Download - Pulmonary Pa Tho Physiology
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Pulmonary Pathophysiology
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Reduction of Pulmonary Function
1. Inadequate blood flow to the lungshypoperfusion
2. Inadequate air flow to the alveoli -hypoventilation
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Signs and Symptoms of PulmonaryDisease
Dyspnea subjective sensation ofuncomfortable breathing, feeling short of
breath
Ranges from mild discomfort after exertionto extreme difficulty breathing at rest.
Usually caused by diffuse and extensiverather than focal pulmonary disease.
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Dyspnea cont. Due to:
Airway obstruction
Greater force needed to provide adequateventilation
Wheezing sound due to air being forcedthrough airways narrowed due toconstriction or fluid accumulation
Decreased compliance of lung tissue
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Dyspnea
Causes
1-Pulmonary embolism
2-Pulmonary edema
3-COPD 4-Pneumonia
5-Large pleural effusion
6-Obesity 7-Sever anemia
8-Malgnancy
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Signs of dyspnea:
Flaring nostrils
Use of accessory muscles in breathing
Retraction (pulling back) of intercostalspaces
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Cough
Attempt to clear the lower respiratorypassages by abrupt and forceful expulsionof air
Most common when fluid accumulates inlower airways
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Cough may result from:
Inflammation of lung tissue
Increased secretion in response tomucosal irritation
Inhalation of irritants
Intrinsic source of mucosal disruption suchas tumor invasion of bronchial wall
Excessive blood hydrostatic pressure inpulmonary capillaries Pulmonary edema excess fluid passes into
airways
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Cyanosis When blood contains a large amount of
unoxygenated hemoglobin, it has a dark red-blue color which gives skin a characteristicbluish appearance.
Most cases arise as a result of peripheralvasoconstriction result is reduced blood flow,which allows hemoglobin to give up more of its
oxygen to tissues- peripheral cyanosis. Best seen in nail beds
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Pain Originates in pleurae, airways or chest
wall Inflammation of the parietal pleura causes
sharp or stabbing pain when pleura
stretches during inspiration Usually localized to an area of the chest wall,
where a pleural friction rub can be heard
Laughing or coughing makes pain worse Common with pulmonary infarction due to
embolism
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Chest Pain
Other Causes
1-Cardiac
2-Osphageal 3-Trauma
4-Local infection
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Pleural Effusion
Causes
1-TB
2-Pnumonia 3-Cardiac Failure
4-Pulmonary infarction
5-Malgnent disease
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Hemoptysis
1-TB
2-Carcinoma
3-Pulmonary infarction
4-Pneumonia
Causes
5-Acute left ventricular failure
6-Leukemia and hemophilia
7-Mitral stenosis
8-Anticoagulant
9-Acute bronchitis
10-Foreign body
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Pneumothorax
Causes
1-Primary
2-Secondary:Tb,COPD,Pulmonaryinfarction, Carcinoma
3-Trauma
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Tests of Pulmonary Function
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Chest radiographs are among the
most common examinations of thepulmonary system.
Chest x-ray
Heart sizeLung mass
Pleural effusion
FibrosisPneumonia
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SpirometryThe diagnosis of COPD is confirmed by spirometry, a test that
measures breathing.
Spirometry measures the forced expiratory volume in one second
(FEV1) which is the greatest volume of air that can be breathedout in the first second of a large breath and the forced vital
capacity (FVC) which is the greatest volume of air that can be
breathed out in a whole large breath. Normally at least 70% of
the FVC comes out in the first second (i.e. the FEV1/FVC ratio is>70%).
http://en.wikipedia.org/wiki/Spirometryhttp://en.wikipedia.org/wiki/Spirometry -
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In COPD, this ratio is less than normal, (i.e.
FEV1/FVC ratio is
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Severity of
COPDFEV1 % predicted
Mild Less than 80
Moderate 50-69
Severe 30-49
Very severe
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Ventilation/perfusion ratio (or V/Q ratio) : It is
defined as: the ratio of the amount of air reaching
the alveoli to the amount of blood reaching the
alveoli.
"V" - ventilation - the air which reaches the
alveoli
"Q" - perfusion - the blood which reaches thealveoli
These two variables constitute the main
determinants of the blood oxygen concentration.
In fact since V determines the quantity of oxygenmass reaching the alveoli per minute (g/min) and
Q expresses the flow of blood in the lungs (l/min),
the V/Q ratio refers to a concentration (g/l).
http://en.wikipedia.org/wiki/Ventilation_(physiology)http://en.wikipedia.org/wiki/Airhttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Airhttp://en.wikipedia.org/wiki/Ventilation_(physiology) -
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Pathophysiology
A lower V/Q ratio usually seen in chronic
bronchitis, asthma and acute pulmonaryedema.
A high V/Q ratio increases paO2 and decreases
paCO2. This finding is typically associatedwith pulmonary embolism (where blood
circulation is impaired by an embolus), but can
also be observed in COPD as a maladaptiveventilatory overwork of the undamaged lung
parenchyma.
http://en.wikipedia.org/wiki/Chronic_bronchitishttp://en.wikipedia.org/wiki/Chronic_bronchitishttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Acute_pulmonary_edemahttp://en.wikipedia.org/wiki/Acute_pulmonary_edemahttp://en.wikipedia.org/wiki/Pulmonary_embolismhttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/wiki/Pulmonary_embolismhttp://en.wikipedia.org/wiki/Acute_pulmonary_edemahttp://en.wikipedia.org/wiki/Acute_pulmonary_edemahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Chronic_bronchitishttp://en.wikipedia.org/wiki/Chronic_bronchitis -
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Sputum : It is usually in air passages
in diseased lungs, bronchi,
pneumonia It can be associate with
blood (hemoptysis) if a chronic
cough is present, possibly fromsevere cases of tuberculosis.
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ABG Arterial blood gas analysis
commonly performed for
individuals with suggested or
diagnosed pulmonary disease.
Provides valuable information aboutan individuals gas exchange & acid-
base status.
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Upper Respiratory Tract Infection
1-Common cold
2-Acute laryngitis
3-Acute Bronchitis 4-Infeunza
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Obstructive Pulmonary Disease
Definition
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Obstructive Pulmonary Disease
Characterized by airway obstruction that is
worse with expiration. More force is required toexpire a given volume of air, or emptying oflungs is slowed, or both.
The most common obstructive diseases areasthma, chronic bronchitis, and emphysema.
Many people have both chronic bronchitis and
emphysema, and together these are oftencalled chronic obstructive pulmonarydisease - COPD
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Major symptom of obstructive pulmonarydisease is dyspnea, and the unifying sign
is wheezing.
Individuals have increased work ofbreathing, V/Q mismatching, and a
decreased forced expiratory volume.
A h
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Asthma More intermittent and acute than COPD,
even though it can be chronic Factor that sets it apart from COPD is its
reversibility
Occurs at all ages, approx. half of allcases develop during childhood, andanother 1/3 develop before age 40
5 % of Adults and 7-10 % of children inU.S. have asthma
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.
Runs in families, so evidence genetics plays a
role. Environmental factors interact with inherited
factors to increase the risk of asthma and
attacks of bronchospasm Childhood exposure to high levels of allergens,
cigarette smoke and/or respiratory viruses
increases chances of developing asthma.
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Clinical manifestions
During remission individual isasymptomatic and pulmonary functiontests are normal
Dyspnea Often severe cough
Wheezing exhalation
Attacks usually of one to two hoursduration, but may be severe and continuefor days or even weeks.
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If bronchospam is not reversed by usual
measures, the individual is considered tohave severe bronchospasm or statusasthmaticus
If continues can be life threatening.
M t
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Management
Avoid triggers (allergens and irritants)
Patient education Acute attacks treated with corticosteroids
,oxygen and bronchodilator
Chronic management based on severity ofasthma and includes regular use of inhaledantiinflammatory medications corticosteroids,
Inhaled bronchodilators *** Immunotherapy allergy shots, etc.
COPD
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COPD
Pathological changes that cause reduced
expiratory air flow Does not change markedly over time
Does not show major reversibility in
response to pharmacological agents
Progressive
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Primary cause is cigarette smoking
Both active and passive smoking havebeen implicated
Other risks are occupational exposures
and air pollution
Genetic susceptibilities identified
Ch i B hiti
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Chronic Bronchitis Hypersecretion of mucus and chronic
productive cough for at least 3 months(usually winter) of the year for at least twoconsecutive years.
Incidence may be increased up to 20times in persons who smoke and more inpersons exposed to air pollution.
T t t
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Treatment Best treatment is PREVENTION because
changes are not reversible. Cessation of smoking halts progression of
the disease
Bronchodilators, expectorants, and chestphysical therapy are used as needed.
Acute attacks may require antibiotics,steroids and possibly mechanical
ventilation. Chronic oral steroids as a last resort.
Home oxygen therapy
E h
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Emphysema Abnormal, permanent enlargement of the
gas-exchange airways and destruction ofthe alveolar walls.
Obstruction results from changes in lung
tissue rather than mucus production andinflammation.
Major mechanism is loss of elastic recoil
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Major cause is cigarette smoking
Other causes are air pollution and
childhood respiratory infections
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Clinical manifestations
Dyspnea
Barrel chest
Minimal wheezing Prolonged expiration
Hypoventilation and polycythemia late in
the progression of the disease
Treatment
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Treatment Similar to chronic bronchitis
Stop smoking Bronchodilating drugs
Breathing retraining
Relaxation exercises
Antibiotics for acute infections
Severe COPD may require inhaled or oralsteroids, and home oxygen