the respiratory system

Hyaline membrane disease

• a disorder affecting premature infants or those born at less than 37-week gestation

• Incomplete maturation of the Type II alveolar cells within the surfactant-producing system causes unstable alveoli

• Signs include rapid and labored breathing within the first 24 hours after delivery with the atelectasis and respiratory failure progressively worsening

Deficiency of surfactant

This deficiency will result in alveolar collapse with atelectasis

Cystic Fibrosis

• generalized disorder resulting from a genetic defect trasnmitted as an autosomal recessive gene that affects the function of exocrine glands

• Basic cause of the disorder remains unknown

• Barrel-shaped chest deformity, clubbing of fingers and cyanosis occur as the disease progresses

Treatment consist of maintenance of a proper thermal environment and satisfactory levels of tissue oxygenation, which is monitored frequently via ABG measurements

Treatment for Hyaline Membrane Disease

Antimicrobial drugs, bronchodilators administered through inhalers, respiratory physical therapy and in some cases, a lung transplant may be performed in patients with endstage lung disease

Treatment for CF

Pneumonia

• an infection in the lungs

• Main cause are bacteria, virus and mycoplasma

Pneumonitis

• inflammation without infection

• Generally caused by a hypersensitivity to dusts and chemicals

1. Pneumococcal lobar pneumonia

2. Staphylococcal pneumonia

3. Streptococcal pneumonia

4. Legionnaire’s disease

5. Mycoplasma pneumonia

6. Aspiration (chemical)pneumonia

Types of pneumonia (6)

Pneumococcal (lobar) pneumonia

• most common bacterial pneumonia

• Bacteria is usually present in healthy throats

• Generally preceded by an upper respiratory infection

• Accompanied by chills, cough, and fever

• Affects the alveoli of the lobes of the lung, without affecting the bronchi

• Giving antibiotics and bedrest

• Immunization with polysaccharide pneumococcal vaccine is recommended for children under 2 yrs of age and older adults

Treatment for lobar pneumonia

Staphylococcal pneumonia

• occurs sporadically

• Severe and fatal especially in infants

• The spread of patchy areas localized in and around the bronchi

Pneumatocele

Thin-walled, air-containing cyst is the characteristic radiographic lesion and is more typically seen in children, may enlarge and form abscesses

Drug therapy with chemotherapeutic agents

Treatment for staphylococcal pneumonia

Streptococcal pneumonias

• even more rare

• Appearance localized around the bronchi, in the lower lobes

Antibiotic therapy

Tx for streptococcal pneumonia

Legionnaire’s disease

• Name given to a severe, bacterial pneumonia that became known after it caused deaths of four people attending an American Legion convention in Philadelphia in 1976

• L. Pneumophila is the causative bacteria

• Malaise, muscular aches, chest pain with nonproductive cough and occasional vomiting and diarrhea

• Risk factors include smoking, alcohol abuse and immunosupression from corticosteroids

Primarily antibiotic administration (Erythromycin or azithromycin) and oxygen therapy

Treatment for Legionnaire’s disease

Mycoplasma pneumonia

• common in children and young adults

• Radiographicallyy, appears as a fine, reticular pattern in a segmental distribution followed by patch areas of air space consolidation

• In sever cases, may mimic tuberculosis

• Caused by mycoplasmas (the smallest group of living organisms)

Aspiration (chemical) pneumonia

• caused by acid vomitus aspirated into the lower respiratory tract, resulting in a chemical pneumonitis

• May follow anesthesia, alcoholic intoxication, or stroke caused by loss of the cough reflex

• CXR wll show edema of the air passages showing as densities radiating from one or both hila to the dependent segments

• correction of hypoxia, control of secretions and replacement of fluids

• Further infections is treated by antimicrobial drugs

Tx of chemical pneumonia

COVID-19

• severe RDS associated with coronavirus

• Can be easilh transferred through droplets from the nose and mouth

• Symptoms may appear between 2-14 days after exposure to including cough, shortness of breath with DOB, fever, and sore throat

• Some infected people are asymptomatic and can act as carriers

• Primary findings on CXR and CT are pneumonia

SARS-CoV-2

Virus associated with COVID-19 disease

March 2020

When did WHO declared COVID-19 as a world pandemic?

CXR

Typically the first imaging modality used in pt with a suspected COVID-19 infection

CT scan

The most sensitive modality for earlier detection of pneumonia related to the disease (covid)

Remdesivir

Tx that is FDA approved for covid

• sinovac Biotech

• AstraZeneca

• Pfizer-BioNTech

• Moderna

• Johnson & Johnson

• Sputnik V

Vaccines for COVID-19 in PH

Bronchiectasis

• a permanent, abnormal dilation of one or more large bronchi occuring as a result of destruction of the elastic and muscular components fo the broncial wall

• Either congenital or acquired weakness

• Most common symptom is a chronic cough, but some are asymptomatic

• The cough becomes more productive with abscess in the broncial wall as it progresses

• Pt may complain of pleuritic pain, recurrent fever, wheezing and shortness of breath

• CXR demonstrated increased bronchovascular markings and parallel lines outlining the dilated bronci (Tram Lines)

Pulmonary Tuberculosis

• infection caused by inhalation of mycobacterium tuberculosis

• May also affect the genitourinary system, skeletal system and the CNS

• Prevalent in individuals in correctional facilities and homeless shelters and IV drug users

• Signs appear when the lesion or nodular scars are large enough to be seen on a chest radiograph

• Lesions may seen more commonly on the apical region of the chest

Asymptomatic; skin test

Early pulmonary TB is ____, and may be identified only with a _____

Anti-TB chemotherapy

• 3 to 4 drug regimen

• Once per day

• 3 times per week

• Infectivity drops to minimal after 2 weeks of treatment

Directly observed treatment, shourt course (DOTS)

The TB patient takes every dose of the medication under the direct observation of health personnel or a designated person.

• six months treatment

• Occasionally 9 months to 1 year

• Infectivity drops to minimal after 2 weeks of treatment

• Chemotherapy is very effective, success rate is very high

Chronic Obstructive Pulmonary Disease (COPD)

• a group of disorders that cause chronic airway obstruction

• The most common forms are chronic bronchitits and emphysema

• Predominant risk factors are cigarette smoking air pollution, airborne chemical fumes and inhalation of hazardous dust such as silica

Chronic Bronchitis

• most often arises from long term, heavy cigarette smoking, or prolonged exposure to high levels of industrial air pollution, which irritates the mucous lining of the bronchial tree, increasing susceptibility to both bacterial and viral infections

• Persistent cough and expectoration are the primary symptoms of this disease

• CXR demonstrate hyperinflation of the lungs

1. Elimination of the causative agent

2. Pulmonary rehabilitation helps manage the disease

3. Antibiotics can reduce the presence of infection

4. Bronchodilators are used to reduce bronchospasm

5. Oxygen therapy may be prescribed for patients

with severe hypoxemia

Tx of Chronic Bronchitis

Emphysema

• a condition in which the lung’s alveoli became distendedm usually from loss of elasticity or interference with expiration

• Primary symptom is dyspnea which at first demostrated only during exertion but eventually even at rest

Hyperinflation

results as the disease progresses

appearing radiographically as a depressed or flattened

diaphragm abnormally radiolucent lungs and an

increased retrosternal air space or barrel-shaped

chest.

Pneumoconioses

• A group of occupational diseases in which inhalation of foreign inorganic dust materials result in pulmonary fibrosis.

silica, coal, asbestos,

and beryllium

Fibrogenic inorganic dusts responsible for

pneumoconiosis

a. Silicosis

b. Anthracosis

c. Asbestosis

The three primary types of pneumoconioses are? (3)

preventing infection, relieving any

respiratory symptoms & maintaining adequate

oxygenation

Tx for pneumoconioses

Silicosis

• Inhaling of silica (quartz) dust and common among

miners, grinders and sandblasters

• The most widespread and most serious type

• Occurs following 10-30 years of exposure to silica dust

• characterized radiographically by multiple small,

rounded opaque nodules throughout the lungs

• sometimes referred to as “eggshell calcifications”

Except for lung transplantation, no Tx exists

Tx for Silicosis

anthracosis

• Commonly referred to as the “Black lung disease”

• results from inhaling of coal dust over an

extended period of about 20 years and is

associated with coal workers.

No real Tx exists

tx for anthracosis

Asbestosis

• Results from inhaling asbestos dust

• Radiographically, diaphragmatic pleural calcifications

are very suggestive of this disease

• The pulmonary fibrosis is predominantly distributed in

the lung bases

Lung Abscess

• A localized area of dead lung tissue surrounded by

inflammatory debris

• may result from pneumonia, periodontal disease,

neoplasm or other organisms that invade the lungs.

• Clinical manifestations include fever, cough,

expectoration of pus and foul sputum

Empyema

consist of accumulation of pus in the

pleural cavity

includes antibiotic therapy, chest

physical therapy, postural drainage and possible fluid

drainage via bronchoscopy

Tx for lung abscess

Pleuritis

• Inflammation of the pleura used to indicate

inconsequential thoracic pain.

• indicative of serious condition such as pneumonia,

pulmonary embolism, tuberculosis or malignant

disease.

• Pain in varying intensity is usually distributed to one

side or the other and along the intercostal nerve

roots

Pleural effusion

• Excess fluid collection in the pleural cavity

• a frequent manifestations of serious thoracic disease,

usually pulmonary or cardiac in origin.

• Maybe caused by inflammation, as in pleurisy or a

neoplasm

• Radiographic signs include blunting of the costophrenic

angle best seen on an erect lateral projection of the

chest

hemothorax

Pleural effusion containing blood is called _____,

& most frequently follows trauma to the thorax or

thoracic surgery

Lateral decubitus; thoracocentesis

____ are of great value in diagnosing

effusion as well as ______, to remove excess

fluids

Sinusitis

• the infection and inflammation of the paranasal sinuses

• Common causes are exposure to extremes in humidity

and temperature or a deviated septum and its

symptoms include nasal discharge and a headache

Radiography

is important in diagnosing sinusitis and

an upright sinus radiographs will demonstrate

increased density and possible air-fluid levels in the

affected sinuses.

CT scan

is the modality of choice, provides better

definition of the extent and degree of sinusitis

nasal polyps

Chronic sinusitis may cause ____

typically involves a saline nasal spray ,

antibiotic therapy and analgesics for pain relief.

Surgery can be done if due to a deviated septum.

Tx for sinusitis

Atelectasis

• It means incomplete expansion of the lung as a result

or partial or total collapse.

• In trauma situations, this often occurs in combination

with a penetrating wound to the chest

Compression

occurs when blood, pleural effusion

and pneumothorax and other space occupying lesion

cause collapse

Absorption

occurs when air is completely absorbed

from the alveoli beyond an obstructed bronchus

accomplished with

appropriate respiratory therapy such as coughing and

deep breathing. Bronchoscopy may also be used to allow

suctioning of secretions that are causing an

obstruction. Thoracentesis is used to relieve the

compression caused by an effusion.

Tx for acute atelectasis

Pneumothorax

• occures when fere air is trapped in the pleural space adn compresses the lung tissue

1. penetrating chest trauma such as stab wounds

2. gunshot wounds

3. fractured ribs

4. thoracentesis needle

3. spontaneous blowout of a bleb (a flaccid vesicle,

like a blister)

• Common causes of pneumothorax

Bronchial carcinoid tumors (adenoma)

• Usually benign but it is included under the WHO

classification of lung cancer due to its tendencies to

invade local tissues, sometimes metastasize to

regional lymph nodes and are treated much like

other malignant neoplasms

• Rare, occur equally in both sexes, affecting adults in

their mid-40s and often have a prolonged course of

disease

• Slow growing and often asymptomatic

Bronchogenic Carcinoma

• carcinoma of the lung that arise from the epithelial tissue in the major bronchi near the hilar area and metastasize via the lymph nodes, the bloodstream or both

• The most common fatal primary malignancy of the lung

• Accounts for more deaths in males than in females

• Occurs in individuals between the ages of 45 annd 70 years, especially among cigarette smokers

1. Non-small cell lung cancer (NSCLC)

2. Small cell lung cancer (SCLC)

Two major categories of Bronchogenic Carcinoma

1. Squamous cell carcinoma

2. Adenocarcinoma

3. Undifferentiated large cell carcinoma (NSCLC)

4. Undifferentiated small cell carcinoma (SCLC)

Four main histologic types of Bronchogenic Carcinoma

6 mm

CXR for bronchogenic carcinoma is essential for the diagnosis but the lesion must be larger than ___ to be visible

CT scan

Is essential in demonstrating nodules smaller than 6 mm, shows calcifications to help differentiate malignant lung tumors from benign and is useful in staging bronchogenic carcinoma

PET-CT

This modality is used for Bronchogenic Carcinoma that can assist in determining metastases to the liver, brain and adrenal glands

MRI

• is of limited value, but helpful in assessing tissue planes and the chest wall before surgery and in cases where apical tumors have invaded the vertebral column

Nuclear medicine bone scans

maybe used to screen

for bone metastases

surgery, chemotherapy,

external radiation therapy, brachytherapy or any

combination of these modalities depending on the

type, location, and stage of disease

Tx for Bronchogenic Carcinoma