Pulmonary Pathophysiology

Front 1

What is the most common type of pulmonary disesase?

Back 1

obstructive pulmonary disease

Front 2

What is the hallmark sign of obstructive pulmonary disease?

Back 2

increased airway resistance

Front 3

What also occurs from obstructive pulmonary diseases?

Back 3

impaired gas exchange and increased work of breathing

Front 4

What does trapping of air in alveoli distal to obstruction increase?

Back 4

increased RV and TLC

Front 5

What is a common symptom to see with obstructive pulmonary disease?

Back 5

wheezing is common and is a manifestation of turbulent air flow

Front 6

What does the pathophysiology of asthma include?

Back 6

airway inflammation and hyper-responsiveness

Front 7

In asthma, airway obstruction results from? (3)

Back 7

bronchiolar constriction, edema, and accumulation of secretions

Front 8

What can asthmatic episodes be precipitated by?

Back 8

1. Airborne substances
2. Ingestion of certain substances
3. Exercise; emotional excitement
4. Viral infections

Front 9

What occurs when asthma is caused by an allergic reaction?

Back 9

Binding of allergen to IgE antibodies on mast cells in the lung interstitium and elsewhere which causes degranulation of mast cells and release of inflammatory mediators, including histamine, leukotrienes, and prostaglandins

Front 10

What contributes to increased airway resistance? (3)

Back 10

bronchospasm, airway edema, accumulation of secretions in small airways

Front 11

What other activity may be involved?

Back 11

parasympathetic hyperactivity

Front 12

What occurs with parasympathetic hyperactivity?

Back 12

1. Vagal afferent nerves in the bronchi are sensitive to inhaled irritants and histamine
2. Reflex vagal efferent activity may contribute to bronchoconstriction

Front 13

In asthma, there is an increase in the?

Back 13

number of lung units with low VA/Q ratios leading to increased physiologic shunt and causes hypoxemia

Front 14

What else is likely to occur in an asthma attack?

Back 14

tachypnea, producing hypocapnia

Front 15

What would indicate a patient not tolerating the attack?

Back 15

normal of high arterial PC02, suggests the patient cannot maintain the increased work of breathing and that respiratory failure is imminent

Front 16

What is included in the classification for COPD?

Back 16

emphysema and chronic bronchitis

Front 17

Is COPD strongly associated with smoking?

Back 17

yes

Front 18

COPD is more prevalent in males or females?

Back 18

males

Front 19

Age and COPD?

Back 19

prevalence increases with age

Front 20

T or F. VA/Q inequalities develop with advancing age

Back 20

true (both shunt and alveolar dead space)

Front 21

How is emphysema characterized?

Back 21

destruction of the lung tissue, including elastic tissue and alveolar septa; alveolar coalescence occurs and bullae may be present

Front 22

What is emphysema caused by? (2)

Back 22

1. Smoking
2. Genetic alpha1-antitrypsin deficiency

Front 23

How does smoking cause emphysema?

Back 23

pulmonary neutrophil and macrophage infiltration and release of protease enzymes (eg, elastase) leads to breakdown of lung tissue

Front 24

How does genetic alpha-1- antitrypsin deficiency cause emphysema?

Back 24

increased activity of protease enzymes which essentially breaks down lung tissue

Front 25

In emphysema, loss of elastic tissue that supporst the smaller airways permits? trapping of air increases?

Back 25

premature collapse during expiration --- RV, FRC, TLC

Front 26

What causes loss of pulmonary capillaries in emphysema?

Back 26

alveolar septal destruction which leads to increased physiologic dead space; nonetheless, arterial P02 may remain normal or near normal and arterial PC02 is normal

Front 27

What occurs late in the disease process in emphysema?

Back 27

pulmonary hypertension and possibly right side heart failure

Front 28

What is classic of a patient with emphysema in regards to their breathing?

Back 28

dyspnea may prompt patients to purse their lips to delay small airway closure ("pink puffers")

Front 29

Chronic bronchitis can be caused by?

Back 29

chronic smoking, exposure to environmental air pollutants, recurrent pulmonary infections

Front 30

In chronic bronchitis, inflammation causes? (3)

Back 30

airway edema, goblet cell hyperplasia, and increased mucous secretion leads to obstruction and bronchospasm

Front 31

In chronic bronchitis, there is an?

Back 31

increased physiologic shunt (VA/Q) and hypoxemia

Front 32

Chronic hypoxemia is associated with?

Back 32

blue bloater syndrome

Front 33

Blue bloater syndrome includes? (3)

Back 33

erythrocytosis, pulmonary hypertension, and cor pulmonale

Front 34

What may develop in blue bloaters and chronic bronchitis?

Back 34

chronic hypercapnia

Front 35

If you have a patient with reactive airways, what should you administer?

Back 35

bronchodilatory therapy, beta-2 agonist, glucocorticoid

Front 36

Volatile agents produce?

Back 36

bronchodilation and humidification

Front 37

What is contraindicated if bullae are present?

Back 37

nitrous oxide

Front 38

When ventilating someone with obstructive airways, what should you set your vent settings to?

Back 38

lower ventilatory rate (8-10/min) with increased tidal volume (10-15mL/kg) to permit sufficient exhalation time; attempt to keep peak airways less than 40 cm H20

Front 39

Monitor the capnograph for?

Back 39

expiratory obstruction

Front 40

What may improve ventilation and oxygenation?

Back 40

PEEP

Front 41

Patients with preoperative FEV1/FVC ratio less than ____% or with preoperative arterial PC02 > ____mmHg will likely require?

Back 41

50%, 50, postoperative mechanical ventilation

Front 42

Restrictive pulmonary disease is characterized by?

Back 42

decreased lung compliance and reduced lung volumes; impaired lung expansion during inspiration, but normal expiratory flow rates

Front 43

Increased ______ _____ causes characteristic rapid, shallow breathing pattern

Back 43

compliance work

Front 44

Restrictive pulmonary disease includes both?

Back 44

extrinsic and intrinsic pulmonary disorders

Front 45

Acute intrinsic disorders is caused by?

Back 45

movement of intravascular fluid into the pulmonary interstitium and possibly alveoli

Front 46

What are some examples of acute restrictive disorders?

Back 46

pulmonary edema, infection pneumonia, aspiration pneumonitis, and ARDS

Front 47

Infectious pneumonia what happens?

Back 47

inflammation of the lung; some or all of alveoli become filled with fluid and blood cells

Front 48

Bacterial pneumonia is most often caused by?

Back 48

pneumococci infection

Front 49

What are the changes in pulmonary function in infectious pneumonia? (3)

Back 49

1. Decreased compliance
2. Reduction in diffusion capacity
3. VA/Q inequality (greatly increased shunt)

Front 50

Acute respiratory distress syndrome is also referred to as?

Back 50

permeability pulmonary edema, increased permeability of alveolar capillaries leads to pulmonary edema

Front 51

What happens in ARDS?

Back 51

inflammatory response (can by systemic) causes release of, or activation of, several mediators that increase capillary permeability

Front 52

What are some causes of ARDS?

Back 52

1. Sepsis and trauma are most common
2. Fat embolism, DIC, aspiration oxygen toxicity and smoke inhalation

Front 53

How are chronic intrinsic disorders characterized?

Back 53

by chronic alveolar inflammation and progressive fibrosis

Front 54

What are causes of chronic intrinsic disorders?

Back 54

drug toxicity (eg, BLEOMYCIN), idiopathic pulmonary fibrosis, and sarcoidosis

Front 55

Extrinsic disorders interfere with?

Back 55

normal lung expansion

Front 56

Extrinsic disorders include?

Back 56

pleural effusion, pneumothorax, mediastinal mass, kyphoscoliosis, neuromuscular disorders, pectus excavatum, obesity

Front 57

What are some anesthesia considerations in restrictive lung disorders?

Back 57

1. FRC is reduced -- anticipate rapid hypoxemia during apnea, even after preoxygenation with an Fl02 of 1.0
2. Compliance is reduced

Front 58

What predisposes a patient to high peak airway pressures?

Back 58

positive pressure ventilation

Front 59

How should you set vent settings for restrictive lung disease pts?

Back 59

lower tidal volume with increased rate

Front 60

Tuberculosis is caused by?

Back 60

infection with Mycobacterium tuberculosis

Front 61

In tuberculosis, what is the lungs response to infection?

Back 61

1. Macrophage infiltration--phagocytosis -- granuloma formation
2. Walling off of infected area by granuloma prevents spread of infection

Front 62

In a small fraction of individuals infected with M. tuberculosis what can occur?

Back 62

if the infection spreads and causes formation of large abscesses in the lungs and widespread fibrosis

Front 63

What are functional changes with advanced disease of tuberculosis?

Back 63

1. Increased work of breathing
2. Reduced vital capacity
3. Reduced diffusion capacity and VA/Q inequality

Front 64

Atelectasis

Back 64

collapse of alveoli; can occur in a localized area, in an entire lobe, or in an entire lung -- produces restrictive lung injury

Front 65

What is atelectasis most often caused by?

Back 65

airway obstruction or insufficient surfactant; occurs to some extent in nearly all patients under GA

Front 66

Airway obstruction can involve?

Back 66

obstruction of many small airways, or obstruction of a major bronchus

Front 67

What happens to air trapped distal to the obstruction?

Back 67

is absorbed and alveoli collapse (absorption atelectasis) -- facilitated by breathing high oxygen concentrations

Front 68

Insufficient surfactant is a characterstic of?

Back 68

infant respiratory distress syndrome (hyaline membrane disease)

Front 69

What happens when there is insufficient surfactant?

Back 69

increased surface tension causes alveolar collapse/filling with fluid

Front 70

Oxygen toxicity

Back 70

breathing high oxygen concentrations for many hours may cause restrictive lung injury

Front 71

What may occur in a person breathing 100% oxygen?

Back 71

absorption atelectasis