Flashcards
Respiratory System
Cards in this deck (148)
- 1Overview• Ventilation (V) – air movedin & out of lungs to facilitate exchange of
O2/CO2betweenenvironmentand air sacs (alveoli);
• Exchange takes place by process of diffusion across pulmonary capillaries;
• rate is proportional to metabolic requirements. - 2Perfusion(Q)• each air sac is covered in a coat if capillaries to allow blood gas exchange
- 3V without Q• Dead space
- 4Q without V• Shunt
- 5Respiratory dysfunction• Problem occurs with either
⇒ Oxygenation process
⇒ Ventilation process - 6Repiratory failure typesType 1 or Type 2
- 7Type 1• Hypoxia with normal/lowCO2
• Mainly due to V/Q mismatch - 8Cause of type 1pneumonia,pulmonary oedema, asthma, emphysema, PE,
congenital heart disease - 9Type 2• Hypoxia with hypercapnia (high CO2)
• Due to alveolar hypoventilation+/-V/Q mismatch - 10Cause of type 2• Pulmonary – COPD, asthma, pulmonary fibrosis, obstructive sleep
apnoea
• Central – reduced respiratory drive(e.g., drugs)
• Neuromuscular– GBS, polio, cord lesion
• Chest wall abnormalities - 11Features of respiratory failure• Thoseof causative illness (e.g.,asthma)
• Hypoxia: short of breath, restlessness, confusion, agitation,
Central cyanosis,“BLUE BLOATER”
⇒ Can develop:pulmonary hypertension,cor pulmonale,polycythemia
• Hypercapnia: headache,bounding tachycardia,peripheral dilatation
” PINK PUFFER”
⇒ Can develop:drowsiness, coma - 12Diagnose• Bloods (esp. ABGs), x-rays, cultures,spirometry
- 13Management• Treat cause
• O2 therapy (with care in type 2 failure) - 14Dyspnoea• Awareness of breathingdifficulty
• +/- awareness of muscleeffort to expand chest
• +/-awarenessof effort to exhale
• +/- respiratorymusclefatique - 15Physiologic• exertion
• hypoxia (altitude)
• high CO2 - 16Pulmonary• restriction,
• obstruction
• failure of V&/or Q - 17Cardiacpulmonary congestion
- 18Haematological• anemia
- 19Biochemicalacidosis
- 20Pain• often inspiratory
⇒ pleuritis
⇒ tracheitis - 21Wheeze• soft expiratory whistle, often musical, due to obstruction
- 22Stridor• coarse, inspiratory noise, upper airway obstruction
- 23Cough• sudden explosive expiratory manoeuvre that tends to clear material from the airways
- 24Haemoptysis• coughing up of blood/blood stained mucous
- 25Asthmafollowing
- 26Definition• Disease characterised by episodic, diffuse airway inflammation and hyperreactivity
- 27Results in• reversible airway obstruction
- 28Incidence• Affects 10% of population
• Attacks triggeredby a variety of stimuli - 29Symptoms• Dyspnoea
• Cough
• Wheeze
• Sputum - 30Pathophysiology• Airways are hyperresponsiveto various triggers, mast cells and
Eosinophils activate - 31Features• Three features combineto cause result and airways narrowing
⇒ Contraction of smooth muscle in bronchial walls
⇒ Oedema/inflammation of bronchial walls
⇒ Excess mucous production - 32Mild/moderate symptoms• Wheeze
• Cough
• Increased respiratory rate
• Tachycardia
• Upright posture - 33Moderate/severe symptoms•In addition to mild/mod symptoms
⇒Recession
⇒Use of accessory muscles
⇒inability to speak
⇒Cyanosis
⇒Decreased breath sounds (“silent chest”) - 34Accompanied• V/Q mismatch causes arterial hypoxaemia & hyperventilation
• As the attack progresses,the patient’s capacity to compensate by hyperventilating unobstructed areas of lung
• is further impaired by more extensive airways narrowing &
muscle fatigue - 35Basics of management• Assessseverity
• Education
• Trigger avoidance
• Monitoring(self, clinical)
• Developmentof personalised AsthmaAction Plan - 36Treatment• Determined by severity& frequency of attacks
• Medications divided into preventers& relievers - 37Preventers• Inhaled corticosteroids
• Leukotriene antagonists
• Mast cell stabilisers - 38Relievers (bronchodilators)• B-agonists (SABA & LABA)
• Anticholinergics
• Methylxanthines no longer in widespread use,but may still have rolein treatment of status asthmaticusin some patients - 39Chronic obstructive pulmonary diseaseCOPD as following
- 40Definition• Chronic, progressiveairways obstruction with little or no reversibility
• Fourth main cause of mortality in Australia - 412 types• Frequently co-exist
• Chronicbronchitis(clinicaldiagnosis)
• Emphysema(histologicaldiagnosis) - 42Causes• SMOKING
• Genetic (alpha-1-AT deficiency)
• Occupational - 43Development• Presents as a slow progression of exertional dyspnoea &
disability,
• punctuated by acute symptomatic exacerbations
• (either infective or non infective) - 44Diagnosis• clinical
• x-ray
• spirometry - 45Clinically• Typically middle aged
• Hyperinflated chest
• +/- wheeze
• Pursed lips (pink puffer)
• Cyanosed(blue bloater) - 46X-ray• Normal
• Hyperflation
• Infection
• Bullae - 47Spirometry• Obstructive pattern
• Little reversibility - 48Emphysema•Enlargement of terminal air spaces ( distal to terminal bronchioles)
• Accompanied by destructive change in alveolar walls - 49Chronic bronchitisas following
- 50dEfinition• chronic cough & sputum production most days for 3/12 in 2
consecutive years - 51Cause• chronic mucous hypersecretion
• and hypertrophy of mucous membranes of airways - 52Management• Confirm diagnosis
• Optimise function
• Prevent deterioration
• Develop support
• Manage exacerbations - 53Optimise function by• Stop smoking
• Exercise
• SABA, anticholinergics,ICS
• Chest physio - 54Obstructive sleep apnoeaas following
- 55Definition• Intermittent closure of pharyngeal airways that cause
• episodes of apnoea during sleep
• (note that not all sleep apnoea is obstructive) - 56Presentation• Snoring
• Day-time somnolence
• Waking unrefreshed
• +/- decrease in cognitive functioning libido& mood - 57Complications• Increased risk stroke, hypertension, vascularevents
• Pulmonary hypertension
• Type 2 respiratory failure - 58Diagnosis• Sleep studies
• Measure RR, O2 saturation, airflow at nose and mouth, chest wall
• movement, limb movements etc.
• Severeif AHI >30 (apnoeas or hypopnoeas/hour) - 59Treatment• Weight loss
• Splint (e.g.,mandibular advancement)
• CPAP
• Surgery - 60Lower respiratory tract infectionas following
- 61Definition• Acute infection of lung parenchyma (alveolar & interstitial tissue)
• Generally associated with fever and often CXR signs - 62Classification• Lobar
• Segmental
• Bronchopneumonia
• Interstitial - 63Clinical features• Fever,
• cough,
• sputrum,
• haemoptysis,
• dyspnoea,
• pleuritic pain - 64Diagnosis• clinical
• cultures
• x-ray
• serology - 65Pneumoniaas following
- 66Aetiologybacterial
viral (primarily kids)
fungal - 67BActerial typical• Strep (Pneumococcus)
• Staph
• Haemophilus - 68Bacterial AtypicalMycoplasma
• Legionella
• Mycobacterial(TB) - 69Viral (especially kids)• Influenza
• RSV
• Adenovirus - 70Risk factors• URTI/agent exposure
• Institutionalisation (HAP)
• Debility
• Smoking
• Decreased level of consciousness
• Immunosuppression
• Swallowing difficulties(aspiration) - 71Ayptical pneumonia: Legionnaire’s diseaseas following
- 72Definition• Legionella pneumophilia identified in 1976 with outbreak of acute
respiratory illness in American army veterans.
• Bacteria colonises water tanks <60ºC (such as hotel air conditioners and hot-water systems) - 73Outbreak• Sporadic
- 74Presentation• with fever, malaise, myalgia & headache, dry cough
- 75Risk• Can progress to pneumonia, GIT symptoms, renal failure,hepatitis and coma and death
• 10% mortality, even with treatment - 76Diagnosis• serology, antigen in urine, CXR – bibasal consolidation
- 77Treatment• Azithromycin or doxycycline
- 78Atypical: mycoplasma pneumonia•Mycoplasma pneumoniae common cause in 5-35yo
• Epidemics common(e.g., schools,military – close contact spread) - 79Symptoms• Presents with flu-like illness of dry cough, myalgia, arthralgia and headache
• Can develop rash, severe pneumonia, haemolytic anaemia,
• Guillain-Barre Syndrome & meningo encephalitis - 80Diagnosis• serology,x-ray – bilateral patchy consolidation
• out of keeping with clinical presentation - 81Treatment• macrolides, tetracyclines
- 82Tuberculosisas following
- 83Definition• Leading cause of death due to infectious disease world wide
(includingHIV TB) - 84Cause of infection• atypical Acid Fast Bacillus (AFB), Mycobacterium tuberculosis,
• can affect any part of the body,
• but usually the lungs is the primary site (othercommonsites are gut and lymph nodes) - 85Pulmonary tuberculosis• primary infection is not usually very severe
- 86Presentation• Fever
• Nightsweats
• Persistentcough
• Hoarseness
• Haemoptysis
• Chest pain – pleuritic
• Weightloss
• Anorexia
• Fatigue - 87Pimrary TB• Generally mild inflammatory reaction at infectionsite (e.g.,subpleural,pharynx or ileum)
• May get spread to regional nodes(e.g., hilar,cervical or mesenteric)
• Characteristics eating granuloma appears at thesesites with the
Development of “tuberculin”sensitivity
• “Primary complex”often heals with fibrosis and calcification with
out any treatment leaving the bacterium encapsulated in tubercles - 88Secondary TB• Occursin previouslysensitisedindividuals
• Reactivation/reinfection results in immediate granulomatous
Response with localisation –
• lymph node involvement uncommon - 89Granuloma may then• Heal
• Rupture into bronchi– TB pneumonia
• Rupture into blood vessel– miliary spread - 90Diagnosis• Suspect in high risk groups (immigrants,ATSI)
• CXR (may be incidential)
• Sputum culture AFBs
• Skin testing – does NOT indicate activity - 91Treatment• Failure rate if drug sensitive<1%
• 1% multi-drug resistant
• 5 year relapse rate<5% - 92Multiple drug regimen• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol - 93Treatment• Treat6-12/12
• Monitor weight, renal function, liver function, vision - 94Bronchiectasisas following
- 95Definition• Irreversible focal bronchial dilatation caused by
• inflammation & chronic infection
• can be diffuse or focal - 96Diffuse tends to occur in• Immunocompromise
• Genetic defects (e.g.,cystic fibrosis) - 97Aetiologyevere pneumonia(e.g., Staph)
• Measles/pertussis
• Foreign body
• Tumours
• CF - 98Presentation• Chronic cough
• Purulent sputum
• +/- SOB , fever & haemoptysis
• Bronchial wall shows extensive destruction,
• inflammation,
• increased mucous and loss of cilia - 99Diagnosis• clinical features and RFs
• x-ray
• CT - 100Treatment• Anitbiotics (culturs important )
• Physiotherapy
• Surgery - 101Cor pulmonaleas following
- 102Definition• Right ventricular enlargement & right heart failure due to
• Chronic pulmonary hypertension - 103Pumonary hypertension can be• Idiopathic (primary)
Secondary
• COPD
• ILD
• OSA
• Obesity
• Vascular disorders
• Tumours - 104Treatment• Diuretics
• Vasodilators
• Surgery - 105Interstitial lung diseaseas following
- 106Aetiology• Idiopathic
• Infective–TB
• Connective tissue diseases– SLE, RA, AS
• Industrial dust diseases- silicosis
• Radiation
• Medications - 107Presentation• Shortness of breath
• Chestpain
• Clubbing
• Crackleson chest - 108Diagosis• Restrictive pattern on spirometry
• CXR
• CT - 109Environmental & occupational lung diseaseas following
- 110Cause• dust, chemicals, gases, allergens & pollutants
- 111Can involve• various parts of the lung
• Pleura
• Interstitium
• Airways - 112Aetiology• Particles small enough to pass into lung
• May depend on mucociliary clearance - 113Response depende on• Particle nature
• Organic particles (e.g., bird fanciers lung)
• Inorganic
• Inert particles (e.g., fibrosis)
• Gas (e.g., acute pulmonary oedema) - 114Asbestosisas following
- 115Definition• Asbestos was commonly used in building trade (e.g., roofing,
fire proofing, wire insulation) - 116Fibre inhalation results in• pulmonary fibrosis,
• pleural plaques - 117Asbestos exposure associated with• increased incidence of mesothelioma & acenocarcinoma
- 118Coal workers pneumonconiosis• Inhalation of coal dust particles causing fibrosis and chronic bronchitis
- 119Silicosis• Inhalation of silica particles causing fibrosis;
• Seen in metal mining,stone quarrying, ceramic manufacture - 120Presentation with• Severe dyspnea
• Nodules in upper lung fields
• Predisposed to TB
• Lymph node calcification - 121Pleural disorderspleuritis
pleural effusion - 122Pleuritis definition• Inflammation of pleura secondary to infection
• Inflammation of infarction - 123Characteristics• Pain worse with inspiration
• Often felt over the site
• But may be referred to - 124Signs• Localized oedema
• Congestion
• Infiltrate +/- adhesions
• May have audible pleural rub
• May be associated with pleural effusion - 125Pleural effusion• Accumulation of fluid in pleural space
- 126Transudate produced by• pressure, low protein content, e.g., CCF, nephrotic syndrome)
• or exudate (high protein content, due to inflammation, e.g., pneumonia, PE)
• Reduced BSI, dullness to percussion - 127Pneumothorax• Free air in the pleural cavity between the layers of pleura
• Normally thereis negative pressure in the pleural space that helps to keep the lungs inflated
• When there is communication with the atmosphere this
pressure equalises
• The elasticity of the lung causes it to deflate - 128Aetiology• Trauma (inc. barotrauma)
• Spontaneous (e.g.,ruptured bullae)
• Iatrogenic(e.g., needle) - 129Clinical features• Dependent on size
• Dyspnoea
• Pleuritic pain
• Mediastinal shift
• Death– tension pneumothorax - 130Diagnosis• CXR – may need insp/exp views if sma
- 131Treatment• Observation
• Drain
• Surgery for recurrences - 132Atelectasis• Shrunken , airless part of lung
- 133Aetiology• Bronchial obstruction (internal – mucous, external – tumour)
• Hypoventilation (post op, # rib)
• Hypoperfusion (PE)
• Intrinsic factors (e.g., reduced surfactant) - 134Presentation• Depends on cause and extent
• Dyspnea +/- pain, cough - 135Treatment• Rx cause & physiotherapy
- 136Complications• Infection,
• Bronchiectasiss
• Fibrosis - 137Lung tumoursas following
- 138classification• Benign
• Malignant
• Secondary (metastatic) - 139Most common• Primary bronchogenic carcinoma
• 85% smoking related
• Main cause of cancer related death worldwide - 1402 main types• •Small cell 15%
• Non small cell
⇒ Largecell 15%
⇒ Adenocarcinoma 35%
⇒ Squamous cell 35% - 141Primary lung tumours• Carcinoma obstruction lef main bronchus
- 142SCLC• 60% have metastasisedon diagnosis
• Tend to be central in large airways – submucosal/perihilarmass - 143NSCLC• 40% have metastasisedon diagnosis
• May be peripheral (e.g.,adenocarcinoma) - 144Prognosis• 15% 5 year survival with treatment
- 145Symptoms• cough
• wheeze (monophonic)
• haemoptysis
• infection - 146Signs• effusion
• atelectasis
• metastatic complications - 147Secondary lung tumours• Malignant tumours may metastasise to the lungs from multiple primary sites
- 148Sites
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- 2016 Semester 1 Medicine (Week 4) Flashcards on Respiratory System, created by Dan Wiendl on 23/03/2016.
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- Dan Wiendl
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