Ch30 - Respiratory tract infections, neoplasms, childhood disorders

Upper Respiratory Tract Infection

Nose, oropharynx, larynx

Lower Respiratory Tract Infection

Lower airways and lungs

Upper and Lower airways infection

trachea, bronchi

The common cold

Viral - rhinoviruses

Season of the year, person’s age, health hx help diagnosis

Nasal mucosa and conjunctival membranes most common portal of entry, spread by direct mucous membrane contact

Common Cold s/s

Stuffiness

rhinitis

sore throat and hoarseness

Common cold dx and tx

Hx

Physical

Symptomatic

Rhinosinusitis

Inflammation of sinuses

Most common cause are conditions that obstruct the ostia that drain sinuses

Rhinosinusitis causes

Upper Resp Infection or allergic rhinitis

Nasal polyps

barotrauma

swimming and diving

abuse of nasal decongestants

Acute rhinosinusitis

Viral, bacterial, or both

5 days to 4 weeks

Chronic rhinosinusitis

over 12 weeks

Rhinosinusitis s/s

Similar to common cold or allergic rhinitis

Facial pain

HA

Purulent nasal drainage

Rhinosinusitis Dx/Tx

Recent hx of upper resp infection or allergic rhinitis

face pain on bending, unilateral maxillary pain, teeth pain, HA, purulent drainage

inspection of nose and throat

Tx depends on cause

Influenza

Viral: A, B, or C. Highly contagious, droplet transmission

Prevention: yearly immunization

Influenza s/s

Malaise

Fever

chills

muscle aches

HA

non-productive cough

sore throat

Influenza dx/tx

goal is to limit spread and tx s/s

Avian flu

Began in birds, now found in pigs, cows, humans

Contamination from infected birds or their droppings

No vaccine, high mortality rate

Swine flu

H1N1

Most virulent in YA <25

Vaccine available

Pneumonia

Inflammation of lower resp tract

Due to infectious and non-infectious agents: inhaling toxic substances

Typical vs Atypical Pneumonia

Typical caused by bacteria, atypical by viruses and mycoplasma

Lobar vs bronchopneumonia

Lobar involves part or all of 1 lobe of the lung

Bronchopneumonia involves more than one lobe

assess via percussion and auscultation

Community vs Hospital acquired Pneumonia

Community acquired due to pathogens acquired outside of hospital and is diagnosed within 48 hrs of admission

Hospital acquired is not present on admission and is diagnosed >48hrs after admission. Harder to tx due to antibiotic resistant bacteria

Acute Bacterial Pneumonia

High mortality in older adults due to aspiration

Smokers have higher risk as smoking damages normal defense mechanisms

Tuberculosis

Rod-shaped aerobic bacteria that is difficult to eradicate and can lay dormant for many yrs

Acid fast bacilli

Airborne infection

Lungs are most frequent site but any organ can be affected

Ghon focus/complex: golf ball with cottage cheese, destruction of lung tissue

Primary Tuberculosis

Develops in previously unexposed persons

Most exposed people develop latent TB

TB Dx

TB skin test

CXR

Sputum culture: definitive dx test, results take up to 8 weeks

QuantiFERON - TB gold

Fungal Infections

Yeasts and molds

Histoplasmosis

Histoplasmosis

Inhaled spores

Most cases occur along major river valleys in US

In otherwise healthy people: mild, febrile resp illness that is self limiting

In very old, very young, immunocompromised can become a fulminating disease

Histoplasmosis s/s

High fever

generalized lymph node enlargement

spleenomegaly

hepatomegaly

muscle wasting

anemia

Lung cancer

Leading CoD in US

High correlation to smoking

• >80% cases

• Pack year hx = # yrs smoked X # packs/day

• Increase in dx of lung cancer in persons who have never smoked

Non-small cell Lung cancer

Can produce paraneoplastic syndromes

Squamous cell, adenocarcinoma, large-cell carcinoma

Squamous Cell Lung Cancer

Hypercalcemia, most common in male smokers

Adenocarcinoma Lung Cancer

Most common in females and non-smokers

Large-cell carcinoma

Metastasize early, poor prognosis

Small-cell carcinoma

Highly malignant, brain metastasis common

Lung Cancer s/s

Due to lung involvement: chronic cough, hemoptysis, wheezing

Due to metastasis

Due to paraneoplastic manifestations: hypercalcemia, ADH

Lung Cancer Dx

Careful hx and physical

CXR, bronchoscopy, cytologic studies, needle biopsy, CT scan, MRI, PET scan for metastasis

Staging

Lung cancer tx

surgery, chemo, radiation

Respiratory Distress Syndrome

In neonates

Central cyanosis

Retractions

Grunting

Decrease in tidal volume

Increased RR

Not producing enough surfactant, so alveoli collapse

Tx: artificial surfactant

Bronchopulmonary dysplasia

In neonates

Chronic respiratory distress

Persistent hypoxemia on RA (21%)

Decrease in lung compliance

Increase in airway resistance

Severe expiratory flow limitation

Ventilation/perfusion mismatch

Chronic lung disease in premies who were treated with long term mechanical ventilation

Epiglotitis

In children, upper airway infection

potentially fatal, anxious, resp distress

Bacterial

Children sit up with mouth open and chin up

Croup

In children, upper airway infection

Inspiratory stridor, hoarseness, barking cough

Viral

Bronchiolitis

In children, lower airway infection

hx of resp infection

Respiratory syncytial virus

Respiratory failure

Increased work of breathing, grunting

Decreased chest movement

Cyanosis not relieved by O2 administration

Increased HR >150bpm

Very rapid breathing

Very slow breathing

Extreme anxiety or agitation

Fatigue