps to keep lung expanded
-when a break in intrapleural space occurs, air rushes in -intrapleural space becomes positive and lung collapses = barometric pressure |
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Causes of pneumothorax
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-spontaneous (bleb, rupture) --> young guys that are tall and skinny
-chest trauma with perforation of chest wall and/or lung (rib fracture, gunshot, stabbing) -COPD |
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Clinical manifestations of pneumothorax
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-chest pain
-shortness of breath, hypoxemia -decreased or absent breath sounds -diminished chest wall movement (especially on injured side) -hyperresonance to percussion |
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Hemothorax
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-type of pleural effusion
-excess blood in pleural space -causes: chest injury and damage to blood vessels -patho: hemorrhage into the pleural space associated with traumatic injury, surgery, or rupture of blood vessels |
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clinical manifestations of hemothorax
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-small amount of blood (<300cc) may cause no signs and symptoms. blood is reabsorbed
-large amount (>1500cc)may be life-threatening. hypovolemia and lung compression -dullness to percussion on affected side -decreased to absent lung sounds -tachycardia -hypotension and shock -decreased tactile fremitus (vibrations felt while talking) |
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Lung abscess
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-pus-containing lesion of the lung that forms a cavity
-cavity formed by necrosis of the lung tissues -causes: most commonly, aspiration into the lung of an organism that produces infection and necrosis of the lung tissue -clinical manifestations: foul smelling/tasting sputum, hemoptysis (blood in sputum), fever/chills, cough with purulent sputum (dark brown), pleuritic pain, dyspnea, dullness to percussion |
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Pulmonary embolism/infraction (PE)
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-obstruction of a branch of the pulmonary artery by a clot or plug of material that travels from one blood vessel to a small blood vessel (blocking blood supply to lungs. no perfusion taking place. higher VQ ratio--> more ventilation than perfusion)
-patho: blood clots that originate in the peripheral circulation and migrate to pulmonary circulation and get lodged (right sided heart failure) **D dimer-->higher level=blood clot indication. followed by tests like VQ scan, echo, ultrasound to see where blood isn't getting to. |
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Causes and clinical manifestations of pulmonary embolism (PE)
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-causes: blood clot from deep vein thrombosis (biggest cause), globule of fat, septic vegetation, foreign object, air, amniotic fluid
-manifestations: pleuritic pain, dyspnea/tachypnea, cough/hemoptysis, behaviors of right sided heart failure-->edema, organ enlargement, thick sputum, upright or leaning forward, pursed lip breathing, accessory muscle use, hyperresonance with percussion, distant breath sounds, increased BP, decreased O2, increased CO2, respiratory acidosis, metabolic acidosis |
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Pneumonia (respiratory tract infection)
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-patho: inflammation of alveoli and bronchioles
-causes: viruses, bacteria, gastric secretions via inhalation, aspiration, direct spread from infected site or blood -manifestations: coughing, sputum production, pleuritic chest pain, chills/fever, tachypnea, SOB, orthopnea, labored breathing, dullness to percussion, decreased breath sounds (in bases of lungs where infection is), low O2 and increased CO2 |
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Types of pneumonia (respiratory tract infection)
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-community: picked up from community
-noscomial: hospital/nursing home acquired -viral -mycoplasma -aspiration -opportunistic: immunocompromised people (cancer patients, people on steroids) |