Exam 2 - Pulmonary and GI

Pulmonary Pain Patterns

substernal or chest region over the involved lung fields that may include the anterior chest, side, or back.

Pulmonary

Disease classifications for Lungs

Respiratory

Disease classifications for breathing tract

Occupational Lung Diseases

a group of preventable conditions caused by breathing in dust, gases, fumes, chemicals, or other harmful substances at work

Pneumoconiosis

“the dust diseases,” inhalation of minerals, notably silica, coal dust, or asbestos.

Pulmonary Disease Risk Factors

40+, smoker, PMH of cancer, upper respiratory infection, MSK pain with breathing, Dyspnea

Ventilation

Air from outside into the body

Respiration

Oxygen uptake and carbon dioxide elimination

Normal

PaO2: 80-100

Tachycardia

PaO2: 60-80

Nausea

PaO2: 50-60

Confusion

PaO2: 35-50

Cardiac arrest

PaO2: 25-35

Pulmonary Disease Signs

Cough, Dyspnea, Chest pain, Cyanosis Clubbing

Persistent

Cough from Tumor, congestion, or hypersensitive airways

Productive

Cough from clear- viral infection, Yellow/green- bacterial infection

pH

Blood acidity

PCO2

How well blood is exchanging with blood in the lungs

HCO3

Amount of alkaline substance in the blood

PO2

Pressure of O2 dissolved in arterial blood

O2 Saturation

Oxyhemoglobin saturation

Respiratory acidosis

results from hypoventilation and increased CO2

Respiratory alkalosis

Loss of acid due to hyperventilation.

Total lung capacity

the sum of all four primary lung volumes

Tidal volume

moves in/out with each breath

Residual volume

amount left after forceful expiration

Obstructive

Limitation of airflow usually resulting from increase in resistance - Difficulty in getting air out

Restrictive

Reduced expansion of lung tissue- difficulty in getting air in

Asthma

Increased responsiveness of the tracheobronchial tree to stimuli- increased resistance in the airway- difficulty getting air out

Extrinsic asthma

allergic reaction. more common

Intrinsic asthma

exercise, emotional stress, anxiety

Asthma Pathophysiology

Hyperreactive smooth muscle cells constrict

Asthma signs

Recurrent episodes of coughing or wheezing, Dyspnea , Chest pain , Prolonged expiration , Signs of respiratory difficulty

Spirometry

Shows evidence in airflow obstruction

Asthma Treatment

Relaxing smooth muscles (β-2 agonists), Control inflammation

Exercise Induced Asthma

Bronchoconstriction due to exercise

Exercise Induced Asthma Signs

SOB with exertion, Out of shape, Tired more easily than their peers, Cough

Exercise Induced Asthma Treatment

Beta agonist 15 minutes before exercise and then prn

Acute Bronchitis

Inflammation of the trachea and bronchi, most commonly caused by viruses

Chronic Obstructive Pulmonary Disease

Caused by environmental factors; Caused by Chronic Bronchitis and Emphysema

COPD Signs

Dyspnea, Cough, Wheezing, Barrel chest, grunting, Cyanosis

COPD

COPD

COPD Treatment

Stop smoking (nicotine patches, nicotine gum, Zyban)

Cystic Fibrosis

Inherited disease of exocrine glands; affects digestive, respiratory, sweat and reproductive tracts

Cystic Fibrosis Epidemiology

genetic disease in caucasians

Cystic Fibrosis Pathophysiology

Mucus plugs with lungs

Cystic Fibrosis Signs

meconium ileus at birth, respiratory disease

Cystic Fibrosis Diagnosis

Prenatal genetic testing, Sweat chloride test

Cystic Fibrosis Treatement

Oral pancreatic enzymes, Chest physical therapy, Aerosol treatments, CFTR modulators

Acute Respiratory Distress Syndrome

Acute onset of increased lung stiffness; Exudative fluid in the alveoli

ARDS Causes 

Septic shock, burns, Inhalation injury, severe trauma

ARDS

ARDS Treatment

Mechanical ventilation, High-dose corticosteroids

Chronic Restrictive Diseases 

Fibrosis of the interstitium, Gradual decrease in respiratory function  

Pneumoconiosis

dust particles of asbestos, coal dust

Hypersensitivity alveolitis

Immune reaction due to repeatedly inhaling mold, bacteria, bird droppings, etc. 

Sarcoidosis

Rare inflammatory disease where immune system overreacts and forms granulomas in organs

Idiopathic pulmonary fibrosis

Chronic, progressive disease that causes irreversible scarring and thickening of the tissue around the air sacs

Chronic Restrictive Disease Treatment

immunosuppressants, anti-inflammatories

Pneumonia

Inflammation of the lungs

Pneumonia Signs

Fever, chills, dyspnea, cough with rust or green sputum, chest pain, Cyanosis, rales or bronchial breath sounds

Pneumonia Tests

Sputum, CXR

Pneumonia

Pneumonia Treatment

Antibiotics, Antivirals

Pneumonia Prevention

Vaccine, most with risk in >65, infants, pregnant women

Tuberculosis

Caused by Mycobacterium tuberculosis

Tuberculosis Risk Factors

Elderly, poverty or crowded conditions, alcohol or drug abusers

Primary tuberculosis

obtained from Airborne droplets, coughing, sneezing, speaking

Secondary tuberculosis

Reactivation of a previously dormant lesion, Immunocompromised

Pott’s Disease

TB spreads to the spine

Miliary TB

TB droplets of bacteria travel through the bloodstream to multiple organs

Primary TB Signs

5% have signs, pneumoina signs

Secondary TB Signs

Reactivation of someone who was previously exposed, fatigue, malaise, anorexia, weight loss

Tuberculosis Tests

PPD (Purified Protein Derivative)- Detects if they have bacteria present

TB Treatment

(+) PPD and (-) CXR for 6-9 months

Lung Cancer Risk Factors

Cigarette smoking

Lung Cancer Signs

Silent, lesions often metastasize, chronic cough, hemoptysis

Lung Cancer Tests

Tissue diagnosis, CT, PET scan

Lung Cancer Treatment

Radiation, Chemotherapy, Immunotherpay

Pulmonary Embolus

Most from DVT, from sources of fat and air ______

Pulmonary Embolus Signs

Sudden onset of dyspnea, pleuritic chest pain, cough, hemoptysis

Pulmonary Embolus Treatment

Heparin Thrombolytic drugs

Atelectasis

Collapse of alveoli

Pneumothorax

Free air in pleural cavity

Tension Pneumothorax 

Allows air in with inspiration, Does not allow air to escape with expiration

Pneumothorax Signs

chest pain, decreased breath sounds, x-ray

Costochondritis

Inflammation of the rib joints

Gastrointestinal Disease Signs

Nausea, Diarrhea, Constipation, Heartburn, Weight loss

Odynophagia

Pain during swallowing

Dysphagia

Difficulty swallowing; Can be result of symptom of disorders unrelated to GI issues like stroke, Alzheimer’s disease, or Parkinson’s disease

Constipation

Condition of prolonged retention of fecal content in GI tract resulting from decreased motility of colon or difficulty expelling stool

Diarrhea

Abnormal increase in stool frequency and liquidity

Fecal Incontinence

Inability to control evacuation of stool and associated with sense of urgency, diarrhea, and abdominal cramping

Arthralgia

Inflammatory GI conditions have arthritic component affecting joints

Hypothesized antigen crosse

Kher’s Sign

pain in left shoulder when pressure placed on upper abdomen

Danforth sign

pain in shoulder with inspiration

Vitamin B12

can cause weakness of lower extremities and numbness