Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Dr. Berry

where does gas exchange not occur?

respiratory pathways like nasal passages, pharanyx

ventiliation

air simply moving in and out

respiration

breathing on a cellular level with mitochondria

which pathogen is the most common cause of respiratory infections?

viruses

what are the 3 classifications of respiratory tract infections?

• upper respiratory- nose, oropharnyx, larnyx

• lower respiratory- lower airways and lungs

• upper and lower- trachea, bronchi

this respiratory tract infection is viral and occurs more frequently than any other respiratory infection and typically enters via nasal mucosa and eye membranes

the common cold (rhinoviruses)

rhinitis

runny nose

rhinosinusitis

inflammation of the sinuses

• most common causes are conditions that obstruct the ostia (parts of your sinuses that are hollow and open) that drain the sinuses

  • ex: upper respiratory infection, allergic rhinitis, nasal polyps(allergy related), barotrauma(pressure), swimming/diving, abuse of nasal decongestants

acute vs chronic rhinosinusitis

• viral, bacterial, or both….lasts 5 days to 4 weeks based on pathogen

• >12 weeks

s/s and diagnosis and treatment of rhinosinusitis

s/s: similar to common cold or allergic reaction, facial pain, headache, purulent nasal drainage

Diagnosis: Recent history an upper respiratory infection or allergic rhinnitis, Face pain on bending, unilateral maxillary pain, teeth pain, headache, purulent drainage, Inspection of the nose and throat

Treatment: depends on cause

this respiratory infection is highly contagious via respiratory droplets, is viral with 3 types, and prevented via yearly vaccination

influenza (flu)

• Types: A, B, C

prevention of influenza?

yearly immunization bc formulation changes yearly in response to evolving virus

• everyone 6 months of age and older

what is each years flu vaccine based on?

each year the flu vaccine is estimated based on the southern hemispheres bc their summers are different than the US

s/s and diagnosis and treatment

s/s: malaise(tiredness), fever, chills, muscle aches, headache, non-productive cough, sore throat.

D/treatment: early/accurate diagnosis is essential to limit spread of flu…treat symptoms

avian flu

began in birds, now found in pigs, cows, and humans

• contamination from birds/droppings

• No vaccine available; high mortality in humans

swine flu

H1N1

• most virulent in young adlts <25 years of age

• older adults typically have immunity due to previous exposure

• vaccine availble

inflammation of lower respiratory tract due to infectious and non-infectious agents due to inhalation.

pneumonia

what are the 3 classifications of pneomonia

• typical vs atypical

• lobar vs bronchopneumonia

• community vs hospital acquired (nosocomial)

typical vs atypical

Typical caused by bacteria, atypical caused by viruses and mycoplasma

• ex: mold, yeast, etc

lobar vs bronchopneumonia

Lobar involves part or all of a lobe of the lung, bronchopneumonia involves more than one lobe of the lung

community vs hospital acquired (nosocomial)

 Community acquired due to pathogens acquired outside of the hospital/nursing home and is diagnosed within 48 hours of admission to a hospital

 Hospital acquired lower respiratory tract infection not present on admission to the hospital and diagnosed > 48 hours after admission (hard to treat)

serves as an important cause of mortality in older adults due to aspiration…smokers have a higher risk of developing this type of pneumonia

acute bacterial pneumonia

aspiration

swallowing gastric contents which can lead to acute bacterial pneumonia

A rod-shaped aerobic bacteria that is difficult to eradicate and can lay dormant for many years…acid fast bacilli and is an airborne infection

Tuberculosis (TB)

most frequent site of infection for TB? What type of damage? pg. 789 in textbook

Permeant lung damage

even with all the technology we still cant technically test for ____ ______

Ghon complex (looks like a golf ball with cottage cheese)

primary vs latent TB

Primary develops in previously unexposed persons while latent is someone previously exposed

TB has to be _____ to transmit to others

active; symptoms worse than a cold

diagnosis of TB

TB skin test, CXR, sputum culture (definitive takes up to 8 weeks)

histoplasmosis

a fungal lung infection, or pneumonia, caused by breathing in spores of the fungus Histoplasma from the environment.

overview of fungal infections? Where? Symptoms?

yeast and molds that are inhaled…most cases along major river valleys

• healthy people: mild, febrile, respiratory illness

• very young/old/immunosuppressed: high fever, generalized lymph node enlargement, enlarged spleen and liver, muscle wasting, anemia, etc.

leading cause of death in the US and highly correlated to smoking…and is increasing in women and young children

lung cancer

what percentage of lung cancer cases are correlated with smoking? Pack year history?

>80%

“pack year history” = # of years smoked x packs smoked per day

classification system of lung cancer?

non-small cell: can produce paraneoplastic syndormes (tumor releasing something it shouldn't...comes malignant very quickly)

small cell carcinoma: highly malignant, brain metastasis common (tiny cells about the size of white blood cells..not really treatable)

3 classes that fall under non-small cell

• squamous cell- common in male smokers, hypercalcemia

• adenocarcinoma- common in females and non-smoker, poor prognosis

• large cell carcinoma- metastasize early, poor prognosis

S/S of lung cancer are based on what 3 categories?

lung involvement (chronic cough, hemoptysis, wheezing)

metastasis

paraneoplastic manifestations (hypercalcemia- increases falls and bone fractures, ADH)

diagnosis and treatment of lung cancer

• careful history and physical

• CXR, bronchoscopy, cytologic studies, needle biopsy, CT scan, MRI, PET scan to identify metastasis

• staging

• surgery, chemo, radiation

what are the 2 respiratory disorders in neonates?

• respiratory distress syndrome (RDS)

• bronchopulmonary dysplasia (BPD)

respiratory distress syndrome (RDS)…treatment?

baby can look normal when born but then central cyanosis, retractions (chest caving inwards), grunting, decreased tidal volume (VT), increased respiratory rate

• very high; very shallow respiratory breaths

• artificial surfactant; doesn’t work for adults

bronchopulmonary dysplasia (BPD)

chronic lung disease in premature infants who were treated with long-term mechanical ventilation

• lungs are stuff which makes it hard to contract; most BPD babies are on ventilator dependent for life

S/S of bronchopulmonary dysplasia (BPD)

chronic respiratory distress, persistent hypoxemia on room air (21%), reduced lung compliance, increased air way resistant, serve expiratory flow limitation, ventilation/perfusion mismatch

respiratory disorders in children

upper airway infections: epiglottis, croup

lower airway infection: bronchiolitis

epiglotitis

bacterial, potentially fatal, anxious, respiratory distress

• develops rapidly; if we don’t catch early on child will die

• airway is too swollen...a tiny incision on neck/trachea to get air ventilation

croup

viral, inspiratory stridor, hoarseness, barking cough

• most common in children…adults don’t typically get croup

bronchiolitis (lower airway infection)

history of upper respiratory infection

• respiratory syncytial virus

respiratory failure (pg. 830 for help)

Increased work of breathing, grunting, decreased chest movement

 Cyanosis not relieved by oxygen administration

 Increased heart rate -> 150 beats per minute

 Very rapid breathing –rate is age dependent

 Very slow breathing –rate is age dependent

 Extreme anxiety or agitation

 Fatigue