Patho Exam 3 Diseases & Disorders

Acute respiratory failure

state of disturbed gas exchange

Acute respiratory failure blood gas values

PaO2 less than 60, PaCO2 higher than 50

Acute respiratory failure etiology

hypoxemia - poorly matched ventilation and perfusion, hypercapnia - poor alveolar ventilation in relation to CO2 production

Acute respiratory failure diagnosis

low PaO2, high PaCO2, low potassium and sodium, increased WBCs or decreased RBC and Hb

Pulmonary hypertension

sustained increase in pulmonary arterial pressure gradient

Secondary pulmonary hypertension

vasoconstriction seen in chronic bronchitis and emphysema

Pulmonary hypertension chest XR

enlargement of pulmonary arteries and right ventricle, abnormal vessel contours

Pulmonary hypertension EKG

right ventricular hypertrophy, mitral valve stenosis, left arterial myxma, and right heart enlargement

Pulmonary hypertension treatment

vasodilators - prostacyclin, diuretics - furosemide, spironolactone

Pulmonary embolism

circulation distal to obstruction is impaired leads to ischemic hypoxia

Pulmonary embolism Virchow’s triad - risk factors

venous sluggishness, hyper coagulability, and damage to venous wall

Pulmonary embolism diagnosis

mismatched ventilation and perfusion seen on scan, low PaO2 and PaCO2, and increased pH

Lung cancer

squamous cell carcinoma, adenocarcinoma, large cell carcinoma, small cell carcinoma, and bronchoalveolar carcinoma

squamous cell carcinoma

originates in central bronchi near hilus as intraluminal growth

squamous cell carcinoma doubling time, metastasizes

100 days, lymph nodes

adenocarcinoma

appears in periphery of lung, acinar bronchoalveolar and papillary tumors

adenocarcinoma doubling time, metastasizes

180 days, distant organs

large cell carcinoma

develops in periphery, large clusters

large cell carcinoma doubling time, metastasizes

100 days, distant organs

small cell carcinoma

originates in central bronchus region compressing and narrowing airway, associated w/ lesion in chromo 3

small cell carcinoma doubling time, metastasizes

33 days, widespread

bronchoalveolar carcinoma

originates in periphery, metastasizes through lymphatics, not associated w/ smoking

Asthma types

intrinsic, extrinsic, exercise induced, occupational, and drug induced

asthma etiology

airway obstruction and inflammation, increased airway responsiveness

asthma pathogenesis

IgE mediated activation of mast cells and cytokines, normal epithelium replaced by goblet cells

extrinsic asthma

allergic, pediatric onset

intrinsic asthma

nonallergic, adult onset

drug induced asthma

aspirin and NSAIDs

asthma diagnosis

forced expiratory volume decrease, FEV1/FVC less than 75, elevated WBCs and eosinophils

asthma treatment

B2 agonists, corticosteroids, leukotriene modifiers, and mast cell inhibitors

Acute bronchitis

acute inflammation of trachea and bronchi. viral and nonviral

Chronic bronchitis

Type B COPD, usually w/ emphysema

Chronic bronchitis etiology

Elevated IL-8 (neutrophil activation) and CD8 T cells and fibrotic changes extend into surrounding alveoli

Chronic bronchitis pathogenesis

increased bronchial wall thickness, high airflow resistance, hypoxemia and hypercarbia

Chronic bronchitis pulmonary function test

normal TLC, increased residual volume and FEV1

Chronic bronchitis arterial blood gas

elevated PaCO2 and decreased PaO2Chronic bronchitis

Chronic bronchitis EKG

artial arrhythmia and right ventricular hypertrophy

Chronic bronchitis treatment

B2 agonists (bronchodilation), anticholinergic bronchodilators, and corticosteriods

Emphysema

Type A COPD. destructive changes of alveolar walls and abnormal enlargement in distal air sacs

Emphysema clinical manifestations

exertional dyspnea, thin, pursed lip breathing, etc

Emphysema pulmonary function test

increased FRC, RV, and TLC. decreased FEV1 and FVC

Bronchiectasis

Obstruction of bronchi due to inflammation, infection, and dilation of wall. H influenza most common cause

Bronchiectasis clinical man

chronic productive cough, purulent foul smelling green sputum, hemoptysis, etc

Bronchiectasis ABG

decreased PaO2 and increase PaCO2

Bronchiolitis

widespread inflammation of bronchioles, half from RSV

Bronchiolitis pathogenesis

proliferation and necrosis epithelium produce obstruction and increase mucus

Bronchiolitis 3 mechanisms of obstruction

inflammatory exudate, release of chemical mediators lead to constriction, and inflammation induced fibrosis which narrows airway

Cystic fibrosis

hypersecretion of abnormal, thich mucus obstructs exocrine glands and ducts. autosomal recessive disorder

Cystic fibrosis pathogenesis

mutations - alters Cl and H2 transport = thick mucus obstructions

Cystic fibrosis diagnosis

stool sample - 95%

Epiglottitis

Rapid progressive cellulitis of epiglottis and soft tissue. mainly caused by H. influenza B

Epiglottis clinical man

pain w swallowing, drooling, etc

Epiglottis diagnosis

neck radio shows thumbprint sign

Croup syndrome

acute viral and inflammatory diseases of larynx, trachea, and bronchic

Croup syndrome diseases

Laryngotrachrobronchitis - viral, bacterial tracheitisCroup syndrome

Croup syndrome causes

parainfluenza type I, RSV, mycoplasma pneumoniae

Diffuse interstitial lung disease

restrictive disease w/ thickening of alveolar interstitial

Diffuse interstitial lung disease clinical manifestations

clubbing of nail beds, velcro rales

Sarcoidosis

systemic disease w/ immunological origin Sarcoidosis

Sarcoidosis pathogenesis

multiple, uniform, and noncaseating epithelioid granulomas = abnormal t cell function

Hypersensitivity pneumonitis

inhalation of organic particles responsible for inflammatory process

Hypersensitivity pneumonitis pathogenesis

type II hypersensitivity reaction

Occupational lung disease

chronic inhalation of toxic gasses or foreign particles

Occupational lung disease pathogenesis

particles paralyze ciliary action

Acute respiratory distress syndrome

damage to alveolar-capillary membrane

Acute respiratory distress syndrome pathogenesis

result of stiff, noncompliant lungs w/ presence of alveolar edema and exudate that exaggerates surface tension

Infant respiratory distress syndrome

hemorrhagic pulmonary edema, patchy atelectasis, and hyaline glassy membranes. under 25 weeks gestation is high risk

Infant respiratory distress syndrome pathogenesis

lack of pulmonary surfactant - increased surface tension and decreased lung compliance

Pneumothorax

accumulation of air in pleural space

Primary Pneumothorax

spontaneous, rupture of small subpleural blebs in apices

secondary Pneumothorax

complication of another disease, ruptured cyst or bleb

Tension Pneumothorax

trauma induced, buildup of pressure

Pneumothorax ABG

decreased PaO2 and acute respiratory alkalosis

Pleural effusion

pathological collection of fluid or pus in pleural cavity

Pleural effusion transudates

increased hydrostatic or decreased osmotic pressure

Pleural effusion exudate

increased production of fluid due to increased permeability of pleural membrane or impaired lymphatic drainagePleural effusion

Pleural effusion diagnosis

Thoracentesis

Pneumonia

inflammatory reaction to alveoli and interstitium of the lung

SARS

alveolar collapse w/ vascular injury occurring at same time

MERS

infection in monocytes and macrophages

TB

caused by mycobacterium tuberculosis

TB pathogenesis

T cells and macrophages surround bacteria in granulomas, limit replication, form necrotic nodules that become fibrotic and calcified

ECV Volume deficit

removal of sodium-containing fluid. flat neck veins

ECV volume excess

excessive aldosterone secretion. neck vein distention

Hyponatremia

low sodium, ECF too diluted - cells enlarge

Hypernatremia

high sodium, ECF too concentrated - cells shrivel

Clinical dehydration

combo of ECV deficit and hypernatremia

Edema

accumulation of excess fluid in interstitial compartment

Edema - increased capillary hydrostatic pressure

pushes fluid out of vessels into interstitial tissue

Edema - increased interstitial colloid osmotic pressure

pulls fluid from vasculature

Edema - blockage of lymphatic drainage (lymphedema)

pulls fluid from vasculature

Edema - decreased capillary osmotic pressure

fluid follows osmotic gradient out of vasculature interstitium

Hypokalemia

low potassium - shift into cells. hyperpolarization - less response to stimuli

Hypokalemia treatment

K wasting diuretics - thiazide, corticosteroids - prednisone

Hyperkalemia

high potassium - shift into ECF. hypopolarization - muscle dysfunction

Hyperkalemia treatment

K sparing diuretics - spironolactone

Hypocalemia

low calcium, decrease in threshold potential, hyper-excitability of neuromuscular cells

Hypercalcemia

high calcium, increase in threshold potential, decreasing neuromuscular excitability, cardiac dysrthemias

Hypomagnesemia

low magnesium, more AcH released, increased neuromuscular excitability

Hypomagnesemia clinical man

hyperactive reflexes, nystagmus