Pathophysiology - Lecture 14 - Respiratory Disorders I

Hypercapnia

-excessive carbon dioxide

-Causes respiratory acidosis

Hypoxemia

deficient amount of oxygen in the blood

Hypocapnia

-insufficient carbon dioxide

-causes respiratory alkalosis

-caused by hyperventilation

-tx is brown paper bag

external respiration

exchange of gases between alveolar air (lungs) and blood

internal respiration

exchange of gases between the blood and the tissues (cells) of the body

Where are the pulmonary capillaries located?

pulmonary capillaries outside of alveolar wall

ventilation

movement of air in and out of the lungs

perfusion

blood flow reaching alveoli

What should the ratio be between ventilation and perfusion in order to have a healthy patient?

ventilation and perfusion must be equal to have a healthy patient

What will affect the ventilation-perfusion ratio?

-partial pressure gradient

-thickness of respiratory membrane

-fluid build up

-lose surface area (i.e. emphysema patient)

Oxygen is bound to what?

to the heme in hemoglobin

Affinity

the binding and release of oxygen to hemoglobin

Higher the affinity,

the more the hemoglobin binds to the oxygen

What lowers the Affinity?

-higher temperature

-higher carbon dioxide

-higher acidity (lower pH)

How does carbon dioxide return as?

bicarbonate ion

Dx test for respiratory diseases

-spirometer

-arterial blood gas

-pulse ox

-imaging

-scope

-sputum

yellowish-green sputum

-bacterial infection

rusty or dark-colored sputum

-pneumococcal pneumonia

purulent sputum with foul odor

-bronchiectasis

bronchiectasis

scar tissue on bronchioles

thick, tenacious mucus

-asthma

-cystic fibrosis

-tumor

-tuberculosis

Hemoptysis

-blood-tinged (bright red) frothy sputum

-pulmonary edema

-left sided CHF

Eupnea

normal breathing

Kussmaul Respirations

deep rapid respirations

Wheezing or whistling sound

obstruction in small airways

Stridor

-high-pitched crowing noise

-usually indicates upper airway obstruction

Rales

light bubbly or crackling sounds

Rhonchi

deeper or harsher sound like snoring

Dyspnea

-Subjective feeling of discomfort

-SOB

Severe Dyspnea

-flaring of nostrils

-use of accessory respiratory muscles

-retraction around ribs

Orthopnea

-difficulty breathing when lying down

-pulmonary edema/pulmonary congestion

Paroxysmal nocturnal dyspnea

-left-sided CHF

-sudden acute type of dyspnea

Cyanosis

-bluish coloring of skin and mucous membranes

-not getting enough oxygen

Pleural pain

results from inflammation or infection of parietal pleura

Friction rub

chronic with scar tissue

Clubbed digits

-fibrotic enlargement at the end of the digits

-chronic hypoxia

-respiratory or cardiovascular diseases

Common cold

-virus

-rhino virus

-Corona virus

sinusitis

-bacterial infection

-in the forehead

Croup (Laryngotracheobronchitis)

-children/baby

-virus

-barking cough

-young kids

-bacterial infection

-epiglottis swollen

-trouble of obstruction airway/swallowing

Bron

-caused by RSV

-children

-viral

-self limiting

-some severe

-treated with antibody serum

Flu

-viral

-constantly mutating

-patients get viral or bacterial pneumonia as a secondary infection

Scarlet Fever

-bacteria

-Streptococcus infection

-strawberry tongue

-can lead to rheumatic fever

Cause of Pneumonia

-2/3 bacteria

-1/3 viral

-1% fungal

Lobar Pneumonia

-bacterial

-strept

-one or more lobes

-productive cough from alveoli

-rusty sputum

-empyema

empyema

pus in pleural cavity

s/s lobar pneumonia

productive cough with rusty-colored sputum

Bronchopneumonia

-bronchioles in both lungs

-bacterial

-antibacterial tx

-yellow or green sputum

-productive cough

Legionnaires' Disease

-pneumonia

-bacteria

-higher fatality rate

-harder to dx

Atypical Pneumonia

-bacterial

-virus

-unproductive cough

-outside of alveoli in interstitial space

Severe Acute Respiratory Syndrome (SARS)

-virus

-respiratory droplets

-fever, headache, fatigue, diarrhea

-dry cough

-SOB

-atypical pneumonia

SARS tx

-antiviral and steroids

-more lethal than Covid

Cause of Tuberculosis

-oral droplets from ACTIVE infection

-resistant bacteria

Where do we see TB?

over crowded conditions

What happens first when a patient is exposed to TB?

The patient is first exposed to TB.

What happens to TB after it enters the lungs?

TB is engulfed by macrophages.

What does TB have that helps it survive in the body?

TB has defenses.

What occurs if cell-mediated immunity is inadequate against TB?

TB will go right into active infection.

If cell-mediated immunity is adequate,

-Stale mate

-granuloma

-Ghom Complex

-no longer active/contagious

-dormant stage for years

Ghom Complex

walled off and calcifying TB bacteria inside the lung

Secondary/re-infection of TB

-older

-immune system weakens

-become active again

-now able to affect other people

Miliary or extrapulmonary TB

-children under 5

-destroy the tissue

Active TB

-cavitation

-highly infectious

-cough/droplet precautions

Cavitation

cause large open areas in lung causing necrosis

Dx test of TB

-scratch test

-acid-fast sputum

-culture

-chest radiography

tx for TB

-BCG Vaccine (false positive)

-6 to 12 month tx

-combination of antibiotics

Tx complication of TB

-expensive for long tx

-patient follow-up (difficult with homeless/crowded living spaces)

Histoplasmosis

-Fungal

-Farmer

-birdl/bat droppings

-spores/dust particles

-body will fight it off

tx for histoplasmosis

antifungal agents

Anthrax

-bacterial

-fast-acting (kill within 3-5 days)

-easily treated (if caught)

-vaccine for those in danger only