Alterations of Pulmonary Function Chapter 33 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Signs and Symptoms of Pulmonary Disease  Dyspnea and cough  Tachypnea  Hyperventilation  Hypoventilation  Hypercapnia  Hypocapnia  Hemoptysis  Abnormal sputum  Cyanosis  Pain  Clubbing

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Signs and Symptoms of Pulmonary Disease  Dyspnea  Sensation of uncomfortable breathing  Orthopnea Dyspnea when a person is lying down Dyspnea when a person is lying down  Paroxysmal nocturnal dyspnea  Abnormal breathing patterns  Kussmaul respirations (hyperpnea)  Cheyne-Stokes respirations

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Signs and Symptoms of Pulmonary Disease  Hypoventilation  Leads to respiratory acidosis  Hyperventilation  Leads to respiratory alkalosis  Cough  Acute cough  Chronic cough  Hemoptysis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Signs and Symptoms of Pulmonary Disease  Cyanosis  5 g of hemoglobin is desaturated regardless of concentration  Insensitive measure of disease Pulmonary disease Pulmonary disease Cardiac disease Cardiac disease Cold Cold Anxiety Anxiety

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7 Clubbing

8 Conditions Caused by Pulmonary Disease or Injury  Hypercapnia  Hypoxemia  Hypoxemia vs. hypoxia  Ventilation-perfusion abnormalities Shunting Shunting  Acute respiratory failure  Pulmonary edema  Excess water in the lungs

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10 Ventilation-Perfusion

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Restrictive Disorders  Pulmonary edema  Atelectasis (collapsed lung)  Pneumothorax  Pleural effusion  Pneumonia

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Pulmonary Edema

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Conditions Caused by Pulmonary Disease or Injury  Aspiration  Passage of fluid and solid particles into lungs Right lower lobe most frequent site Right lower lobe most frequent site  Atelectasis  Compression atelectasis  Absorption atelectasis  Bronchiectasis  Persistent abnormal dilation of the bronchi  Cylindrical, saccular, and varicose

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Bronchiectasis

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Absorption Atelectasis

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Conditions Caused by Pulmonary Disease or Injury  Bronchiolitis  Inflammatory obstruction of the small airways  Most common in children  Occurs in adults with chronic bronchitis, a viral infection, or inhalation of toxic gases  Bronchiolitis obliterans  Late-stage fibrotic disease of the airways  Can occur with all causes of bronchiolitis

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26

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Pleural Abnormalities  Pneumothorax  Open pneumothorax  Tension pneumothorax  Spontaneous pneumothorax  Secondary pneumothorax

28

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Pneumothorax

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Pleural Abnormalities  Pleural effusion  Transudative effusion  Exudative effusion  Pleurisy  Hemothorax  Empyema  Infected pleural effusion

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Conditions Caused by Pulmonary Disease or Injury  Abscess formation and cavitation  Abscess  Consolidation  Cavitation  Pulmonary fibrosis  Excessive amount of fibrous or connective tissue in the lung

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Conditions Caused by Pulmonary Disease or Injury  Chest wall restriction  Compromised chest wall Deformation, immobilization, and/or obesity Deformation, immobilization, and/or obesity  Flail chest  Instability of a portion of the chest wall

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Flail Chest

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Conditions Caused by Pulmonary Disease or Injury  Inhalation disorders  Exposure to toxic gases  Pneumoconiosis Silicosis Silicosis Coal worker pneumoconiosis (black lung) Coal worker pneumoconiosis (black lung) Asbestosis Asbestosis  Allergic alveolitis Extrinsic allergic alveolitis (hypersensitivity pneumonitis) Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Pulmonary Disorders  Acute respiratory distress syndrome (ARDS)  Fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury  Injury to the pulmonary capillary endothelium  Inflammation and platelet activation  Surfactant inactivation  Atelectasis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Pulmonary Disorders  ARDS  Manifestations Rapid, shallow breathing Rapid, shallow breathing Respiratory alkalosis Respiratory alkalosis Dyspnea Dyspnea Decreased lung compliance Decreased lung compliance Unresponsive hypoxemia Unresponsive hypoxemia

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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Acute Respiratory Distress Syndrome (ARDS)

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Pulmonary Disorders  Postoperative respiratory failure  Atelectasis  Pneumonia  Pulmonary edema  Pulmonary emboli  Prevention Frequent turning, deep breathing, early ambulation, air humidification, and incentive spirometry Frequent turning, deep breathing, early ambulation, air humidification, and incentive spirometry

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Obstructive Disorders  Asthma  Chronic bronchitis  Emphysema  Chronic bronchitis + emphysema = chronic obstructive pulmonary disease (COPD)  Clinically: dyspnea and wheezing

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Obstructive Pulmonary Disease  Airway obstruction that is worse with expiration  Common signs and symptoms  Dyspnea and wheezing

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Asthma

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Chronic Obstructive Pulmonary Disease

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Chronic Obstructive Pulmonary Disease  Chronic bronchitis  Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years  Inspired irritants increase mucus production and the size and number of mucous glands  The mucus is thicker than normal

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Chronic Obstructive Pulmonary Disease  Emphysema  Abnormal permanent enlargement of the gas- exchange airways accompanied by destruction of alveolar walls without obvious fibrosis  Loss of elastic recoil  Centriacinar emphysema  Panacinar emphysema

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Emphysema

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Chronic Obstructive Pulmonary Disease

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Obstructive Pulmonary Disease

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Respiratory Tract Infections

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Pneumococcal Pneumonia

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Pneumonia  Community-acquired pneumonia  Streptococcus pneumoniae  Hospital-acquired (nosocomial) pneumonia  Pneumococcal pneumonia  Viral pneumonia

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 53 Respiratory Tract Infections  Tuberculosis  Mycobacterium tuberculosis  Acid-fast bacillus  Airborne transmission  Tubercle formation  Caseous necrosis  Positive tuberculin skin test

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 54 Respiratory Tract Infections  Acute bronchitis  Acute infection or inflammation of the airways or bronchi  Commonly follows a viral illness  Causes symptoms similar to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 55 Pulmonary Vascular Disease  Pulmonary embolism  Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble  Pulmonary emboli commonly arise from the deep veins in the thigh  Triad of Virchow Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 56 Pulmonary Embolism

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 57 Pulmonary Vascular Disease  Pulmonary hypertension  Mean pulmonary artery pressure 5-10 mmHg above normal or >20 mmHg  Classifications Pulmonary arterial hypertension Pulmonary arterial hypertension Pulmonary venous hypertension Pulmonary venous hypertension Pulmonary hypertension from a respiratory disease or hypoxemia Pulmonary hypertension from a respiratory disease or hypoxemia Pulmonary hypertension from thrombotic or embolic disease Pulmonary hypertension from thrombotic or embolic disease Pulmonary hypertension from diseases of pulmonary vasculature Pulmonary hypertension from diseases of pulmonary vasculature

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 58 Pulmonary Vascular Disease  Primary pulmonary hypertension  Idiopathic  Diseases of the respiratory system and hypoxemia are more common causes of pulmonary hypertension

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 59 Pulmonary Hypertension

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 60 Cor Pulmonale  Pulmonary heart disease  Right ventricular enlargement  Secondary to pulmonary hypertension  Pulmonary hypertension creates chronic pressure overload in the right ventricle

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 61 Cancer  Lip cancer  Most common form Exophytic Exophytic  Stages  Laryngeal cancer  Forms Carcinoma of true vocal cords (most common) Carcinoma of true vocal cords (most common) Supraglottic Supraglottic Subglottic Subglottic

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 62 Lip and Laryngeal Cancer

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 63 Lung Cancer  Bronchogenic carcinomas  Most common cause is cigarette smoking  Heavy smokers have 20 times’ greater chance of lung cancer than nonsmokers  Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder  Environmental or occupational risk factors also associated with lung cancer

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 64 Lung Cancer  Non–small-cell lung cancer  Squamous cell carcinoma  Adenocarcinoma  Large cell carcinoma (undifferentiated)  Small cell carcinoma

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 65 Lung Cancer

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 66 Other Lung Cancers  Bronchial carcinoid tumors  Adenocystic tumors (cylindromas)  Mucoepidermoid carcinomas  Mesotheliomas