Pulmonary Pathology

gas exchange

pH regulation

protection

speech

what are the functions of the pulmonary system

movement of gases in and out of the lungs

what is ventilation

ventilation AND distribution, diffusion, perfusion, and circulation

what is respiration

distribution

air traveling to areas of the lungs is known as

diffusion

movement of gases between the alveoli and blood

perfusion

the volume of blood pushed through the capillaries capillaries to the tissue

circulation

movement of blood through the body

hypoxemia

too little oxygen in blood

hypercapnia

too much carbon dioxide in blood

pulse oximetry and ABGs

how can hypoxia be measured

hypoventilation, impaired diffusion, reduced oxygen from altitude

what are causes of hypoxia

HCO3: 21-27

PO2: 80-100

PCO2: 35-45

SaO2: 95-100

pH: 7.35-7.45

what are normal ABG values

PCO2

what value of the ABGs indicates a respiratory issue?

Bicarb (HCO3)

what value of the ABGs indicates a metabolic issue?

pH:

What values would be abnormal for someone with respiratory acidosis

hypoventilation

obstructive disease

what can cause respiratory acidosis

pH: >7.45

PCO2:

what values would be abnormal for someone with respiratory alkalosis, what is a cause

hyperventilation

mechanical ventilation

what can cause respiratory alkalosis

H+

decreases

increased CO2 means more ___ production which __________________ pH

pH:

what abnormal ABG values are indicative of metabolic acidosis

pH: >7.45

HCO3: >27

what abnormal ABG values are indicative of metabolic alkalosis

gravity

perfusion increases in the direction of ___________

stretch-ability of lungs

surface tension

what contributes to lung compliance

trachea and bronchii

where is most of the resistance in the respiratory system

system length, viscosity, radius of tubing

what factors contribute to resistance

increased compliance

limited exhalation

increased lung volumes

what are characteristics of obstructive disorders (compliance, where air flow is limited, volume)

decreased compliance

limited inhalation

decreased lung volume

what are characteristics of restrictive disorders (compliance, where airflow is limited, volume)

chronic bronchitis

chronic swelling and inflammation of the bronchi and bronchioles due to irritation leading to the production of mucus

Chronic productive cough

what is the most common symptoms in someone with chronic bronchitis

a productive cough on most days for at least 3 months for 2 years

what is required for a diagnosis for chronic bronchitis

smoking

age

gender (male)

infections

exposure to chemicals

asthma

what are some risk factors for chronic bronchitis

emphysema

abnormal enlargement of alveoli accompanied by destructive changes to the alveolar walls

SOB, wheezing, thin appearance, barrel chest, pinkish skin color

what are clinical manifestations of emphysema

significant smoking

environmental exposure

lung infections

genetics

what are risk factors for emphysema

#packs/day*years smoked

how do we calculate pack years

COPD

obstruction of airflow through the lungs with airway inflammation, some combination of emphysema, chronic bronchitis, and asthma

remodeling and narrowing of airways

what does the chronic inflammation and obstruction present in COPD cause?

severely limited activity level

decreased time between exacerbations

digital clubbing

cardiac and respiratory failure

what are clinical manifestations of late stage COPD

right ventricle

it has to work harder to overcome the pressure in the pulmonary artery

what part of the heart will fail due to pulmonary HTN and vasoconstriction in the lungs, why?

chronic bronchitis

blue: hypoxia

bloater: right heart failure leading to systemic edema

in the term blue bloater, what disease is being described, and what is the reasoning behind the terminology

emphysema

pink: increased work of breathing

puffing: hyperventilation to compensate for poor O2

in the term pink puffer, what disease is being described, and what is the reasoning behind the terminology

smoking

age

gender (female)

environmental exposure

genetics

what are risk factors for COPD

alpha-1-antitrypsin protein deficiency

what is the genetic component that makes someone more at risk for emphysema or COPD

silhouetted

when air in the lungs is replaced by other things, the heart can be _____________

diaphragm- depressed

lung fields- hyper inflated (white infiltrate more in COPD due to mucus)

what will the diaphragm and lung fields look like in an Xray for someone with emphysema and COPD

pulmonary function test

this test involves forced exhalation from total lung capacity to residual volume

ERV+TV+IRV

what is forced vital capacity

the amount of air that can be forcefully expired in 1 second

what is FEV1

80-120% of normal

what is a normal FEV1

spirometry

this test is used to determine lung volumes and capacities

max inhale

forceful exhale

continue exhale till failure

what are the 3 phases of spirometry

increased RV and FRC

what will spirometry results show in someone with obstructive disorders

residual volume (air trapped in lungs)

what increases the total lung volume and functional residual capacity for someone with obstructive disorders

reduced lung volumes

what will spirometry results show in someone with restrictive disorders

decreased mobility of chest and lung tissues

what causes the decrease in volume for a person with restrictive disorders

FEV1/FVC

this pulmonary function test represents the portion of a persons vital capacity they can exhale in 1 second

FEV1

FEV1/FVC ratio

in obstructive disorder, what pulmonary test values will be reduced

FVC decreased

TLC decreased

in restrictive disorders, what pulmonary test values will be reduced

normal because restrictive disorders don't affect the ability to inhale or exhale, it just effects the amount of air intake

what do the FEV1 and FEV1/FVC ratio look like in a patient with restrictive lung disease, why?

1: >80%

2: 50-80%

3: 20-49%

4:

what are the COPD gold standards for FEV1? (mild, moderate, severe, very severe)

flow volume loop

how much airflow a person can produce when breathing, shown on a graph with a continuous line. Commonly used for testing in obstructive diseases

increase inspiration dip, with small expiration

what will a flow volume loop look like for someone with obstructive disorders?

respiratory acidosis (increased CO2 and normal HCO3)

what will ABGs look like for someone with obstructive disease

because there is air trapped in the lungs that can't exchange with the gases in the blood

why will someone with obstructive disease have respiratory acidosis

stopping smoking, oxygen therapy, vaccinations, exercise, surgery

how do we medically manage obstructive disorders

bronchodilators, corticosteroids or both

mucolytics, antibiotics, opiods

what medications will be used for obstructive disorders

shaky, increased HR, nervous

what are side effects of bronchodilators that are beta agonsists

pulmonary rehab, be aware of triggers, inhaler, strength training of proximal muscles

what are PT implications for obstructive disorders

asthma

increased reactivity of the trachea and bronchi to various stimuli leading to bronchoconstriction and increased mucus secretion secondary to inflammation

wheezing, cough, SOB, chest tightness, nighttime exacerbation

what are clinical manifestations of asthma

exercise, stress, cold

what are three "abnormal" risk factors for asthma

10-15 min

how long will it take for exercise induced asthma to present with symptoms

warm up and prolonged cool down

what two things can be done to help with exercise induced bronchoconstriction

reduced FEV1/FVC ratio

what will spirometry show for someone with asthma

short acting beta agonists and oral corticosteroids

what can be used for quick relief from asthma

inhaled corticosteroids, mixed beta-agonist/corticosteroid

what can be used for long term relief from asthma

exercise

what can increase VO2 max and increase pulmonary flow to help with asthma

intrinsic (lung tissue) and extrinsic (surrounding tissues and structures)

what are causes for restrictive diseases

P: pleural

A: alveolar

I: interstitial lung disease

N: neuromuscular

T: thoracic

PAINT describes the causes of restrictive lung disease (intrinsic and extrinsic) what does it mean

interstitial lung disease

a group of disorders characterized by fibrosis of the lungs

idiopathic

autoimmune/CT disorders

environmental exposure

what are the 3 causes of interstitial lung disease?

idiopathic pulmonary fibrosis

scarring of the lungs for an unknown cause

decreases

idiopathic pulmonary fibrosis has what effect on lung volumes

RR

decreased lung volumes leads to increased ____ in idiopathic PF

scarring interferes with oxygen exchange

what is the reason for decreased diffusion in idiopathic pulmonary fibrosis

rheumatoid arthritis

scleroderma

systemic lupus

what are examples of autoimmune/connective tissue disorders that cause interstitial lung disease

hypersensitivity pneumonitis

environmental and occupation exposure lead to what in interstitial lung disease

dust, mold spores, animal dander, chemicals

what types of things can cause hypersensitivity pneumonitis

crackles or diminished breath sounds

what will auscultation reveal in interstitial lung disease

clubbing and cyanosis

end stage restrictive lung disease will present with...

shaggy heart borders

fibrosis

what will imaging with ILD reveal

cause of lung disease

medical treatment of ILD is specific to...

reduce scarring and inflammation

what is the goal of treatment to ILD

corticosteroids, anti-fibrotics, immunosuppressives

what medications may be prescribed to someone with ILD

pulmonary rehab, know triggers, supplemental oxygen, strength training, postural/breathing exercise

what are PT implications for ILD

sarcoidosis

collection of granulomas throughout body especially found in lungs, lymph nodes, eyes and skin, believed to be an immune response

African Americans

Females

what race and gender are most affected by sarcoidosis

pneumonia

multistage inflammatory reaction of the distal airways due to inhalation of foreign material. Can be community or hospital acquired

fever

dyspnea

fatigue

shaking chills

chest pain

cough

what are clinical manifestations of pneumonia

increased infiltrate

what will an xray show for someone with pneumonia