causes of pulmonary dysfunction

pain caused by pleuritis, when the pleura stretches during inspiration and are accompanied by a pleural friction rub

pleural pain

caused by muscle or rib pain (rib fracture)

chest wall pain

respiratory disorders that result in hypoventilation of alveoli lead to this

hypercapnia

hypoxemia may be due to problems with these 4 things

1. oxygen delivery to alveoli

2. ventilation of alveoli (v/q mismatch)

3. diffusion of oxygen from alveoli into blood

4. perfusion of pulmonary capillaries

common clinical causes of decreased oxygen delivery (leading to hypoxemia)

high altitude, low oxygen content of gas mixture, suffocation

the decrease in diffusion of oxygen from alveoli to blood (leading to hypoxemia) is dependent on these 2 factors

v/q mismatch

thickened membrane and decrease in surface area

most common cause of hypoxemia

V/Q mismatch

shunting aka very low V/Q is another cause of this

hypoxemia

causes of poor perfusion of capillaries (leading to hypoxemia)

diffusion impairment due to thickening of the surface (edema, fibrosis) and decrease in surface area (emphysema - destruction of alveoli)

gas exchange failure manifested by hypoxaemia is a main cause of this

acute respiratory failure

this can be a complication of a major surgical procedure (e.g. atelectasis, pneumonia, pulmonary edema, PE)

acute respiratory failure

this may be due to direct injury to the lungs, airways, chest walls, brain (indirectly) and liver

acute respiratory failure

respiratory failure is mostly characterized by a mix of these two things

hypercapnia (pts need ventilatory support), hypoxemia (pts need oxygen therapy)

causes of ventilatory failure (due to chest wall restriction)

deformity, trauma, immobilization (pain/disease/fat tissue)

causes of impairment of respiratory muscle function (due to neuromuscular disease)

due to conditions like muscular dystrophy, myasthenia gravis, guillain-barre syndrome

caused by instability of a portion of the chest wall from rib or sternal fractures (3+ contiguous ribs broken in 2+ places)

flail chest

caused by a rupture in the visceral pleura or the parietal pleura and chest wall

pneumothorax

cause of this pneumothorax can be idiopathic. happens spontaneously due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space.

primary (spontaneous) pneumothorax

cause of this pneumothorax is disease (COPD), trauma, injury (mechanical ventilation)

secondary pneumothorax

cause of this pneumothorax is medical treatments, especially transthoracic needle aspiration

iatrogenic pneumothorax

this pneumothorax is caused by a flap-valve leak that allows air to enter pleural space during inspiration but prevents its escape by closing during expiration.

tension pneumothorax

this pneumothorax is often a complication of an untreated simple pneumothorax

tension pneumothorax

this pneumothorax is caused by a rupture in the visceral pleura or the parietal pleura and chest wall and results in inadequate ventilation

open pneumothorax

this pneumothorax is an open wound to the chest wall that may be caused by blunt trauma

open pneumothorax

these types of effusions are most commonly caused by congestive heart failure

transudative pleural effusion

these types of effusions are commonly caused by inflammation, infection, or cancers.

exudative pleural effusions

these types of effusions are commonly caused by injury, infections, or specific lymphatic disorders

chylothorax pleural effusions

these types of effusions are caused by blood accumulation in the pleural space, most commonly caused by trauma

hemothorax

these types of effusions are caused by pus accumulation in the pleural space, usually as a complication of pneumonia, infections, inflammation, or lung abscesses

empyema

caused by passage of fluid and solid particles into the lungs

aspiration

collapse of lung tissue due to external compression on the lung (e.g. by a tumor, fluid/pleural effusion, air/pneumothorax, abdomen distention)

compression atelectasis

type of atelectasis that is caused by airway obstruction that prevents air from reaching alveoli.

absorption atelectasis

airway obstruction that can also be caused by inhalation of concentrated oxygen (during anesthesia) because o2 gets absorbed quickly and leaves alveoli empty

absorption atelectasis

how does absorption atelectasis disrupt pores of khan function

because there is a lack of collateral ventilation through Pores of Khan and the collapse worsens

this type of atelectasis is caused by low or dysfunctional surfactant

surfactant impairment/contraction atelectasis

how does low or dysfunctional surfactant cause surfactant impairment/contraction atelectasis?

surfactant normally reduces surface tension and keeps alveoli open.

without enough surfactant → alveoli stick together and collapse.

chronic bronchial inflammation (usually due to infection), leading to destruction of elastic and muscular components of the airway wall.

bronchiectasis

this condition leads to

• bronchial lumen obstruction.

• traction from adjacent fibrosis.

• an initial insult followed by ongoing inflammation and/or infection if left untreated.

bronchiectasis

this condition occurs in adults with chronic bronchitis or those with a viral infection or who have inhaled toxic gases *most common in children

bronchiolitis

this condition can occur with all causes of bronchiolitis, and is commonly caused by breathing in toxicants over time or after lung transplantation (due to new drugs, scarring changes)

bronchiolitis obliterans

occurs due to

- chronic inflammation.

- alveolar epithelialization

- myofibroblast proliferation.

pulmonary fibrosis

more specifically, pulmonary fibrosis may be caused by

• inhalation of toxic gases

• Inhalation of inorganic dusts (pneumoconiosis: silicosis, asbestosis).

• inhalation of organic dusts

• underlying autoimmune system disorders (rheumatologic disease).

• idiopathic

significant respiratory dysfunction (pulmonary fibrosis) from inhalation of gaseous irritants causes damage to these aspects of the airway

damage to airway epithelium, cilia, and alveoli

this condition occurs due to changes in lung from inhaled inorganic dust particles, typically occurs in the workplace

pneumoconiosis

caused by inhalation of organic particles or fumes (e.g., bird droppings, feathers, wood dust, animal pelts, grain molds, fumes from paint or resins).

hypersensitivity pneumonitis

caused by prolonged exposure to high concentrations of supplemental oxygen.​

oxygen toxicity

caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, and capillary permeability.

pulmonary edema

most commonly caused by left sided heart disease

pulmonary edema (cardiogenic)

severe, life-threatening inflammatory conditions caused by acute lung inflammation, fluid build-up, and diffuse alveolocapillary injury

acute lung injury (ALI) / acute respiratory distress syndrome (ARDS)

most common predisposing factors to these conditions are genetics, sepsis, and multiple traumas

acute lung injury (ALI) / acute respiratory distress syndrome (ARDS)

these obstructive diseases are associated with an abnormal inflammatory response of the lung to noxious particles or gases.

obstructive pulmonary disease

unifying symptom of obstructive pulmonary disease

dyspnea

unifying sign of obstructive pulmonary disease

wheezing

one half of all cases in this obstructive disease develop during childhood and have familial disorder

asthma

hygiene hypothesis -> decreased exposure to certain infectious agents creates immunologic imbalance that favors development of these conditions

allergy and asthma

primary cause of this obstructive disease is tobacco smoke

COPD

this obstructive disease may also be caused by

• occupational dusts and chemicals.

• indoor and outdoor air pollution.

• any factor that affects lung growth during gestation and childhood.

COPD

this condition may be caused by an Inherited mutation in the alpha-1 antitrypsin gene.

COPD (more specifically emphysema)

a classic sign of this is a productive cough. may also seen hypersecretion of mucus

chronic bronchitis

this type of COPD is continuous bronchial irritation/inflammation that is caused by inspired irritants (e.g., tobacco smoke), which increase mucus production and bronchial edema.

chronic bronchitis

this type of COPD is caused by a loss of elastic recoil in the alveoli and airways.

emphysema

this emphysema is caused by an inherited deficiency of the enzyme α1-antitrypsin.

primary emphysema

this emphysema is caused by cigarette smoke (main cause), air pollution, occupational exposures, childhood respiratory infections.

secondary emphysema

this type of emphysema tends to occur in smokers with chronic bronchitis (bc irritants aren't able to make all the way to distal alveoli)

centriacinar (centrilobular) emphysema

this type of emphysema is strongly associated with a genetic condition called alpha-1 antitrypsin deficiency. affects entire acinus

panacinar emphysema

lower respiratory tract infection caused by viruses, bacteria, fungi, protozoa, parasites

pneumonia

this lung infection is caused by a virus (e.g., influenza is the most common viral cause).

• can be a primary infection or a complication of other viral infections.

viral pneumonia

this disease is caused by Mycobacterium tuberculosis, an acid-fast bacillus

tuberculosis

a pus-filled cavity in the lungs caused most commonly by aspiration

lung abscess

this infection/inflammation of airways or bronchi commonly follows a viral illness (e.g., a cold).

acute bronchitis

this occlusion commonly arises from deep veins in the thigh

pulmonary embolism

risk factors of pulmonary embolism

virchow's triad: venous stasis, endothelial injury, hypercoagulability

causes of pulmonary artery hypertension

- elevated LV pressure

- increased blood flow through the pulmonary circulation

- obliteration or obstruction of the vascular bed

- active constriction of the vascular bed produced by hypoxemia or acidosis

risk factors for this cancer are

- tobacco smoke

- heightened with smoking and alcohol consumption

- gastroesophageal reflux disease

- human papillomavirus (HPV)

laryngeal cancer

this cancer is most commonly caused by cigarette smoking and is the most frequent cause of cancer death in the US

bronchogenic carcinomas

most common type of lung cancer

adenocarcinoma

risk factors for all of the non-small-cell lung cancers

cigarette smoking

asbestos exposure is the most common cause of this cancer

mesotheliomas