Download - Pathophysiology Respiratory System
Respiratory Respiratory SystemSystem
Dr. Mohamad Nidal KhabazDr. Mohamad Nidal KhabazAssistant Professor of Pathology,Assistant Professor of Pathology,Pathology Department, Faculty of Pathology Department, Faculty of
Medicine,Medicine,Jordan University of Science and Jordan University of Science and
TechnologyTechnology
Components of the Components of the Respiratory SystemRespiratory System
VentilationVentilation The movement of air between the The movement of air between the
atmosphere and the respiratory atmosphere and the respiratory portion of the lungsportion of the lungs
PerfusionPerfusion The flow of blood through the lungsThe flow of blood through the lungs
DiffusionDiffusion The transfer of gases between the air-The transfer of gases between the air-
filled spaces in the lungs and the bloodfilled spaces in the lungs and the blood
Structural Organization Structural Organization of the Respiratory of the Respiratory
SystemSystem Consists of the air passages and the Consists of the air passages and the
lungslungs Divided into two parts by function: Divided into two parts by function:
Conducting airways:Conducting airways: through through which air moves as it passes which air moves as it passes between the atmosphere and the between the atmosphere and the lungslungs
Respiratory tissues of the lungs:Respiratory tissues of the lungs: where gas exchange takes placewhere gas exchange takes place
Structures of the Structures of the Conducting AirwaysConducting Airways
Nasal passagesNasal passages Mouth and pharynxMouth and pharynx LarynxLarynx TracheaTrachea BronchiBronchi Bronchioles Bronchioles
Respiratory TreeRespiratory Tree LarynxLarynx Trachea – supplies both lungsTrachea – supplies both lungs Primary bronchi – supplies each lungPrimary bronchi – supplies each lung Secondary bronchi – supplies each lobeSecondary bronchi – supplies each lobe Tertiary bronchi – supplies each Tertiary bronchi – supplies each
bronchopulmonary segment (lobule)bronchopulmonary segment (lobule) BronchiolesBronchioles Terminal bronchiolesTerminal bronchioles Respiratory bronchiole (capable of gas Respiratory bronchiole (capable of gas
exchange)exchange) Alveolar ducts (capable of gas exchange)Alveolar ducts (capable of gas exchange) Alveolar sacs with alveoli (capable of gas Alveolar sacs with alveoli (capable of gas
exchange)exchange)
VentilationVentilation
Depends on the conducting Depends on the conducting airways:airways: Nasopharynx and oropharynxNasopharynx and oropharynx LarynxLarynx Tracheobronchial treeTracheobronchial tree
Function:Function: Moves air in and out of the lung but Moves air in and out of the lung but
does not participate in gas exchangedoes not participate in gas exchange
Pulmonary ventilationPulmonary ventilation
Inspiration is due to muscle Inspiration is due to muscle contraction which increases thoracic contraction which increases thoracic cage size.cage size.
The compliant lungs inflate due to The compliant lungs inflate due to the negative pressure created in the the negative pressure created in the pleural cavitypleural cavity
Expiration is due to the elasticity of Expiration is due to the elasticity of the thoracic soft tissue and the lungs the thoracic soft tissue and the lungs themselves.themselves.
Structures of the LungsStructures of the Lungs
Soft, spongy, cone-shaped organs Soft, spongy, cone-shaped organs located side by side in the chest cavitylocated side by side in the chest cavity Separated from each other by the Separated from each other by the
mediastinum and its contentsmediastinum and its contents divided into lobes (3 in the right lung, 2 in divided into lobes (3 in the right lung, 2 in
the left).the left). Apex:Apex: upper part of the lung; lies upper part of the lung; lies
against the top of the thoracic cavityagainst the top of the thoracic cavity Base:Base: lower part of the lung; lies lower part of the lung; lies
against the diaphragmagainst the diaphragm
Composition of the Composition of the Alveolar StructuresAlveolar Structures
Type I alveolar cells Type I alveolar cells Flat squamous epithelial cells across Flat squamous epithelial cells across
which gas exchange takes placewhich gas exchange takes place Type II alveolar cells Type II alveolar cells
Produce surfactant, a lipoprotein Produce surfactant, a lipoprotein substance that decreases the surface substance that decreases the surface tension in the alveoli and allows for tension in the alveoli and allows for greater ease of lung inflationgreater ease of lung inflation
Lung CirculationLung Circulation Pulmonary circulationPulmonary circulation
Arises from the pulmonary arteryArises from the pulmonary artery Provides for the gas exchange Provides for the gas exchange
function of the lungsfunction of the lungs Bronchial circulation Bronchial circulation
Arises from the thoracic aortaArises from the thoracic aorta Supplies the lungs and other lung Supplies the lungs and other lung
structures with oxygenstructures with oxygen Distributes blood to the conducting Distributes blood to the conducting
airwaysairways Warms and humidifies incoming airWarms and humidifies incoming air
Ventilation and Gas Ventilation and Gas ExchangeExchange
VentilationVentilation The movement of gases into and out of The movement of gases into and out of
the lungsthe lungs InspirationInspiration
Air is drawn into the lungs as the Air is drawn into the lungs as the respiratory muscles expand the chest respiratory muscles expand the chest cavitycavity
ExpirationExpiration Air moves out of the lungs as the chest Air moves out of the lungs as the chest
muscles recoil and the chest cavity muscles recoil and the chest cavity becomes smallerbecomes smaller
Respiratory PressuresRespiratory Pressures
Intrapulmonary pressure or Intrapulmonary pressure or alveolar pressurealveolar pressure Pressure inside the airways and Pressure inside the airways and
alveoli of the lungsalveoli of the lungs Intrapleural pressureIntrapleural pressure
Pressure in the pleural cavityPressure in the pleural cavity Intrathoracic pressure Intrathoracic pressure
Pressure in the thoracic cavityPressure in the thoracic cavity
Lung Compliance Lung Compliance
Lung complianceLung compliance (C) = (ΔV)/(ΔP)(C) = (ΔV)/(ΔP) The change in lung volume (ΔV) The change in lung volume (ΔV)
that can be accomplished with a that can be accomplished with a given change in respiratory given change in respiratory pressure (ΔP)pressure (ΔP)
Airway ResistanceAirway Resistance
Airway ResistanceAirway Resistance The volume of air that moves into and The volume of air that moves into and
out of the air exchange portion of the out of the air exchange portion of the lungslungs
Directly related to the pressure Directly related to the pressure difference between the lungs and the difference between the lungs and the atmosphere atmosphere
Inversely related to the resistance the Inversely related to the resistance the air encounters as it moves through the air encounters as it moves through the airwaysairways
Lung VolumesLung Volumes Tidal volume (TV)Tidal volume (TV)
Amount of air that moves into and out Amount of air that moves into and out of the lungs during a normal breath of the lungs during a normal breath
Inspiratory reserve volume (IRV)Inspiratory reserve volume (IRV) The maximum amount of air that can The maximum amount of air that can
be inspired in excess of the normal TVbe inspired in excess of the normal TV Expiratory reserve volume (ERV)Expiratory reserve volume (ERV)
Maximum amount of air that can be Maximum amount of air that can be exhaled in excess of the normal TVexhaled in excess of the normal TV
Residual volumeResidual volume The air that remains in the lungs after The air that remains in the lungs after
forced respirationforced respiration
Lung CapacitiesLung Capacities
Vital capacity:Vital capacity: equals the IRV plus the TV plus the equals the IRV plus the TV plus the ERV ERV The amount of air that can be exhaled from the The amount of air that can be exhaled from the
point of maximal inspirationpoint of maximal inspiration Inspiratory capacity: Inspiratory capacity: equals the TV plus the IRVequals the TV plus the IRV
The amount of air a person can breathe in The amount of air a person can breathe in beginning at the normal expiratory level and beginning at the normal expiratory level and distending the lungs to the maximal amountdistending the lungs to the maximal amount
Functional residual capacity:Functional residual capacity: sum of the RV and sum of the RV and ERVERV The volume of air that remains in the lungs at the The volume of air that remains in the lungs at the
end of normal expirationend of normal expiration Total lung capacity:Total lung capacity: the sum of all the volumes in the sum of all the volumes in
the lungsthe lungs
Pulmonary Function Pulmonary Function StudiesStudies
Maximum voluntary ventilation Maximum voluntary ventilation The volume of air a person can move into The volume of air a person can move into
and out of the lungs during maximum and out of the lungs during maximum effort lasting for 12 to 15 secondseffort lasting for 12 to 15 seconds
Forced expiratory vital capacity (FVC) Forced expiratory vital capacity (FVC) Involves full inspiration to total lung Involves full inspiration to total lung
capacity followed by forceful maximal capacity followed by forceful maximal expiration. expiration.
Forced expiratory volume (FEV) Forced expiratory volume (FEV) The expiratory volume achieved in a The expiratory volume achieved in a
given time periodgiven time period Forced inspiratory vital flow (FIF) Forced inspiratory vital flow (FIF)
The respiratory response during rapid The respiratory response during rapid maximal inspirationmaximal inspiration
Processes of Pulmonary Gas Processes of Pulmonary Gas ExchangeExchange
Ventilation Ventilation The flow of gases into and out of the The flow of gases into and out of the
alveoli of the lungsalveoli of the lungs Perfusion Perfusion
The flow of blood in the adjacent The flow of blood in the adjacent pulmonary capillariespulmonary capillaries
Diffusion Diffusion Transfer of gases between the Transfer of gases between the
alveoli and the pulmonary capillariesalveoli and the pulmonary capillaries
Types of Air Movement in Types of Air Movement in the lungthe lung
Bulk flow Bulk flow Occurs in the conducting airways Occurs in the conducting airways Controlled by pressure differences Controlled by pressure differences
between the mouth and that of between the mouth and that of airways in the lungairways in the lung
Diffusion Diffusion The movement of gases in the alveoli The movement of gases in the alveoli
and across the alveolar capillary and across the alveolar capillary membranemembrane
Types of Dead SpaceTypes of Dead Space
Anatomic dead spaceAnatomic dead space That contained in the conducting That contained in the conducting
airwaysairways Alveolar dead spaceAlveolar dead space
That contained in the respiratory That contained in the respiratory portion of the lungportion of the lung
Physiologic dead space Physiologic dead space The anatomic dead space plus The anatomic dead space plus
alveolar dead space alveolar dead space
Types of ShuntsTypes of Shunts
Anatomic shuntAnatomic shunt Blood moves from the venous to the Blood moves from the venous to the
arterial side of the circulation without arterial side of the circulation without moving through the lungsmoving through the lungs
Physiologic shuntPhysiologic shunt Mismatching of ventilation and Mismatching of ventilation and
perfusion with the lungperfusion with the lung Results in insufficient ventilation to Results in insufficient ventilation to
provide the oxygen needed to provide the oxygen needed to oxygenate the blood flowing through oxygenate the blood flowing through the alveolar capillariesthe alveolar capillaries
Factors Affecting Alveolar-Factors Affecting Alveolar-Capillary Gas ExchangeCapillary Gas Exchange
Surface area available for diffusionSurface area available for diffusion Thickness of the alveolar-capacity Thickness of the alveolar-capacity
membranemembrane Partial pressure of alveolar gasesPartial pressure of alveolar gases Solubility and molecular weight of Solubility and molecular weight of
the gasthe gas
Matching Ventilation and Matching Ventilation and PerfusionPerfusion
Required for exchange of gases between Required for exchange of gases between the air in the alveoli and the blood in the air in the alveoli and the blood in pulmonary capillaries pulmonary capillaries
Two factors interfere with the process:Two factors interfere with the process: Dead air space and shuntDead air space and shunt
The blood oxygen level reflects the The blood oxygen level reflects the mixing of blood from alveolar dead space mixing of blood from alveolar dead space and physiologic shunting areas as it and physiologic shunting areas as it moves into the pulmonary veinsmoves into the pulmonary veins
Mechanisms of Carbon Mechanisms of Carbon Dioxide TransportDioxide Transport
Dissolved in carbon dioxide (10%)Dissolved in carbon dioxide (10%) Attached to hemoglobin (30%) Attached to hemoglobin (30%) Bicarbonate (60%) Bicarbonate (60%)
Acid-base balance is influenced by Acid-base balance is influenced by the amount of dissolved carbon the amount of dissolved carbon dioxide and the bicarbonate level in dioxide and the bicarbonate level in the bloodthe blood
Control of BreathingControl of Breathing Automatic regulation of ventilation Automatic regulation of ventilation
Controlled by input from two types of sensors Controlled by input from two types of sensors or receptors:or receptors: Chemoreceptors:Chemoreceptors: monitor blood levels of monitor blood levels of
oxygen, carbon dioxide and adjust oxygen, carbon dioxide and adjust ventilation to meet the changing metabolic ventilation to meet the changing metabolic needs of the bodyneeds of the body
Lung receptors:Lung receptors: monitor breathing monitor breathing patterns and lung functionpatterns and lung function
Voluntary regulation of ventilationVoluntary regulation of ventilation Integrates breathing with voluntary acts such Integrates breathing with voluntary acts such
as speaking, blowing, and singingas speaking, blowing, and singing These acts, initiated by the motor and These acts, initiated by the motor and
premotor cortex, cause a temporary premotor cortex, cause a temporary suspension of automatic breathingsuspension of automatic breathing
Mechanisms Involved in Mechanisms Involved in DyspneaDyspnea
Stimulation of lung receptorsStimulation of lung receptors Increased sensitivity to changes in Increased sensitivity to changes in
ventilation perceived through central ventilation perceived through central nervous system mechanismsnervous system mechanisms
Reduced ventilatory capacity or Reduced ventilatory capacity or breathing reservebreathing reserve
Stimulation of neural receptors in the Stimulation of neural receptors in the muscle fibers of the intercostals and muscle fibers of the intercostals and diaphragm and of receptors in the diaphragm and of receptors in the skeletal jointsskeletal joints
Respiratory Tract Respiratory Tract InfectionsInfections
Areas Involved in Areas Involved in Respiratory Tract Respiratory Tract
InfectionsInfections Upper respiratory tract Upper respiratory tract
Nose, oropharynx, and larynxNose, oropharynx, and larynx Lower respiratory tract Lower respiratory tract
Lower airways and lungsLower airways and lungs Upper and lower airwaysUpper and lower airways
Common Respiratory Common Respiratory InfectionsInfections
Common coldCommon cold InfluenzaInfluenza PneumoniaPneumonia TuberculosisTuberculosis Fungal infections of the lungFungal infections of the lung
Factors Affecting the Signs Factors Affecting the Signs and Symptoms of and Symptoms of Respiratory Tract Respiratory Tract
InfectionsInfections
The function of the structure involvedThe function of the structure involved The severity of the infectious processThe severity of the infectious process The person’s age and general health The person’s age and general health
statusstatus
Rhinitis and SinusitisRhinitis and Sinusitis
Rhinitis Rhinitis Inflammation of the nasal mucosa Inflammation of the nasal mucosa
Sinusitis Sinusitis Inflammation of the paranasal sinusesInflammation of the paranasal sinuses
Types of SinusesTypes of Sinuses Paranasal sinusesParanasal sinuses
Air cells connected by narrow openings or Air cells connected by narrow openings or ostia with the superior, middle, and inferior ostia with the superior, middle, and inferior nasal turbinates of the nasal cavity nasal turbinates of the nasal cavity
Maxillary sinusMaxillary sinus Inferior to the bony orbit and superior to the Inferior to the bony orbit and superior to the
hard palatehard palate Its opening is located superiorly and medially Its opening is located superiorly and medially
in the sinus, a location that impedes drainagein the sinus, a location that impedes drainage Frontal sinuses Frontal sinuses
Open into the middle meatus of the nasal Open into the middle meatus of the nasal cavitycavity
Types of Sinuses (cont.)Types of Sinuses (cont.)
Sphenoid sinusSphenoid sinus Just anterior to the pituitary fossa behind Just anterior to the pituitary fossa behind
the posterior ethmoid sinusesthe posterior ethmoid sinuses Its paired openings drain into the Its paired openings drain into the
sphenoethmoidal recess at the top of the sphenoethmoidal recess at the top of the nasal cavitynasal cavity
Ethmoid sinusesEthmoid sinuses Comprise 3 to 15 air cells on each side, Comprise 3 to 15 air cells on each side,
with each maintaining a separate path to with each maintaining a separate path to the nasal chamberthe nasal chamber
Classifications of Classifications of RhinosinusitisRhinosinusitis
Acute rhinosinusitis Acute rhinosinusitis May be of viral, bacterial, or mixed May be of viral, bacterial, or mixed
viral-bacterial origin viral-bacterial origin May last from 5 to 7 days up to 4 weeksMay last from 5 to 7 days up to 4 weeks
Subacute rhinosinusitis Subacute rhinosinusitis Lasts from 4 weeks to less than 12 Lasts from 4 weeks to less than 12
weeksweeks Chronic rhinosinusitisChronic rhinosinusitis
Lasts beyond 12 weeksLasts beyond 12 weeks
Allergic RhinosinusitisAllergic Rhinosinusitis
Occurrence Occurrence Occurs in conjunction with allergic rhinitisOccurs in conjunction with allergic rhinitis Mucosal changes are the same as allergic Mucosal changes are the same as allergic
rhinitisrhinitis SymptomsSymptoms
Nasal stuffiness, itching and burning of Nasal stuffiness, itching and burning of the nose, frequent bouts of sneezing, the nose, frequent bouts of sneezing, recurrent frontal headache, watery nasal recurrent frontal headache, watery nasal dischargedischarge
TreatmentTreatment Oral antihistamines, nasal decongestants, Oral antihistamines, nasal decongestants,
and intranasal cromolynand intranasal cromolyn
Types of Influenza Types of Influenza VirusesViruses
Type AType A Most common typeMost common type Can infect multiple speciesCan infect multiple species Causes the most severe diseaseCauses the most severe disease Further divided into subtypes based on Further divided into subtypes based on
two surface antigens: hemagglutinin two surface antigens: hemagglutinin (H) and neuraminidase (N)(H) and neuraminidase (N)
Type B Type B Has not been categorized into subtypesHas not been categorized into subtypes
Antiviral DrugsAntiviral Drugs
AmantadineAmantadine RimantadineRimantadine ZanamivirZanamivir OseltamivirOseltamivir
Types of Influenza Types of Influenza VaccinationsVaccinations
Trivalent inactivated influenza Trivalent inactivated influenza vaccine (TIIV)vaccine (TIIV) Developed in the 1940sDeveloped in the 1940s Administered by injectionAdministered by injection
Live, attenuated influenza vaccine Live, attenuated influenza vaccine (LAIV)(LAIV) Approved for use in 2003Approved for use in 2003 Administered intranasallyAdministered intranasally
PneumoniaPneumonia DefinitionDefinition
Respiratory disorders involving inflammation Respiratory disorders involving inflammation of the lung structures (alveoli and of the lung structures (alveoli and bronchioles)bronchioles)
CausesCauses Infectious agents: such as bacteria and Infectious agents: such as bacteria and
viruses viruses Noninfectious agents: such as gastric Noninfectious agents: such as gastric
secretions aspirated into the lungssecretions aspirated into the lungs Factors Facilitating Development of Factors Facilitating Development of
PneumoniaPneumonia An exceedingly virulent organismAn exceedingly virulent organism A large inoculumA large inoculum Impaired host defensesImpaired host defenses
TuberculosisTuberculosis
Infectious disease caused by the Infectious disease caused by the bacterium bacterium Mycobacterium Mycobacterium tuberculosistuberculosis
Symptoms include fever, night Symptoms include fever, night sweats, weight loss, a racking cough, sweats, weight loss, a racking cough, and splitting headacheand splitting headache
Treatment entails a 12-month course Treatment entails a 12-month course of antibioticsof antibiotics
Positive Tuberculin Skin Positive Tuberculin Skin TestTest
Results from a cell-mediated Results from a cell-mediated immune response immune response Implies that a person has been infected Implies that a person has been infected
with M. tuberculosis and has mounted a with M. tuberculosis and has mounted a cell-mediated immune responsecell-mediated immune response
Does not mean the person has active Does not mean the person has active tuberculosistuberculosis
Disorders of Disorders of Ventilation and Ventilation and Gas ExchangeGas Exchange
Disorders of Lung Disorders of Lung InflationInflation Causes Causes
Conditions that produce lung Conditions that produce lung compression or lung collapsecompression or lung collapse Compression of the lung by an Compression of the lung by an
accumulation of fluid in the intrapleural accumulation of fluid in the intrapleural spacespace
Complete collapse of an entire lung as Complete collapse of an entire lung as in pneumothoraxin pneumothorax
Collapse of a segment of the lung as in Collapse of a segment of the lung as in atelectasisatelectasis
Pleural EffusionPleural Effusion
DefinitionDefinition An abnormal collection of fluid in the An abnormal collection of fluid in the
pleural cavity pleural cavity Types of fluidTypes of fluid
TransudateTransudate ExudateExudate Purulent drainage (empyema)Purulent drainage (empyema) ChyleChyle BloodBlood
Pleural Effusion Pleural Effusion Diagnosis and TreatmentDiagnosis and Treatment Diagnosis Diagnosis
Chest radiographs, Chest ultrasoundChest radiographs, Chest ultrasound Computed tomography (CT)Computed tomography (CT)
Treatment: Treatment: Directed at the cause of Directed at the cause of the disorderthe disorder ThoracentesisThoracentesis Injection of a sclerosing agent into the Injection of a sclerosing agent into the
pleural cavitypleural cavity Open surgical drainageOpen surgical drainage
Pneumothoraxes: TypesPneumothoraxes: Types
Spontaneous pneumothorax Spontaneous pneumothorax Occurs when an air-filled blister on the Occurs when an air-filled blister on the
lung surface ruptureslung surface ruptures Traumatic pneumothoraxTraumatic pneumothorax
Caused by penetrating or non-Caused by penetrating or non-penetrating injuriespenetrating injuries
Tension pneumothoraxTension pneumothorax Occurs when the intrapleural pressure Occurs when the intrapleural pressure
exceeds atmospheric pressureexceeds atmospheric pressure
AtelectasisAtelectasis Definition
The incomplete expansion of a lung or portion of a lung
Causes Airway obstruction Lung compression such as occurs in
pneumothorax or pleural effusion Increased recoil of the lung due to loss of
pulmonary surfactant Types of AtelectasisTypes of Atelectasis
Primary: Primary: Present at birth Present at birth Secondary: Secondary: Develops in the neonatal Develops in the neonatal
period or later in lifeperiod or later in life
Chronic Obstructive Chronic Obstructive Pulmonary Diseases (COPD)Pulmonary Diseases (COPD)
COPD are Asthma, Chronic bronchitis, COPD are Asthma, Chronic bronchitis, Emphysema, Cystic fibrosis, Bronchiectasis. Emphysema, Cystic fibrosis, Bronchiectasis.
Patients have a history of:Patients have a history of: SmokingSmoking Dyspnea, where labored breathing occurs Dyspnea, where labored breathing occurs
and gets progressively worseand gets progressively worse Coughing and frequent pulmonary infectionsCoughing and frequent pulmonary infections
COPD victims develop respiratory failure COPD victims develop respiratory failure accompanied by hypoxemia, carbon dioxide accompanied by hypoxemia, carbon dioxide retention, and respiratory acidosisretention, and respiratory acidosis
AsthmaAsthma Chronic inflammatory disorder characterized by Chronic inflammatory disorder characterized by
hyperactive airways leading to episodic, hyperactive airways leading to episodic, reversible bronchospasms owing to increased reversible bronchospasms owing to increased responsiveness of the tracheobronchial free to responsiveness of the tracheobronchial free to various stimuli.various stimuli.
It has been divided into two basic types:It has been divided into two basic types:1.1. Extrinsic asthma.Extrinsic asthma.2.2. Intrinsic asthma.Intrinsic asthma.
Characterized by dyspnea, wheezing, and chest Characterized by dyspnea, wheezing, and chest tightnesstightness
Airways thickened with inflammatory exudates Airways thickened with inflammatory exudates and occluded by thick mucous, which magnify and occluded by thick mucous, which magnify the effect of bronchospasms the effect of bronchospasms
AsthmaAsthma Extrinsic Asthma:Extrinsic Asthma: Initiated by type 1 Initiated by type 1
hypersensivity reaction induced by exposure to hypersensivity reaction induced by exposure to extrinsic antigen.extrinsic antigen. Subtypes include:Subtypes include:
atopic (allergic) asthma.atopic (allergic) asthma. occupational asthma.occupational asthma. allergic bronchopulmonary aspergillosis.allergic bronchopulmonary aspergillosis.
Intrinsic Asthma:Intrinsic Asthma: Initiated by diverse, non- Initiated by diverse, non-immune mechanisms, including ingestion of immune mechanisms, including ingestion of aspirin, pulmonary infections, cold, inhaled aspirin, pulmonary infections, cold, inhaled irritant, stress and exercise.irritant, stress and exercise.
AsthmaAsthma
Factors Contributing to the Factors Contributing to the Development of an Asthmatic AttackDevelopment of an Asthmatic Attack AllergensAllergens Respiratory tract infectionsRespiratory tract infections ExerciseExercise Drugs and chemicalsDrugs and chemicals Hormonal changes and emotional upsetsHormonal changes and emotional upsets Airborne pollutantsAirborne pollutants Gastroesophageal refluxGastroesophageal reflux
EmphysemaEmphysema
Enlargement of air spaces and destruction of Enlargement of air spaces and destruction of lung tissuelung tissue
Types: centriacinar and panacinar Types: centriacinar and panacinar Smoking historySmoking history Age of onset: 40 – 50 yearsAge of onset: 40 – 50 years Often dramatic barrel chestOften dramatic barrel chest Weight lossWeight loss Decreased breath soundsDecreased breath sounds Normal blood gases until late in disease processNormal blood gases until late in disease process Cor pulmonale only in advanced casesCor pulmonale only in advanced cases Slowly debilitating diseaseSlowly debilitating disease
Chronic BronchitisChronic Bronchitis Obstruction of small airwaysObstruction of small airways Smoking historySmoking history Age of onset 30 – 40 yearsAge of onset 30 – 40 years Barrel chest may be presentBarrel chest may be present Shortness of breath predominant early Shortness of breath predominant early
symptomsymptom Rhonchi often presentRhonchi often present Sputum frequent early manifestationSputum frequent early manifestation Often dramatic cyanosisOften dramatic cyanosis Hypercapnia and hypoxemia may be presentHypercapnia and hypoxemia may be present Frequent cor pulmonale and polycythemiaFrequent cor pulmonale and polycythemia Numerous life threatening episodes due to Numerous life threatening episodes due to
acute exacerbationsacute exacerbations
Cystic FibrosisCystic Fibrosis
DefinitionDefinition An autosomal recessive disorder An autosomal recessive disorder
involving fluid secretion in the exocrine involving fluid secretion in the exocrine glands, the epithelial lining of the glands, the epithelial lining of the respiratory, gastrointestinal and respiratory, gastrointestinal and reproductive tractsreproductive tracts
CauseCause Mutations in a single gene on the long Mutations in a single gene on the long
arm of chromosome 7 that encodes for arm of chromosome 7 that encodes for the cystic fibrosis transmembrane the cystic fibrosis transmembrane regulator (CFTR), which functions as a regulator (CFTR), which functions as a chloride (Clchloride (Cl--) channel in epithelial cell) channel in epithelial cell
Manifestations of Cystic Manifestations of Cystic FibrosisFibrosis
Pancreatic exocrine deficiencyPancreatic exocrine deficiency PancreatitisPancreatitis Elevation of sodium chloride in the Elevation of sodium chloride in the
sweatsweat Excessive loss of sodium in the sweatExcessive loss of sodium in the sweat Nasal polypsNasal polyps Sinus infectionsSinus infections Cholelithiasis Cholelithiasis
Diffuse Interstitial Lung Diffuse Interstitial Lung DiseasesDiseases
DefinitionDefinition A diverse group of lung disorders that A diverse group of lung disorders that
produce similar inflammatory and fibrotic produce similar inflammatory and fibrotic changes in the interstitium or interalveolar changes in the interstitium or interalveolar septa of the lungsepta of the lung
TypesTypes SarcoidosisSarcoidosis The occupational lung diseasesThe occupational lung diseases Hypersensitivity pneumonitisHypersensitivity pneumonitis Lung diseases caused by exposure to toxic Lung diseases caused by exposure to toxic
drugs drugs
Pulmonary EmbolismPulmonary Embolism DevelopmentDevelopment
A blood-borne substance lodges in a branch of A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flowthe pulmonary artery and obstructs the flow
TypesTypes Thrombus:Thrombus: air accidentally injected during air accidentally injected during
intravenous infusionintravenous infusion Fat:Fat: mobilized from the bone marrow after a mobilized from the bone marrow after a
fracture or from a traumatized fat depot fracture or from a traumatized fat depot Amniotic fluid:Amniotic fluid: enters the maternal enters the maternal
circulation after rupture of the membranes at circulation after rupture of the membranes at the time of deliverythe time of delivery
Prevention of Pulmonary Prevention of Pulmonary EmbolismEmbolism
Identification of persons at riskIdentification of persons at risk Avoidance of venous stasis and Avoidance of venous stasis and
hypercoagulability stateshypercoagulability states Early detection of venous thrombosisEarly detection of venous thrombosis
Secondary Pulmonary Secondary Pulmonary Hypertension Signs and Hypertension Signs and
SymptomsSymptoms
Dyspnea and fatigue Dyspnea and fatigue Peripheral edemaPeripheral edema AscitesAscites Signs of right heart failure (cor Signs of right heart failure (cor
pulmonale)pulmonale)
Cor PulmonaleCor Pulmonale Right heart failure resulting from Right heart failure resulting from
primary lung disease and long-standing primary lung disease and long-standing primary or secondary pulmonary primary or secondary pulmonary hypertensionhypertension
Involves hypertrophy and the eventual Involves hypertrophy and the eventual failure of the right ventriclefailure of the right ventricle
Manifestations include the signs and Manifestations include the signs and symptoms of the primary lung disease symptoms of the primary lung disease and the signs of right-sided heart failureand the signs of right-sided heart failure
Causes of ARDSCauses of ARDS Aspiration of gastric contentsAspiration of gastric contents Major trauma (with or without fat Major trauma (with or without fat
emboli)emboli) Sepsis secondary to pulmonary or Sepsis secondary to pulmonary or
non-pulmonary infectionsnon-pulmonary infections Acute pancreatitisAcute pancreatitis Hematologic disordersHematologic disorders Metabolic eventsMetabolic events Reactions to drugs and toxinsReactions to drugs and toxins
Causes of Respiratory Causes of Respiratory FailureFailure
Impaired ventilationImpaired ventilation Upper airway obstructionUpper airway obstruction Weakness of paralysis of respiratory Weakness of paralysis of respiratory
musclesmuscles Chest wall injuryChest wall injury
Impaired matching of ventilation Impaired matching of ventilation and perfusionand perfusion
Impaired diffusionImpaired diffusion Pulmonary edemaPulmonary edema Respiratory distress syndromeRespiratory distress syndrome
Signs and Symptoms of Signs and Symptoms of HypercapniaHypercapnia
Increased Increased PCOPCO22 HeadacheHeadache Conjunctival hyperemiaConjunctival hyperemia Flushed skinFlushed skin Increased sedationIncreased sedation TachycardiaTachycardia DiaphoresisDiaphoresis Mild to moderate increase in blood Mild to moderate increase in blood
pressurepressure