Patho Exam 2

Pink Puffer

- Thin

- Barrel Chest

- Hyperventilation and marked dyspnea

- Pursed-lip breathing

- Reddish skin

- Use of accessory muscles

- Decreased BS, HS, prolonged expiration

- Hyperresonance

- Decreased DLCO

Pink Puffer CXR

- Hyperinflation

- narrow mediastinum

- normal or small vertical heart

- low flat diaphragm

- presence of blebs or bullae

Blue Bloater

- Stocky, overweight

- Normal chest

- Diminished respiratory drive

- Hypoventilation

- Cough

- Sputum

- Cynaosis

- Peripherial edema

- Neck vein distension

- Wheezes, crackles, rhonchi

- Polycythemia

- Infections

- Pulmonary hypertension

- Cor pulmonale

Blue Bloater CXR

- congested lung fields

densities

- increased bronchial vascular markings

- enlarged horizontal heart

What is the most common form of emphysema?

Centrilobular emphysema

Emphysema is:

- uncurable disease but can be treated

- progressive disease

Asthma is:

- reversible

If a COPD patient is relatively in controlled of things and keeps up with treatment and episode happens, could they be on a vent?

When on an Acute situation happens you can put them on a vent and give them a chance to come off

- can't withhold vent

When an Asthmatic patient comes into ER, most time we won't:

know if its intrinsic or extrinsic

What's going on with the chemical mediators of asthma?

- permeability of capillaries

- Dilation of blood vessels and tissue edema

If an asthmatic patient is not treated properly and they have long-term airway inflammation, they can have?

Airway remodeling or irreversible loss of airway caliber (size)

What are the anatomic alterations found with emphysema? *

- Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles

- Destruction of alveolar capillary membrane

- Weakening of the distal airways, primarily the respiratory bronchioles

- Air trapping and hyperinflation

COPD don't seek medical attention right at the beginning, wait for worsening symptoms during what stage?

Stage 3 (Moderate)

What are the causative factors of chronic bronchitis?

- Genetic predisposition

- Age and gender

- Conditions that affect normal lung growth

- Exposure to particles

- Socioeconomic status

- Asthma/bronchial hyperreactivity

- Chronic bronchitis

- Respiratory infections

- Tuberculosis

Number one risk factor of COPD

Cigarette smoking

What are the anatomic alterations of Chronic Bronchitis? *

- Chronic inflammation and thickening of the wall of the peripheral airways

- Excessive mucous production and accumulation

- Partial or total mucous plugging of the airways

- Smooth muscle constriction of bronchial airways (bronchospasm)—a variable finding

- Air trapping and hyperinflation of alveoli—may occur in late stages

What are the PFTs for Chronic Bronchitis?

Decreased: FVC, FEVT, FEV1/FVC, FEF, PEFR, MVV, VC

Increased: FRC

Increased or Normal: VT, RV, RV/TLC, TLC

Decreased or normal: IRV, ERV, IC

What could happen as result of severe mucous plugs are present?

submucosal bronchial glands to enlarge and the number of goblet cells to increase

For chronic bronchitis, what will they look like? What they have going on?

Type B: Blue Bloater

- Stocky, overweight

- Cyanosis

Management of COPD

- Smoking cessation

- Smoking prevention

- Occupational exposure

- Indoor and outdoor air pollution

- Physical activity

- Pharmacologic therapy for stable COPD

What do Chest x-ray look like for Emphysema?

- Translucent (dark)

- Depressed or flattened diaphragms

- Long or narrow heart

- Increased retrosternal air space

What type of COPD is emphysema?

Type A (Pink Puffer)

Three common triggers with associated with extrinsic asthma:

- Allergens—outdoors and indoor air pollution

- Infections

- Occupational sensitizers

- Tobacco smoke

- Diet

Definition of chronic bronchitis

based on the major "clinical manifestations" associated with the disease

What is a blue bloater?

Patient with chronic bronchitis, patient with

Type B COPD

- Derived from cyanosis (bluish skin and lips)

Chronic Bronchitis

Is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded (Type B, Blue Bloater), not reversible; clinical manifestations

Emphysema

is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. (Type A, Pink Puffer); not reversible, anatomic alteration of lung

Asthma

Chronic airway inflammation; wheezing, SOB, chest tightness, and cough that vary over time and in intensity and includes variable expiratory airflow limitation; reversible

How measuring Peak flow is helpful in management of asthma?

An improvement of 60 L/min (or ≥ 20% of the pre-bronchodilator [PEFR] after inhalation of a bronchodilator), or diurnal variation in PEFR of more than 20% (with twice-daily readings, more than 10%), suggests a diagnosis of asthma

Five steps of general management of asthmatic defined by (GINA)

- Component 1: Develop Patient/Doctor Partnership

- Component 2: Identify and Reduce Exposure to Risk Factors

- Component 3: Assess, Treat, and Monitor Asthma

- Component 4: Manage Asthma Exacerbations

- Component 5: Special Considerations

What are Charcot-Leyden crystals?

Deprived from the breakdown of eosinophils with allergic asthma

What is the genetic link in emphysema?

alpha-1 antitrypsin

Clinical findings associated with chronic bronchitis

- Excessive Bronchial Secretions

- Bronchospasm

- Distal Airway and Alveolar Weakening

What are Pulses paradoxes?

Systolic blood pressure that is more than 10 mm Hg lower on inspiration than on expiration

- To be caused by the major intrapleural swings that occur during inspiration and expiration and is associated with severe life-threatening condition

Which obstructive disease has decrease DLCO?

Type A: Pink Puffer

Biphasic asthmatic

an early asthmatic response followed by and late asthmatic response

Early asthmatic response

begins within minutes of exposure to an inhaled antigen and resolves in about 1 hour

Late asthmatic response

begins several hours after exposure to an inhaled antigen but lasts much longer

What happens when chemical mediators of asthma are released?

Stimulates the parasympathetic nerve endings in the bronchial airways leading to reflex bronchoconstriction and mucous hypersecretion

What happens during an Extrinsic type asthma attack?

IgE elevated

Which of the following group has an increase chance of asthma?

Onset before 20 years

Obesity

Genetics

Sex

Clinical manifestation of asthma

Bronchospasm

Excessive bronchial secretions

Centrilobular emphysema

abnormal enlargement of all structures distal to terminal bronchioles; most common form of chronic bronchitis and associated with cigarette smoking

Panlobular emphysema

abnormal weakening and enlargement of all alveoli distal to the terminal bronchioles, surface area is decreased, found in the lower parts of the lungs and associated with alpha-1-antitrypisin