Chapter 33 Alterations of Pulmonary Function Mosby items
Chapter 33 Alterations of Pulmonary Function Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 1
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 affiliate of Elsevier Inc. 6
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 affiliate of Elsevier Inc. 8
Restrictive Disorders Pulmonary edema Atelectasis (collapsed lung) Pneumothorax Pleural effusion Pneumonia Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 9
Pulmonary Edema Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 10
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. , an affiliate of Elsevier Inc. 12
Bronchiectasis Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 13
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 affiliate of Elsevier Inc. 16
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. , an affiliate of Elsevier Inc. 20
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 Mosby, Inc. , an affiliate of Elsevier Inc. 24
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 affiliate of Elsevier Inc. 28
Chronic Obstructive Pulmonary Disease Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 29
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 affiliate of Elsevier Inc. 32
Chronic Obstructive Pulmonary Disease Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 33
Obstructive Pulmonary Disease Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 34
Respiratory Tract Infections Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 35
Pneumococcal Pneumonia Mosby items and derived items © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. 36
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. , an affiliate of Elsevier Inc. 41
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. , an affiliate of Elsevier Inc. 44
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, Inc. , an affiliate of Elsevier Inc. 47
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. , an affiliate of Elsevier Inc. 50
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
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