Essentials of Human Diseases and Conditions 4 th edition Margaret Schell Frazier Jeanette Wist Drzymkowski

Chapter 9 Diseases and Conditions of the Respiratory System

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives  Explain the process of respiration.  Discuss the causes and medical treatment for (a) the common cold, (b) sinusitis, and (c) pharyngitis.  Name the treatment of choice for nasal polyps.  Discuss the prognosis of cancer of the larynx.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  Define atelectasis and discuss some possible causes.  Name some systemic disorders that might cause epistaxis.  Compare the clinical pictures of (a) a patient with pulmonary embolism and (b) one with pneumonia.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  List some possible causes of pulmonary abscess.  Compare legionellosis with Pontiac fever.  Explain who is at greatest risk for (a) respiratory syncytial virus pneumonia and (b) histoplasmosis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  List the groups recommended to receive prophylactic use of influenza vaccines.  Contrast the pathologic course of acute bronchitis with that of chronic bronchitis.  Compare the pathology involved in bronchiectasis with that of pulmonary emphysema.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  Name and describe three causes of pneumoconiosis.  Explain the difference between pneumothorax and hemothorax.  Describe the presenting symptoms of pleurisy.  Discuss contributing factors to and concern about the rising prevalence of pulmonary tuberculosis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  Describe the clinical course of infectious mononucleosis.  Explain the pathologic changes of the lungs in adult respiratory distress syndrome (ARDS).  Name the leading cause of cancer deaths worldwide for both men and women.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.)  Discuss the early findings concerning the threat of a SARS epidemic.  List some health hazards of common molds.

Chapter 9 Lesson 9.1

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Respiratory System

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Respiration  Maintains life by supplying oxygen to organs, tissues and cells and allows removal of carbon dioxide.  External respiration - in the lungs, oxygen inhaled from the air is exchanged with carbon dioxide from the blood.  Internal respiration - exchange of gases between the blood and tissue cells

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Respiration (cont’d.) Pulmonary circulation  Pulmonary arteries - carry deoxygenated venous blood from the heart to the lungs  Pulmonary capillaries - where gas exchange occurs  Pulmonary veins - return the freshly oxygenated blood to the heart for systemic circulation

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Respiratory System (cont'd.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes:  Infection  Circulatory disorders  Tumors  Trauma  Immune diseases  Inflammatory disturbances  Congenital defects  Central nervous system damage or diseases  Environmental conditions Diseases of the Respiratory System

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Chest pain  Dyspnea (difficulty breathing)  Productive or nonproductive cough (acute or chronic)  Hemoptysis (spitting up blood)  Dysphonia (hoarseness)  Chills  Low- or high-grade fever  Wheezing  Fatigue Symptoms of Respiratory Disorder

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Common cold: acute inflammatory process that affects the mucous membrane that lines the upper respiratory tract  Sinusitis: acute or chronic inflammation of the mucous membranes of the paranasal sinuses Upper Respiratory Tract Infections

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Pharyngitis: acute or chronic infection of the pharynx  Laryngitis: inflammation of the larynx, including the vocal cords Upper Respiratory Tract Infections (cont'd.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Sinusitis Treatments for Sinusitis  Broad-spectrum antibiotics  Decongestants  Antihistamines

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pharyngitis Causes:  Viral infections - often an extension of bacterial streptococcal infection from tonsils, adenoids, nose, or tonsils (particularly in children)  May be secondary to systemic viral infection such as chickenpox or measles

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Disorders  Deviated septum: crooked nasal septum (cartilage partition between the nostrils)  Nasal polyps: benign growths that form as consequence of distended mucous membranes protruding into the nasal cavity

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Disorders (cont'd.)  Anosmia: impairment or loss of the sense of smell  Epistaxis (nosebleed): hemorrhage from the nose

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Polyps Nasal Polyps - benign growths that form as a consequence of distended mucous membranes protruding into nasal cavity Causes:  overproduction of fluid in the cells of the mucous membrane,  often the result of allergic rhinitis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epistaxis (nosebleed) First aid:  Mild hemorrhage - controlled by applying direct, constant pressure on either side of nose for 5 to 10 minutes  Persistent bleeding - treated with local application of epinephrine followed by cauterization or nasal packing  Severe - surgical ligation of bleeding artery

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Disorders of the Larynx  Tumors of the larynx: benign or malignant growths on the larynx  Laryngeal cancer: neoplasm of the larynx  The larynx is the most common site for head and neck tumors

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Atelectasis Atelectasis (collapsed lung): airless or collapsed state of the pulmonary tissue  Caused by an obstruction in bronchial tree; may be mucous plug, foreign object, or bronchogenic cancer  Complication – pneumonia  Risk factors: obesity, upper abdominal or chest surgery, neuromuscular weakness or any pulmonary disease

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders  Pulmonary embolism: occurs when a blood clot or other material, such as a foreign body or tumor, lodges in and blocks an artery in the pulmonary circulation  Pneumonia: inflammation of the lungs due to infection

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Embolism  Occurs when embolism is lodged in artery and interrupts blood supply  Uncomplicated embolism - cough, chest pain, low- grade fever and apprehension  More extensive - dyspnea, tachypnea (at least 20 breaths/minute), chest pain, occasional hemoptysis  Massive embolism - sudden onset of cyanosis, shock and death

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumonia Causes of Pneumonia: Bacterial infection-  Pneumococci  Staphylococci  Group A hemolytic streptococci  Haemophilus influenzae type B  Klebsiella pneumoniae types 1 and 2  Atypical pneumonia caused by legionella, mycoplasma and chlamydia agents

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumonia (cont’d.) Causes of Pneumonia: Virus  Adenoviruses  Influenza viruses  Syncytial viruses  May also be caused by damage to lungs, such as inhalation of poisonous gas such as chlorine or aspiration of foreign matter

Chapter 9 Lesson 9.2

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Severe acute respiratory syndrome (SARS): Highly contagious new mutation of the Corona virus  Symptoms:  Sudden onset of fever  Mild sore throat  Muscle aches  Dry, unproductive cough Severe Acute Respiratory Syndrome

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Common molds: fungal growths that grow naturally indoors or outdoors, especially where there is a constant supply of moisture Health Hazards of Common Molds

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Home: professional cleaning and/or reconstruction  Cleaning with weak bleach and water solution (1:10)  Discard moldy items  Ensuring adequate ventilation, using paint with mold inhibitors, cleaning bathrooms with mold killing products, promptly removing flooded carpets Methods of Preventing Mold Growth

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders Pulmonary abscess: area of contained infectious material in the lung Causes:  Often a complication of pneumonia caused by bacteria  Aspiration of food, foreign object, bronchial stenosis or neoplasms  Septic embolism is carried to lung via pulmonary circulation

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders (cont'd.)  Legionellosis (Legionnaires disease): pneumonia caused by the bacterium Legionella pneumophila  Pontiac fever: milder form of legionellosis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders (cont'd.)  Respiratory syncytial virus pneumonia (RSV): inflammatory and infectious condition of the lungs  Histoplasmosis: fungal disease originating in the lungs caused by inhalation of dust containing Histoplasma capsulation

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Groups at risk for RSV  Children younger than three years old  Elderly individuals  Patients with compromised respiratory systems  Infants who were premature or who have a congenital cardiac defect or preexisting pulmonary disorder

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Influenza Influenza:  Highly contagious, acute viral disease that occurs in annual outbreaks

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Influenza (cont’d.) At risk of complications of influenza:  Persons over 50 years of age  Residents of nursing homes  Patients with chronic pulmonary cardiac disorder (including asthma)  Patients with chronic metabolic disease (diabetes), renal dysfunction, hemoglobinopathies, immunosuppression  Children and teens receiving long-term aspirin  Health care employees

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute and chronic bronchitis: inflammation of the mucous membrane lining the bronchi  COPD includes:  Chronic bronchitis  Bronchiectasis  Asthma  Emphysema  Cystic fibrosis  pneumoconiosis Chronic Obstructive Pulmonary Disease (COPD)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute and Chronic Bronchitis  Acute - symptoms subside within a week, cough may continue for 2-3 weeks  Physical signs within lungs are few or absent  Chronic - inflammation persists and worsens, often occurs after colds or flu  Obstructive and asthmatic symptoms appear  Dyspnea, scattered rales and wheezing

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chronic Obstructive Pulmonary Disease (cont'd.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Effects of Smoking  Cancer of oral cavity, larynx, esophagus  Lung cancer  Peptic ulcer  Chronic bronchitis  Emphysema  Myocardial infarction  Systemic atherosclerosis  Cancer of pancreas  Cancer of bladder

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Bronchiectasis: permanent, irreversible dilation or distortion of one or more bronchi, resulting from destruction of muscular and elastic portions of bronchial walls  Pulmonary emphysema: chronic obstructive pulmonary disorder characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces Chronic Obstructive Pulmonary Disease (cont'd.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes of Bronchiectasis  Pneumonia  Recurrent airway infections  Tuberculosis  Bronchial obstruction  Inhalation of corrosive gas  Complication of cystic fibrosis or other childhood infection such as measles and pertussis  Immune deficiency

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Pneumoconiosis: any disease of the lung caused by long-term dust inhalation Chronic Obstructive Pulmonary Disease (cont'd.)

Chapter 9 Lesson 9.3

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pleurisy  Pleurisy (pleuritis): inflammation of membranes surrounding the lungs and lining the pleural cavity  Symptoms  Sharp, needle-like pain that increases with inspiration and coughing  May also experience fever, chills, and shallow breathing

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pleurisy (cont’d.)  Wet - when fluid is present, causes compression of pulmonary tissue and dyspnea  Dry - pleura fluid decreases in volume, resulting in dryness between the pleura; layers rub together and become congested and edematous

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumothorax and Hemothorax  Pneumothorax: collection of air or gas in the pleural cavity that results in a collapsed or partially collapsed lung  Hemothorax: accumulation of blood and other fluids in the pleural cavity

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumothorax  Symptoms of Collapsed Lung  Severe shortness of breath  Sudden sharp chest pain  Falling blood pressure  Rapid weak pulse  Shallow and weak respirations  May be cyanotic and anxious

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Tuberculosis  Pulmonary tuberculosis: chronic, acute, or subacute infection of the lungs by Mycobacterium tuberculosis  Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Infectious Mononucleosis  Infectious mononucleosis (Epstein-Barr virus infection): acute herpesvirus infection (glandular fever)  Symptoms:  Lymphadenopathy  Fever that typically peaks in afternoon  Listlessness, malaise, chills, anorexia  Sore throat, fever, headache, fatigue, and cervical generalized lymphadenopathy

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Adult respiratory distress syndrome (ARDS): severe pulmonary congestion characterized by acute respiratory distress and hypoxemia  Symptoms:  Sudden, severe dyspnea with rapid, shallow respirations  Inspiratory intercostals and suprasternal retractions along with cyanosis or mottled skin  May also have rales, rhonchi and wheezes Adult Respiratory Distress Syndrome

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  ARDS - trauma causes increased capillary permeability in the lungs, pulmonary edema, and resulting respiratory failure  Alveoli fill within hours of injury, and then tend to collapse at end of expiration, leaving less pulmonary tissue for gas exchange  Result: low pulmonary compliance, pulmonary hypertension, hypoxemia Adult Respiratory Distress Syndrome (cont’d.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer  Lung cancer: cancerous condition caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell division  Leading cause of death worldwide in both men and women, 30% of all cancer deaths

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer (cont’d.) 4 major types: Non-small cell lung cancer (NSCLC)  Squamous cell carcinoma - 30% of all lung cancers  Adenocarcinoma - 40%  Large cell carcinoma - 10% Small cell lung cancer (SCLC) - occurs almost exclusively in smokers  Small cell carcinoma - 20%

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer (cont’d.) Prognosis for patients with lung cancer is generally poor  5-year for all stages and types of lung cancer combined is 15%  Prevention: Cessation of smoking Cessation of smoking Avoidance of exposure to second hand smoke Avoidance of exposure to second hand smoke