pulmonary vascular diseases/ malignancies of respiratory tract

Virchow's triad

-vessel injury

-venous stasis

-hypercoagulability

prevention of venous stasis

-bed exercises, early ambulation

-frequent position changes

-pneumatic calf compression

-prophylactic anticoagulation

-filter in inferior vena cava (prevent emboli from reaching lungs)

pulmonary embolism

-occlusion of portion of pulmonary vascular bed by thrombus, embolus, tissue fragment, lipids, air bubbles

-Virchow's triad

-release of neurohumeral substances that cause vasoconstriction

-leads to pulmonary edema, pulmonary HTN, shock, death

where do pulmonary emboli most commonly come from?

veins in deep thigh

pulmonary embolism symptoms

-sudden onset of pleuritic chest pain

-dyspnea, tachypnea

-tachycardia, unexplained anxiety

-V/Q imbalances

-decreased CO, shock

pulmonary artery HTN

-high blood pressure in blood vessels of lungs

-mean pulmonary artery pressure greater than 25 mmHg

-overproduction of vasoconstrictors and decreased production of vasodilators

-remodeling

-resistance to pulmonary artery blood flow

-workload of right ventricle increases

types of pulmonary artery HTN

-idiopathic (unknown cause)

-familial/inherited

-associated (from disease)

which type of pulmonary artery HTN is most common?

idiopathic

pulmonary HTN symptoms

-ECG shows right ventricular hypertrophy

-primary pulmonary or CV disease

-chest radiograph shows enlarged arteries

-diagnosis confirmed by right heart Cath

causes of pulmonary artery HTN

-elevated left ventricular pressure

-increased blood flow through pulmonary circulation

-obliteration or obstruction of vascular bed

-active constriction of vascular bed produced by hypoxemia or acidosis

lung cancer classification system

T=extent of primary tumor

N= nodal involvement

M= extent of metastasis

laryngeal cancer

-throat cancer

-between 2-3% of all cancers in US

-hoarseness, dyspnea, cough

-risk factors= tobacco smoke, alcohol consumption, GERD, HPV

bronchogenic carcinomas

-AKA lung cancers

-most frequent cause of cancer death in US

non-small cell carcinoma accounts for how much of all lung cancers?

85%

most common cause of lung cancer?

cigarette smoking

progression of lung cancer:

metaplasia to carcinoma in situ to invasive carcinoma to metastasis

mesotheliomas

-associated with asbestos

-may take 20-40 years before cancer appears

-presents as chest pain and dyspnea

types of non-small cell carcinomas

-squamous cell carcinoma

-adenocarcinoma

-large cell carcinoma

squamous cell carcinoma

-nonproductive cough or hemoptysis

-grows in proximal lung tissue close to hilum

what is the most common type of lung cancer?

adenocarcinoma

adenocarcinoma

-tumor arises from gland cells and goblet cells

-grows in peripheral tissues

-asymptomatic or pleuritic chest pain/SOB

-treatment= surgical resection

large cell carcinoma

-undifferentiated

-large tumors in proximal or peripheral lung tissue

-surgical therapy limited (palliative procedures)

-radiation and chemotherapy not helpful

small cell carcinoma

-worst prognosis

-tumor grows proximally at hilum

-involves neuroendocrine cell s

-limited vs. extensive disease

neuroendocrine

-approximately 14% of all lung cancers

-formation of neuroendocrine cells results in paraneoplastic syndrome

-results from small cell carcinoma and squamous cell carcinoma

-release lots of substances that mimic hormones