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44 Cards in this Set
- Front
- Back
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What is the main cause of COPD? |
Smoking |
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What kind of term in COPD? |
Umbrella terrm |
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What diseases does COPD include? |
Chronic bronchitis Emphysema |
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what does chronic bronchitis involve? |
Mucus hyper secretion in bronchial tree |
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What does the mucus hyper secretion cause? |
Airflow obstruction |
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Can bacteria make use of the mucus? |
Yes, colonise and make use of a glycoprotein |
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What is emphysema? |
Collagen and elastin in the lungs is digested away - increase of airspaces |
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What does emphysema cause? |
Airflow limitations and decreased gas transfer |
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What measurement is airway obstruction seen with? |
A reduced FEV1 and a reduced FEV/FVC ratio |
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What do we use to measure away limitation? |
Spirometry |
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Why does destroying alveoli cause small airways to collapse? |
Alveoli have attachment points to keep them open as small airways don't have cartilage |
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What is ventilation perfusion matching? |
The circulation can divert if (for example) pneumonia is in one area. |
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What are the two types of respiratory failure? |
Type 1 and type 2 |
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What is type 1 respiratory failure? |
Low pO2 |
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What is type 2 respiratory failure? |
Low pO2 AND high pCO2 |
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What is type 2 due to? |
Poor/under ventilation due to central obstruction, mechanical failure, central loss of drive, chronic lung disease etc |
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Why is giving a patient too much oxygen risky? |
PC will immediately switch off but the CC can't do anything quickly due to the disease so the patient will stop breathing as CO2 increases and suppresses the central drive. |
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Why do lung transplants have the least success? |
Most susceptible to airborne infections |
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What percentage of people develop chronic rejections (alloimmune injury) within 3 years? |
50% |
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What is the pathway of non-alloimmune injury to lung transplants? |
Aspiration --> epithelial damage --> airway remodelling --> fixed airflow obstruction |
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What is aspiration involved with? |
Gastric contents into the lungs |
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What does airway remodelling cause? |
Structural changes and inflammation |
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What are 4 methods of detection in the lungs (4B's)? |
1) Bronchoscopic surveillance 2) Bronchoalveol-lavage (BAL) 3) Biopsies 4) Brush cultures |
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What does BAL involve? |
'A wash' - can count cells and solutes in the airway |
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What can you do to biopsies? |
Stain them for inflammatory cells |
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What are allograft airways vulnerable to? |
Gastro-Oesophageal reflux and aspiration |
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What can aspiration lead to? |
Inflammation, epithelial damage and fibrosis |
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What do allograft people get given? |
A proton-pump inhibitor |
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What does the proton-pump inhibitor do? |
Stops acid secretion |
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However, what is the problem with this? |
You can still be aspirating, but just don't have the symptoms of aspiration (hidden) |
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What is a technique or looking at aspiration? |
Using a catheter in the oesophagus |
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What is the keyhole surgery used to tighten up the lower oesophageal sphincter? |
Fundoplication |
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What is the chronic injury or allograft known as? |
BOS = bronchiolitis obliterates syndrome |
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What does BOS lead to? |
Loss of lung function |
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What does early fundoplication prevent? |
Chronic allograft dysfunction |
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What is present in BAL samples in allografts that is evidence for hidden aspiration? |
Pepsin |
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What is pepsin? |
A gastric acid protease |
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What do proteases do to the lungs? |
Digest them |
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What cytokine is produced by injured epithelial cells? |
IL-8 |
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What does IL-8 bring in to the lungs? |
Neutrophils |
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What do neutrophils have that destroy the collagen type-4 holding the epithelium? |
MMP-9 (= collagenase) |
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What else is present in neutrophils that destroys the elastin of the lungs? |
Elastase |
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What is an antibiotic used to 'reverse airflow obstruction in BOS'? |
Azithromycin |
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Is azithromycin anti-inflammatory? |
Yes, and it helps gastric motility |
