disorders of oxygenation and carbon dioxide elimination

dyspnoea

difficulty in breathing

hyperventiliation

ventilation in excess of what is needed for normal elimination of CO2

hypoventilation

decreased ventilation, unable to eliminate adequate amounts of CO2

hyperpnoea

increase in rate and depth of breathing (normal during exercise)

tachypnoea

increased respiratory rate

bradypnoea

decreased respiratory rate

orthopnoea

difficulty in breathing when lying flat

hypoxia

reduction in tissue oxygenation

hypoxaemia

decreased levels of oxygen in the blood

hypercapnia

increased levels of carbon dioxide content of the blood

acidosis (respiratory or metabolic)

clinical condition as a result of a low blood pH (

alkalosis (respiratory or metabolic)

clinical condition as a result of a high blood pH (>7.45)

atelectasis

lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation

cyanosis

bluish discoloration of skin and/or mucous membrane due to increased levels of deoxygenated blood in the small vessels

ventilation

the amount of air that enters the alveoli

perfusion

ventilation/perfusion (V/Q) mismatch

abnormal ventilation/perfusion ratio, e.g. when areas of the lungs are better perfused by blood than they are ventilated (e.g. lack of alveoli), or better ventilated than perfused with blood (e.g. lack of blood supply to a well-ventilated lung with sufficient alveoli)

cough

protective reflex that helps clear the airways

acute cough

resolves within 2-3 weeks of onset of illness or with treatment

chronic cough

persistent, does not resolve with treatment

haemoptysis

coughing up of blood or bloody secretions

minute volume

volume of air/gas inhaled (inhaled minute volume) or exhaled (exhaled minute volume ) from a person’s lungs in one minute

common cold clinical manifestations

nasal congestion, rhinorrhea, sneezing, increased secretions, watery eyes, HA, fever, malaise

influenza clinical manifestations

fever, chills, myalgia, HA, rhinorrhea, non productive cough, sore throat

rhinitis

inflammation of nasal passages

sinusitis

inflammation/infection of the parasinal sinuses

otitis media

inflammation of middle ear space

otitis media clinical manifestations

coldlike symptoms and/or upper respiratory problems

AOM (acute otitis media)

inflammation of middle ear with acute onset. moderate to severe bulging of TM and middle ear effusion

AOM treatment

antibiotics

COM (chronic otitis media)

infection longer than six weeks with persistent effusion in middle ear space. mild to moderate conductive hearing loss

COM treatment

topical antibiotics and/or steroids. frequent cleaning of ear canal.

croup

acute laryngotracheobronchitis. usually occurs after an episode of rhinorrhea, sore throat, low-grade fever, inspiratory stridor, and hoarse voice. seal-like barking cough. severe cases are treated with nebulized epinephrine

croup pathophysiology

inflammation and edema, upper airway obstruction, increased resistance to airflow, increased intrathoracic negative pressure, collapse of upper airway, respiratory failure

acute epiglottitis

severe, rapidly progressive, life-threatening infection of the epiglottis and surrounding area

acute epiglottitis manifestations

high fever, irritability, sore throat, inspiratory stridor, muffled voice, sever respiratory distress

acute epiglottitis treatment

no throat exams, emergency airway and antibiotics

most common URI

bacterial tracheitis

____ is the most common cause of community-acquired bacterial pneumonia

pneumococcal pneumonia

most common viral pneumonia in young children is

RSV (respiratory syncytial virus)

TB spreads

via airborne

TB clinical manifestations

dyspnea, fever, weight loss, night sweats

bronchiolitis

fibrotic obstruction of the respiratory bronchioles and alveolar ducts secondary to intense inflammation

pneumothorax

presence of air between visceral and parietal pleura, compressing lung tissue

pneumothorax causes

trauma, complications related to medical procedures, chronic diseases, traumatic pneumothorax

pneumothorax clinical manifestations

dyspnea, tachypnea, tachycardia, ipsilateral chest pain, anxiety, no breath sounds, hyper resonant on percussion

pneumothorax diagnosis

PE, chest x-ray, CT scan

pneumothorax treatment

chest tube inserted into intrapleural space

pleural effusion causes

excess fluid is drained by the lymphatic system (if lymphatic system is blocked, pleural fluid accumulates), left ventricular failure, cirrhosis, atelectasis

pleural effusion clinical manifestations

small- asymptomatic

larger- SOB, dyspnea, tachypnea, dullness to percussion over effusion on affected side

pleural effusion fluid- transudate (straw-colored, clear)

…patho?

increased filtration pressure or more negative intrapleural pressure allows for accumulation of pleural fluid in pleural space

pleural effusion fluid- empyema (yellow-green pus)

…patho?

fibrous tissue extending beyond localized areas can obliterate pleural space or surround lung, limiting its expansion

pleural effusion fluid- chylothorax (milky)

…patho?

chylomicrons are absorbed from the GI tract and transported through the lymphatic system

pleural effusion diagnosis

chest x-ray, CT scan

pleural effusion treatment

drained with insertion of chest tube, pleurodesis

aspiration

passage of fluid and solid particles into the lungs

atelectasis

compression atelectasis, absorption atelectasis, surfactant impairment

brochiectasis

persistent abnormal dilation of the bronchi

compression atelectasis

external pressure exerted by tumour, fluid or air in pleural space, or by abdominal distension, causing alveolar collapse

absorption atelectasis

removal of air from obstructed/hypoventilated alveoli, inhalation of: anaesthetic agents, concentrated O2

surfactant impairment

decreased production or inactivation of surfactant due to premature birth,, acute respiratory distress syndrome (ARDS), anaesthetics, mechanical ventilation

asthma

chronic inflammatory disorder of airways, recurrent episodes of reversible airway obstruction, hyperreactive airways, incidence greatest in industrialized countries

____ asthma is the most common; allergen causes type 1 hypersensitivity response

allergic

recurrent asthma

airways remodeled, bronchial smooth muscles hypertrophy, increasing capacity from bronchoconstriction

asthma clinical manifestations

recurrent chest tightness, SOB, wheezing, cough with or without production of thick sputum, tachypnea/tachycardia (severe)

asthma diagnosis

medical hx and PE, PFTs before and after bronchodilator use, challenge test, exhaled nitrogen oxide

asthma treatment

environmental control, asthma education, bronchodilator, anti-inflammatory medications

COPD (chronic obstructive pulmonary disease)

progressive airflow limitations that are not fully reversible, linked to cigarette smoking

COPD etiology

chronic airflow limitation due to abnormal inflammatory response to inhaled particles and gases in lung

COPD patho

airway obstruction results from fixed airways that have increased resistance, slowing the rate of airflow, chronic inflammation, structural remodeling of lung tissue, alterations in vascular structure, destruction of pulmonary structures, hypercapnia, hyperinflation

COPD- emphysema

damage to lung parenchyma, destruction of gas-exchanging pulmonary surfaces, pulmonary hyperinflation

COPD- emphysema causes

cigarette smoking (primary cause)

COPD clinical manifestations

depends on whether symptoms of chronic bronchitis or emphysema are dominant, pulmonary acini, chronic bronchitis

COPD- emphysema clinical manifestations

increased DOE (dyspnea on exertion), barrel chest, respiratory muscles, hypoxemia, foot and ankle swelling

advanced COPD

reduced capacity for gas exchange, deterioration of pulmonary function

COPD diagnosis

PFTs, spirometry, body plethysmography, x-ray

bronchiesctasis

excessive mucus accumulation leads to irreversibly dilated bronchi

bronchiectasis causes

blockage of airways and chronic necrotizing infection, persistent airway dilation, thickening of bronchial walls

bronchiectasis clinical manifestations

severe persistent cough,, tenacious, mucopurulent sputum, dyspnea, wheezing, pleuritis, chest pain

bronchiectasis diagnosis

high-resolution CT scan, sputum cultures, x-ray

bronchiectasis treatment

antibiotics, bronchial hygiene

most common lethal genetic disorder

cystic fibrosis

CF patho

recessive genetic disorder, affects epithelial transport of fluids

CF clinical manifestations

thick pulmonary secretions, frequent respiratory infections, chronic cough, abdominal distention, large, fatty, foul-smelling stools

CF diagnosis

skin sweat test

CF treatment

antibiotics for secondary infections, vitamin supplements, pancreatic digestive enzyme replacement

most common lung disease

idiopathic pulmonary fibrosis (IPF)

IPF clinical manifestations

insidious onset, dyspnea on exertion and/or a cough, deterioration secondary to infection, rapid, shallow respirations, hypoxemia, cyanosis

IPF treatment

oxygen therapy, lung transplant

sarcoidosis

noncaseating granulomas of lung, lymph nodes, skin, eyes

sarcoidosis clinical manifestations

often asymptomatic, cough, dyspnea

sarcoidosis diagnosis

exclusion of other diseases

sarcoidosis treatment

corticosteroids

pulmonary embolism

occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble

type I respiratory failure

severe hypoxemia, PaO2 less than 60 mmHg

type II respiratory failure

hypercapnia, PaCO2 greater than 50 mmHg

type I and II respiratory failure clinical manifestations

underlying cause, acute/chronic, severity of failure

type I and II respiratory failure signs/symptoms

dyspnea, SOB, wheezing, tachypnea/tachycardia, cyanosis

ARDS (acute respiratory distress syndrome

severe inflammation leads to increased pulmonary vascular permeability, increased lung weight, loss of aerated lung tissue

ARDS clinical manifestations

acute onset of dyspnea, progressive hypoxemia despite increasing FIO2, bilateral pulmonary infiltrates seen on chest x-ray, tachycardia/tachypnea