Restrictive Lung diseases

main points

• parenchyma

• chest wall

• loss of volume

• restricted lung expansion

• extrinsic or intrinsic factors

MAIN TYPES

acute and chronic types

what is in the pleural cavity

full of tiny amount of serous fluid

acute types

• sudden

• lasts up to 6 weeks

• healthy before, can return to healthy

1. intrapulmonary restriction

2. extrapulmonary restriction

3. pressure restriction

Intrapulmonary restriction

• inside the lungs

• not the alveoli

e.g.

pneumonia

• inflammation and fluid build-up

pulmonary oedema

• fluid accumulation in lung tissue

• impairs gas exchange

Pulmonary oedema

• Cardiogenic

  • due to left heart failure or increased pul. capillary pressure

  ↑ HR = ↑ hydrostatic pressure

  = left-sided heart failure

• Non- cardiogenic

  • infection

  • sepsis

  • altitude sickness (epithelial damage)

  • inflammation

extrapulmonary restriction

• thoraxes - parenchyma

  • between parietal and visceral layer

    = pleural cavity

• Hydrothorax

  • accumulation of serous fluid in pleural cavity

• hemothorax

  • blood in cavity

  • trauma, capillary burst

• hemopneumothorax

  • blood and air

• Pneumothorax

  • air in lung

  • causes it to collapse

  • 3 types

how does normal inhalation happen

step by step

• ribs expand and move out, pulling the parietal layer with it

• this causes the pressure in the pleural cavity to ⇓

• causes the visceral layer to move out too

• causes the lung pressure to ⇓

• negative pressure gradient

  = air to enter the lungs

types of pneumothorax

• open

• spontaneous/ closed

• tension

Open pneumothorax

1. Open

• traumatic

• due to damage to the parietal layer

• air enters the pleural cavity

• so there isn’t a negative pressure in the P/C

- ribs expand

parietal pressure is pulled out

- should pull out the visceral layer

- the hole allows air to enter the p/c

- results is pressure equilibrium

- no pressure to pull the visceral layer

-visceral layer collapses

Treatment

• patch the hole, only 3 sides

• removes the air from the p/c during exhalation

• during inhalation, gets sucked in against the skin to seal it

  • doesn't allow air to enter

• chest tube-

spontaneous/ closed pneumothorax

• no external wound

• alveoli burst

• air enters the lungs itself

  • not the alveoli or caps

• bulla- pockets of air in the lungs

• rupture of blebs

• visceral layer is torn

• air leaks into the p/c

• diaphragm is not pushed down

• not fatal

• the bulla results is the p/c not decreasing enough

• so not enough pressure gradient for air to enter fully

• partial collapse of the lung

Blebs and bullas

air-filled blisters (blebs) that can form on the surface of the lungs

small, thin-walled, air-filled spaces on the surface of the lung

bullae form from small short leaks of air from the alveoli

if the bullae burst,

• hole in visceral pleura

• air enters the p/c

tension pneumothorax

• Emergency

• caused by a small hole in the parietal layer

• air can enter through the hole but can’t leave

  • trapped in the p/c

• acts as a one-way flap

• pneumothorax increases with each breath

• increases the pressure in the thorax

• will push structures

  • pushes the trachea, heart and large vessels

• It compresses the heart and lungs

  • leading to shock and respiratory failure.

• bore cannula needed asap

• chest drain

hypostatic pneumothorax

• lungs can’t expand properly

• Pneumonia that develops due to poor lung expansion and inadequate ventilation.

common in:

• Elderly, bedbound patients.

• Post-surgical patients who have shallow breathing.

pressure restrictive

• diaphragm, muscles, ribs and drugs

brainstem- breathing centre

drugs- opioids, suppress the respiratory centre

-hiccups

Chronic Types of restrictive diseases

permanent, irreversible damage is done

• pulmonary fibrosis

  • scared and thickened

  • can’t expand as much

• MS

  • neuromuscular disorders

• lobectomy

  • surgical removal of the lung lobe

  • reduced lung capacity

• Neuromuscular disorders

  • Gillian-Barre syndrome

  • muscles are weakened

• spinal problems

  • scoliosis

  • disrupts nerve signals to the lungs

• pectus excavatum

  • inwards chest

• Acities

  • fluid build-up in the abdomen

  • diaphragm can’t move down

• obesity

  • fat puts extra pressure on the chest

• tumours

  • damage the lung or physically prevent it from expanding fully

• pregnancy

  • abdominal organs shift upwards

  • less space for the lungs to expand

  • diaphragm can’t move down as much