Chapter 33 Alterations of Pulmonary Function Mosby items

Signs and Symptoms of Pulmonary Disease Dyspnea and cough Tachypnea Hyperventilation Hypoventilation Hypercapnia Hypocapnia Hemoptysis Abnormal sputum Cyanosis Pain Clubbing Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

Signs and Symptoms of Pulmonary Disease Dyspnea Sensation of uncomfortable breathing Ø Orthopnea • Dyspnea when a person is lying down Ø Paroxysmal nocturnal dyspnea Ø Abnormal breathing patterns Kussmaul respirations (hyperpnea) Ø Cheyne-Stokes respirations Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Signs and Symptoms of Pulmonary Disease Hypoventilation Ø Hyperventilation Ø Leads to respiratory acidosis Leads to respiratory alkalosis Cough Acute cough Ø Chronic cough Ø Hemoptysis Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Signs and Symptoms of Pulmonary Disease Cyanosis 5 g of hemoglobin is desaturated regardless of concentration Ø Insensitive measure of disease • Pulmonary disease • Cardiac disease • Cold • Anxiety Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

Clubbing Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Conditions Caused by Pulmonary Disease or Injury Hypercapnia Hypoxemia vs. hypoxia Ø Ventilation-perfusion abnormalities • Shunting Ø Acute respiratory failure Pulmonary edema Ø Excess water in the lungs Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Ventilation-Perfusion Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Restrictive Disorders Pulmonary edema Atelectasis (collapsed lung) Pneumothorax Pleural effusion Pneumonia Mosby items and

Pulmonary Edema Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Conditions Caused by Pulmonary Disease or Injury Aspiration Ø Passage of fluid and solid particles into lungs • Right lower lobe most frequent site Atelectasis Compression atelectasis Ø Absorption atelectasis Ø Bronchiectasis Persistent abnormal dilation of the bronchi Ø Cylindrical, saccular, and varicose Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 11

Absorption Atelectasis Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Bronchiectasis Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Conditions Caused by Pulmonary Disease or Injury Bronchiolitis Inflammatory obstruction of the small airways Ø Most common in children Ø Occurs in adults with chronic bronchitis, a viral infection, or inhalation of toxic gases Ø Bronchiolitis obliterans Late-stage fibrotic disease of the airways Ø Can occur with all causes of bronchiolitis Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 14

Pleural Abnormalities Pneumothorax Open pneumothorax Ø Tension pneumothorax Ø Spontaneous pneumothorax Ø Secondary pneumothorax Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 15

Pneumothorax Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Pleural Abnormalities Pleural effusion Transudative effusion Ø Exudative effusion Ø Pleurisy Ø Hemothorax Ø Empyema Ø Infected pleural effusion Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 17

Conditions Caused by Pulmonary Disease or Injury Abscess formation and cavitation Abscess Ø Consolidation Ø Cavitation Ø Pulmonary fibrosis Ø Excessive amount of fibrous or connective tissue in the lung Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 18

Conditions Caused by Pulmonary Disease or Injury Chest wall restriction Ø Compromised chest wall • Deformation, immobilization, and/or obesity Flail chest Ø Instability of a portion of the chest wall Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 19

Flail Chest Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Conditions Caused by Pulmonary Disease or Injury Inhalation disorders Exposure to toxic gases Ø Pneumoconiosis • Silicosis • Coal worker pneumoconiosis (black lung) • Asbestosis Ø Allergic alveolitis • Extrinsic allergic alveolitis (hypersensitivity pneumonitis) Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 21

Pulmonary Disorders Acute respiratory distress syndrome (ARDS) Fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury Ø Injury to the pulmonary capillary endothelium Ø Inflammation and platelet activation Ø Surfactant inactivation Ø Atelectasis Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 22

Pulmonary Disorders ARDS Ø Manifestations • Rapid, shallow breathing • Respiratory alkalosis • Dyspnea • Decreased lung compliance • Unresponsive hypoxemia Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 23

Acute Respiratory Distress Syndrome (ARDS) Mosby items and derived items © 2010, 2006 by

Pulmonary Disorders Postoperative respiratory failure Atelectasis Ø Pneumonia Ø Pulmonary edema Ø Pulmonary emboli Ø Prevention • Frequent turning, deep breathing, early ambulation, air Ø humidification, and incentive spirometry Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 25

Obstructive Disorders Asthma Chronic bronchitis Emphysema Ø Chronic bronchitis + emphysema = chronic obstructive pulmonary disease (COPD) Clinically: dyspnea and wheezing Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 26

Obstructive Pulmonary Disease Airway obstruction that is worse with expiration Common signs and symptoms Ø Dyspnea and wheezing Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 27

Asthma Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Chronic Obstructive Pulmonary Disease Mosby items and derived items © 2010, 2006 by Mosby,

Chronic Obstructive Pulmonary Disease Chronic bronchitis Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years Ø Inspired irritants increase mucus production and the size and number of mucous glands Ø The mucus is thicker than normal Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 30

Chronic Obstructive Pulmonary Disease Emphysema Abnormal permanent enlargement of the gasexchange airways accompanied by destruction of alveolar walls without obvious fibrosis Ø Loss of elastic recoil Ø Centriacinar emphysema Ø Panacinar emphysema Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 31

Emphysema Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an

Obstructive Pulmonary Disease Mosby items and derived items © 2010, 2006 by Mosby, Inc.

Respiratory Tract Infections Mosby items and derived items © 2010, 2006 by Mosby, Inc.

Pneumococcal Pneumonia Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Pneumonia Community-acquired pneumonia Ø Streptococcus pneumoniae Hospital-acquired (nosocomial) pneumonia Pneumococcal pneumonia Viral pneumonia Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 37

Respiratory Tract Infections Tuberculosis Mycobacterium tuberculosis Ø Acid-fast bacillus Ø Airborne transmission Ø Tubercle formation Ø Caseous necrosis Ø Positive tuberculin skin test Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 38

Respiratory Tract Infections Acute bronchitis Acute infection or inflammation of the airways or bronchi Ø Commonly follows a viral illness Ø Causes symptoms similar to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 39

Pulmonary Vascular Disease Pulmonary embolism Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble Ø Pulmonary emboli commonly arise from the deep veins in the thigh Ø Triad of Virchow • Venous stasis, hypercoagulability, and injuries to the Ø endothelial cells that line the vessels Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 40

Pulmonary Embolism Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Pulmonary Vascular Disease Pulmonary hypertension Mean pulmonary artery pressure 5 -10 mm. Hg above normal or >20 mm. Hg Ø Classifications • Pulmonary arterial hypertension • Pulmonary venous hypertension • Pulmonary hypertension from a respiratory disease or Ø hypoxemia • Pulmonary hypertension from thrombotic or embolic disease • Pulmonary hypertension from diseases of pulmonary vasculature Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 42

Pulmonary Vascular Disease Primary pulmonary hypertension Ø Idiopathic Diseases of the respiratory system and hypoxemia are more common causes of pulmonary hypertension Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 43

Pulmonary Hypertension Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Cor Pulmonale Pulmonary heart disease Right ventricular enlargement Ø Secondary to pulmonary hypertension Ø Pulmonary hypertension creates chronic pressure overload in the right ventricle Ø Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 45

Cancer Lip cancer Most common form • Exophytic Ø Stages Ø Laryngeal cancer Ø Forms • Carcinoma of true vocal cords (most common) • Supraglottic • Subglottic Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 46

Lip and Laryngeal Cancer Mosby items and derived items © 2010, 2006 by Mosby,

Lung Cancer Bronchogenic carcinomas Most common cause is cigarette smoking Heavy smokers have 20 times’ greater chance of lung cancer than nonsmokers Ø Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder Ø Environmental or occupational risk factors also associated with lung cancer Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 48

Lung Cancer Non–small-cell lung cancer Squamous cell carcinoma Ø Adenocarcinoma Ø Large cell carcinoma (undifferentiated) Small cell carcinoma Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 49

Lung Cancer Mosby items and derived items © 2010, 2006 by Mosby, Inc. ,

Other Lung Cancers Bronchial carcinoid tumors Adenocystic tumors (cylindromas) Mucoepidermoid carcinomas Mesotheliomas Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 51