[OT 105] Lec. 5 - Pulmonary System Pathology

Pulmonary Pathology

• diseases of the lungs, respiratory system

Pulmonary Pathology is categorized according to impact on

• lung function

• lung structure

This impairs gas exchange

ventilation and perfusion imbalance

Ventilation vs Perfusion

ventilation: process of air flow

perfusion: flow of blood

Hypoxemia

deficiency of oxygen in the blood

Symptoms of hypoxemia

Si Cee To Dad

• shortness of breath

• confusion

• tachycardia

  • the heart will try to compensate for the loss of oxygen = increased heart rate

• drowsiness

Hypoxia vs Hypoxemia

hypoxia: specific to tissues

hypoxemia: blood

Pathological processes usually encountered in pulmonary conditions:

IFEE

• inflammation

• fibrosis

• embolism and infarction

• edema and congestion

Inflammation

• typical response to injury or infection

• two types:

  • acute 

  • chronic

Fibrosis

• excessive formation of connective tissue

  • will be strong instead of elastic

• thickens and stiffens lung tissue

  • prevents air exchange

• compromises the surface area and effectiveness of air exchange in the alveoli

• it is permanent

Embolism and Infarction

• Pulmonary embolism: an embolus lodges in the pulmonary arteries

• Blood flow is blocked

  • formation of emboli and any obstruction in the pulmonary artery will block blood flow = ischemic processes = infarction

Edema and Congestion

• fluid and blood build-up in the lungs

• fluid in interstitial spaces, within the alveoli

• common in inflammation or heart failure

  • patients with history of heart failure = breathing may be compromised

• tends to limit the functionality of the lungs

  • limited space of lungs = introduction of substances may limit functionality

Congestion

prolonged state of fluid in a particular area

Classification of Lung Pathologies

ORPIP 

• Obstructive Lung Disease (OLD)

• Restrictive Lung Disease (RLD)

• Pulmonary Vascular Abnormalities (PVA)

• Infectious Disease (ID)

• Pulmonary Neoplasms (PN)

Obstructive Lung Disease

• Airway obstruction: air remains trapped in lungs

• difficulty exhaling

• can be: partial or complete

• airway resistant to airflow

  • preventing exhalation

O-bstructive = O-ut: characterized by difficulty expelling OUT air

Restrictive Lung Disease

• air cannot get into the lungs

• difficulty inhaling

• lung volume and capacities are reduced

• lungs’ ability to expand is restricted

• two types: extrinsic and intrinsic

Extrapulmonary Restrictive Lung Disease

ERLD, EXtra = EXtrinsic

• extrinsic

• problem in the structures surrounding the lungs

  • chest wall

  • neuromuscular junction: ms are no longer effectively innervated = cannot contract

  • diaphragm: problem with innervation = not enough space for lungs to expand

  • pleura

CNDP

• obesity

• kyphosis

  • kyphotic posture = obstruction of air coming into the lungs = cannot mechanically fill the lungs effecticely

  • we want our patients to maintain an upright position

• impairs lung filling

Intrapulmonary Restrictive Lung Disease - Acute

IRLD, INtra = INtrinsic

• intrinsic

  • problems within the structures of the lungs

• acute, minutes to days

• secondary to sepsis or shock

• common causes: SISA

  • infection

  • aspiration: common in dysphagia intervention. any abnormalities in lung sound = stop feeding and call medical attention

  • sepsis: infection and toxins circulating in the body, restricting functionality of the cell

  • severe trauma

• acute pancreatitis, cardiopulmonary bypass, fat emboli, viral infections (SARS, COVID)

  • limits the functionality of lungs

Intrapulmonary Restrictive Lung Disease - Chronic Causes

WADIA

• work-related

• drug-induced

• autoimmune

• idiopathic

• affects the interstitial or alveolar structures

important when you need more oxygen to be supplied to the tissues during strenuous activities

Pulmonary Vascular Abnormality

• structural issues with the vessels of the lungs

• diagnosed with image tests

  • looks at what is deposited in the structure and change in its structural integrity

  • note of the following:

    • shortness of breath

    • coughing 

    • chest pain

PVA is treated with

• medication

• surgery

  • if damage needs to be removed or obstructions need to be repaired

PVA can be

• congenital

  • malformations or abnormal connections

  • valve stenosis: abnormal narrowing of the valves

• acquired

  • if there are atherosclerotic changes: narrowing, blockage, and destruction of pulmonary vessels

Infectious Diseases

• pneumonias

• not completely separate between types of pneumonias

  • one pneumonia can lead to another type of pneumonia

• involves infection with bacteria, viruses, and fungi

ID is evidenced by

FEAS

• abscess formation

• empyema

• fibrosis

• scarring

ID leads to the following complications

complicated ID ni MAE

• meningitis

• arthritis

• endocarditis

ID - Types of Pneumonia

CCC PANN

• Community-acquired typical

• Community-acquired atypical

• Nosocomial

• Aspiration

• Necrotizing

  • dead tissue - bacterial activity - more damages

• Chronic

  • prolonged hosting of pathogens

• Pneumonia in Immunocompromised Hosts

  • people with HIV are more prone because they are more at risk of opportunistic infections

Pulmonary Neoplasms

• formation of tumors

• often associated with smoking

  • non-small cell lung carcinoma: benign

  • small cell lung carcinoma (metastatic): expect specific tumors that have made themselves prominent in the lungs

Benign vs Metastatic

benign: non-cancerous, grows slowly, does not spread

metastatic: amlignant, grows rapidly, and can spread

Implications for OT: Health promotion, occupational health, and workplace safety

• identification of home, community, and workplace hazards

• metals: cadmium

• dust: silica, coal dust, abestos SAC

• smokes and fumes

Implications for OT: Detection of signs of distress

STUCPTH

• sudden shortness of breath

• tachypnea

  • rapid breathing

• unexplained sharp pain

• cough with or without bloody mucus

• pale, clammy, cyanotic skin

• tachycardia

• hyperhidrosis

  • excessive sweating not related to heat or exercise

Implications for OT: cont.

• promotion of functional independence and symptom management during the performance of daily tasks

• early rehabilitation

• prevention of complications

• breathing optimization

  • Eating and swallowing require proper coordination of breathing and muscle control

• energy conservation

• task simplification

  • break down tasks into smaller steps

• adoption of assistive technology and adaptive equipment

• environmental modification

  • we can remove and minimize hazards