Patho Exam Respiratory and Urinary

hypoxia

reduced oxygenation of cells in tissue

hypoxemia

reduction in arterial blood oxygen

ventilation

a process of inspiration and expiration of air through the pulmonary airways

perfusion

amount of blood through the pulmonary circulation, eventually providing oxygen to the system

normal alveolar rate of reception

4L/min

normal capillary supply time

5L/min

normal V/Q rate

4:5 or 0.8

what is ventilation perfusion rate

ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli

when does ventilation-perfusion mismatch occur?

when air cannot flow into alveolus or when blood flow around alveolus is altered

inadequate ventilation

v/q rate is low, pulmonary circulation is adequate but not enough oxygen is available to the alveoli, blockage of airway, CO2 cannot be cleared from blood and O2 can not enter

inadequate perfusion

the v/q rate is high; ventilation is normal but alveolar perfusion is reduced or absent

upper respiratory infections

common and uncomfortable but not life threatening

lower respiratory infections

pneumonia or TB, often serious or fatal

rhinitis

inflammation of nasal mucosa

most common type of rhinitis

common cold

clinical manifestations of rhinitis

malaise, sore throat, nasal discharge, cough hoarseness

sinusitis

inflammation of paranasal sinuses

rhinosinusitis

inflammation of both nasal and sinus cavities

etiology of rhinosinusitis

viral (rhinovirus), bacterial and fungal

clinical manifestations of rhinosinusitis

headache, facial pain or pressure over sinus area, bending forward causes headache, purulent nasal discharge, fever, ear pain, decreased sense of smell, sore throat

complication of rhinosinusitis

otitis media

bronchiolitis

inflammation of bronchioles seen in children under 1 year

etiology of acute bronchitis

bacteria, viruses (majority), inhalation of chemicals or gases, pollution, allergies

Pathophysiology of acute bronchitis

bronchial tissue cells are irritated, and mucous membrane becomes edematous leading to decrease function of mucociliary apparatus and narrowing of the airway

clinical manifestations of acute bronchitis

sore throat, nasal discharge, productive cough, fever, muscle ache, wheezing

chronic bronchitis

indicated by repeated attacks of acute bronchitis and coughing with sputum production, last for at least 3 months for 2 consecutive years

signs and symptoms of chronic bronchitis

hypoxemia, cyanosis, hyperapnea, polycythemia, dyspnea at rest, abnormal lung sounds

emphysema

overdistention of alveoli with trapped air creating obstruction of expiratory airflow

etiology of emphysema

smoking is the major cause, environmental exposure to chemicals, dusts, and secondhand smoke

clinical manifestations of emphysema

dyspnea with exertion, tachypnea, cough, wheezes, prolonged exhalations, barrel shaped chest, hypoxia, hypercapnia, advanced cases hypoventilation produces hypoxemia and hypercapnia

COPD

chronic obstructive pulmonary disease, combination of emphysema and chronic bronchitis and hyperactive airway disease

pneumonia

inflammation of the lung, lobar

bronchopnuemonia

patchy spread throughout several lobes

etiology of pneumonia

bacteria, viruses, fungi, chlamydia, mycoplasma, rickettsia

pathophysiology of pneumonia

inhalation of droplets containing pathogen enter in upper airway and gain entry into lungs

clinical manifestations of pneumonia

crackles heard, fever, tachypnea, use of accessory muscles when breathing, tachycardia, possible cyanosis, cough, dypsnea

diagnostic tests for pneumonia

auscultation, CBC (elevated WBCs), chest radiographs, pulse oximetry & ABGs, culture and sensitivity

atypical or interstitial pneumonia

caused by a variety of microorganisms, including viruses and unusual bacteria called mycoplasma pneumoniae, involves alveolar septa rather than alveoli

aspiration pneumonia

inhalation of gastric contents, food, or foreign body enters the lungs

asthma

chronic inflammatory disorder that causes reversible constriction of the walls of the small bronchi and bronchioles and increase mucus secretions, subject to acute episodes, no cure

etiology of asthma

gene mutation or environmental factors (allergies, viral infections, reflux, NSAIDs, job, exercise, anxiety)

pathophysiology of asthma

allergen trigger immune system causing bronchial constriction, inflammation, and increase in size and number of goblet cells which increase mucous production

clinical manifestations of asthma

asymptomatic between attacks, coughing, wheezing, prolong exhalations, dyspnea, non productive cough, use of accessory muscles used during breathing

treatment for asthma

bronchodilators, corticosteroids, inhalers, epinephrine

status asthmaticus

persistent bronchoconstriction that endures despite attempts to treat

treatment for status asthmaticus

endotracheal intubation with ventilator, can be fatal

neonatal respiratory distress syndrome

progressive respiratory distress soon after birth, premature infants at risk

pathogenesis of NRDS

inadequate surfactant in lungs, alveoli collapse, increased permeability of pulmonary capillaries, fibrinogen leaks out causing clotting and adhesion of membranes

treatment of NRDS

oxygen and surfactant, endotracheal tube

pneumothorax

air entrance into the pleural cavity, leads to collapse of lungs and atelectasis (incomplete expansion)

pathophysiology of pneumothorax

intrapleural pressure is pressure within pleural cavity, normally negative

etiology of pneumothorax

trauma which lacerates the parietal pleural from the outside and air enters into the pleural space, rupture of visceral pleura (emphysema)

spontaneous pneumothorax manifestations

chest pain, shortness of breath, reduced breath sounds

tension pneumothorax

positive pressure develops in pleural cavity, displaces heart and mediastinal structures away from affected side, life threatening

treatment of pneumothorax

chest tube

pleural effusion

accumulation of fluid in pleural cavity

etiology of pleural effusion

pneumonia, cancer, heart failure, cirrhosis of liver, kidney disease

hemothorax

blood in the pleural cavity (trauma)

chylothorax

effusion is high in triglycerides from damage to thoracic duct

empyema

pus in the pleural cavity from infection

pleurisy or pleurisies

inflammation of the pleural membrane

clinical manifestations of pleural effusion

dyspnea, chest pain, tachypnea, tracheal deviation, diminished lung sounds

components of the urinary system (4)

kidneys, ureters, urinary bladder and urethra

which vertebrae are the kidneys positioned between?

12th thoracic and 3rd lumbar

urine formation

glomerular filtration, tubular reabsorption, tubular secretion

urinalysis

physical description of urine, biochemical, and microscopic analysis

reagent strips (dipsticks)

tests acidity, pH should be close to neutral

normal specific gravity of urine

between 1.001 (dilute) and 1.030 (concentrated)

microscopic analysis of urine

inspection for WBCs, bacteria, RBCs or collections of cellular debris, crystals, and cast

what does increased RBCs in urine mean

hematuria

what does increased WBCs in urine mean

pyuria

what are crystals in urine associated with

renal calculi

urea

byproduct of amino acid catabolism by liver, reflects amount of protein in diet

uric acid

product of nucleic acid metabolism, increased levels in blood or decreased excretion in urine can lead to gout

blood urea nitrogen (BUN)

measurement of urea levels in blood

increased serum creatinine indicates

decreased filtering of creatinine at the glomerulus

azotemia elevation

elevation of BUN and creatinine

renal biopsy

small sample of kidney tissue removed, often used to evaluate a transplanted kidney or to evaluate an unknown kidney disease

prerenal dysfunction

caused by decreased blood flow and perfusion to kidneys, directly related to blood flow and renal perfusion

causes of prerenal dysfunction

decrease CO or severe hypovolemic shock, large blood loss

intrarenal dysfunction

develops secondary to actual injuries to the kidney itself

etiology of intrarenal dysfunction

direct damage to nephrons from trauma, toxins, infections, atherosclerosis, most commonly NSAIDs, renal infections or systemic illness

post renal dysfunction

related to obstruction of urine outflow from the kidneys

etiology of post renal dysfunction

obstructive uropathy, urine backs up within the ureter and kidneys (hydronephrosis)

glomerulonephritis

inflammation of the glomeruli of the kidney, leading cause of chronic kidney disease, acute or chronic

etiology of glomerulonephritis

infections, immune-mediated diseases, inherited

pathophysiology of glomerulonephritis

decreased urine output, less urine formation leads to less waste product being excreted, increase BUN and creatinine, protein and red cells leak through damaged glomerular membrane, low GFR leads to hyperbole inc BP, low albumin in blood leads to diminished oncotic pressure

nephrotic syndrome

refers to a group of abnormalities characterized by a severe loss of protein in the urine

etiology of nephrotic syndrome

glomerulonephritis, diabetes, systemic lupus erythematosus, NSAID use

lower urinary tract infection

bladder and urethra, cystitis

most common bacteria for lower UTI

E. coli gram negative

predisposing factors of UTI

stagnation of urine, any condition that impairs free damage of urine, injury to mucosa by kidney stone, introduction of catheter

etiology of UTI

more common in women due to shorter urethra, sex, older men due to enlarge prostate

clinical manifestations of UTI

burning pain while urination, frequent urination

diagnostic test for UTI

urinalysis

pyelonephritis

suppurative inflammation of the kidney and renal pelvis, caused by E. coli found in the colon

clinical manifestations of pyelonephritis

localized pain and tenderness over kidney, fever, chills, nausea & vomiting, hematuria

chronic pyelonephritis may lead to

kidney failure

diagnostic tests for pyelonephritis

urinalysis, culture and sensitivity, radiographs, ultrasounds

urolithiasis

stones or calculi may form anywhere in the urinary tract