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Alterations of Pulmonary Function
Chapter 26
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Signs and Symptoms of Pulmonary Disease
Dyspnea Subjective sensation of uncomfortable breathing Orthopnea Dyspnea when a person is lying down Paroxysmal nocturnal dyspnea (PND)
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Signs and Symptoms of Pulmonary Disease
Abnormal breathing patterns Kussmaul respirations (hyperpnea) Cheyne-Stokes respirations
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Signs and Symptoms of Pulmonary Disease
Hypoventilation Hypercapnia Hyperventilation Hypocapnia Cough Acute cough Chronic cough Hemoptysis
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Signs and Symptoms of Pulmonary Disease
Cyanosis Pain Clubbing Abnormal sputum
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Clubbing
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Conditions Caused by Pulmonary Disease or Injury
Hypercapnia Hypoxemia Hypoxemia versus hypoxia Ventilation-perfusion abnormalities Shunting Acute respiratory failure Pulmonary edema Excess water in the lungs
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Ventilation-Perfusion
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Pulmonary Edema
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Conditions Caused by Pulmonary Disease or Injury
Aspiration Passage of fluid and solid particles into the lungs Atelectasis Compression atelectasis Absorption atelectasis Bronchiectasis Persistent abnormal dilation of the bronchi
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Compression Atelectasis
Squeeze
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Absorption Atelectasis
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Conditions Caused by Pulmonary Disease or Injury
Bronchiolitis Inflammatory obstruction of the small airways Most common in children Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases
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Conditions Caused by Pulmonary Disease or Injury
Bronchiolitis obliterans Late-stage fibrotic disease of the airways Can occur with all causes of bronchiolitis
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Pleural Abnormalities
Pneumothorax Open pneumothorax Tension pneumothorax Spontaneous pneumothorax Secondary pneumothorax
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Pneumothorax
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Tension Pneumothorax One way valve
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Pleural Abnormalities
Pleural effusion Transudative effusion Exudative effusion Hemothorax Empyema Infected pleural effusion Chylothorax
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Pleural Effusion Pleural space
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Hemothorax Blood
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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
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Conditions Caused by Pulmonary Disease or Injury
Chest wall restriction Compromised chest wall Deformation, immobilization, and/or obesity Flail chest Instability of a portion of the chest wall
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Flail Chest
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Conditions Caused by Pulmonary Disease or Injury
Inhalation disorders Exposure to toxic gases Pneumoconiosis Silica Asbestos Coal Allergic alveolitis Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
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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
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Pulmonary Disorders Acute respiratory distress syndrome (ARDS)
Manifestations Hyperventilation Respiratory alkalosis Dyspnea and hypoxemia Metabolic acidosis Hypoventilation Respiratory acidosis Further hypoxemia Hypotension, decreased cardiac output, death
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Pulmonary Disorders Acute respiratory distress syndrome (ARDS)
Evaluation and treatment Physical examination, blood gases, and radiologic examination Supportive therapy with oxygenation and ventilation and prevention of infection Surfactant to improve compliance
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Pulmonary Disorders Postoperative respiratory failure Atelectasis
Pneumonia Pulmonary edema Pulmonary emboli Prevention Frequent turning, deep breathing, early ambulation, air humidification, and incentive spirometry
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Obstructive Pulmonary Disease
Airway obstruction that is worse with expiration Common signs and symptoms Dyspnea and wheezing Common obstructive disorders Asthma Emphysema Chronic bronchitis
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Asthma “Chronic inflammatory disorder of the airways”
Inflammation results from hyperresponsiveness of the airways Can lead to obstruction and status asthmaticus
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Asthma
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Asthma Symptoms include expiratory wheezing, dyspnea, and tachypnea
Peak flow meters, oral corticosteroids, inhaled beta-agonists, and anti-inflammatories used to treat
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Bronchial Thermoplasty
The Wall STREET Journal-health November 1, 2010
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Abscess Formation & Cavitation
Kle bsiella or Staphylococcus- aspiration Abscess-suppuration & destruction Consolidation-fluid, pus, & bacteria with necrosis to form communication with a bronchus Cavitation- abscess empties into the bronchus with a cavity
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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
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Chronic Obstructive Pulmonary Disease
Chronic bronchitis The mucus is thicker than normal Bronchodilators, expectorants, and chest physical therapy used to treat
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Bronchitis
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Chronic Obstructive Pulmonary Disease
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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
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Emphysema
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Emphysema
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Emphysema ULL
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Chronic Obstructive Pulmonary Disease
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Obstructive Pulmonary Disease
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Respiratory Tract Infections
Pneumonia Community-acquired pneumonia (CAP) Streptococcus pneumoniae Hospital-acquired (nosocomial) pneumonia Ventilation – Associated Pneumonia (VAP)-p 695 Immunocompromised pneumonia (HIV/Trsnsplants) See page 695-common microorganisms
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Pneumococcal Pneumonia
Lobar
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Brittany Murphy Died : Community acquired pneumonia
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Respiratory Tract Infections
Tuberculosis* Mycobacterium tuberculosis Acid-fast bacillus Airborne transmission Tubercle formation Caseous necrosis Positive tuberculin skin test (PPD) *known for 15,000 years 1.4 million RIP 2006
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Tuberculosis Cavitary
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Respiratory Tract Infections
Acute bronchitis Acute infection or inflammation of the airways or bronchi Commonly follows a viral illness Acute bronchitis causes similar symptoms to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates
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Pulmonary Vascular Disease
Pulmonary embolism Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble Pulmonary emboli commonly arise from the deep veins in the thigh Virchow triad Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels
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Pulmonary Embolism
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Pulmonary Vascular Disease
Pulmonary hypertension Mean pulmonary artery pressure > 25 mm Hg
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Pulmonary Vascular Disease
Pulmonary hypertension Classifications Pulmonary arterial hypertension: ?, inherited, drugs, toxins Pulmonary venous hypertension-CHF-left Pulmonary hypertension due to a respiratory disease or hypoxemia-COPD Pulmonary hypertension due to thrombotic or embolic disease-PE Pulmonary hypertension due to diseases of the pulmonary vasculature
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Pulmonary Vascular Disease
Primary pulmonary hypertension Idiopathic Women age years Endothelial dysfunction vasoconstrictors (THX) Cor pulmonale
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Pulmonary Hypertension & cor pulmonale
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Cor Pulmonale Pulmonary heart disease Right ventricular enlargement
Secondary to pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle with hypertrophy and dilation
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Cancer Lip cancer ( < men, 3,000/yr) Most common form
Exophytic Stages Laryngeal cancer (2-3% of cancers, ,000/yr; tobacco + EtOH; HPV) Forms Carcinoma of the true vocal cords (most common) Supraglottic Subglottic
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Lip Cancer
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Laryngeal Cancer
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Lung Cancer Bronchogenic carcinomas
Most common cause is cigarette smoking (80-90%)- >30 carcinogens Heavy smokers have a 20 times’ greater chance of developing lung cancer than nonsmokers Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder
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Lung Cancer
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Lung Cancer Environmental or occupational risk factors are also associated with lung cancer
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Lung Cancer Non–small cell lung cancer(80%)
1. Squamous cell carcinoma (30%) 2. Adenocarcinoma(35-40%) 3. Large cell carcinoma (10-15%) (undifferentiated) Neuroendocrine Tumors 1.Small cell lung cancer-paraneoplastic syndrome See Table 26-3
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Squamous Cell Carcinoma
“Couhg”
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Adenocarcinoma Glands Pleural effusion
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Large Cell Carcinoma Anaplastic Pain ,couhg hemoptysis
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Small Cell (oat cell) Cough, pain, hemoptysis
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Dana Reeves-Nonsmokers “different genetic mutations” Nov 2010
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Lung Cancer TNM classification Evaluation and treatment
Tumor Nodal involvement Metastasis Surgery, chemotherapy, and radiation
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