Respiratory System Diseases

Introduction to Human DiseasesChapter 11

Respiratory System Anatomy

Upper respiratory tract From nasopharynx to trachea

Lower respiratory tract From trachea to alveoli

AlveoliRespirationVentilationOxygen & carbon dioxide

Epistaxis (nosebleed)

HemorrhageMore common in childrenTreatment: Pressure, vasoconstricting meds, cautery

Etiology: Trauma, rhinitis, sinutitis, HTN,

coagulation diseases, anticoagulant medicines

Sinusitis

Inflammation of the paranasal sinusesAcute (infection: viral or bacterial)Chronic (often allergic or hyperplastic)Treatment: Varies with type

Acute & Chronic Pharyngitis

Inflammation of the pharynxMost common throat disorderAcute (viral, streptococcal bacteria, etc)Chronic (allergy, persistent cough, etc)Treatment: Varies with etiology

Acute & Chronic Laryngitis

Inflammation of the larynx & vocal cordsAcute: viral or bacterial infections, excessive use of the voice, inhalational injuries (dust or chemicals)Chronic: often due to other ENT diseases (polyps, sinusitis, allergies, etc)Treatment: Varies with etiology

Infectious Mononucleosis

Acute viral infectionUsually adolescents & young adultsSore throat, fever, enlarged cervical LNEtiology: Epstein-Barr virus (EBV)Disease: episodes of the above symptoms, fatigue, splenomegaly, often 6-8 week course.Treatment: pain & fever relief, steroids in some cases.

Pneumonia

Inflammation of bronchioles and alveoliUsually infectious Bacterial & viral = most common Also fungal, protozoa, rickettsiae

May be unilateral or bilateralMay involve one to all five lobes of the lungs

Pneumonia

Aspiration pneumonia: Inhalation of gastric contents, then chemical

irritation & infection

Most common infectious agents: Pneumococcus and influenza virus

S/S: cough, fever, sputum production, dyspnea, rales, wheezingTesting: chest X-ray (CXR)Treatment: antibiotics (if bacterial)

Legionnaire’s DiseaseLegionella Pneumonia

Pneumonia caused by bacteria: Legionella pneumophilia

Named for 1976 outbreak at an American Legion conventionSeverity variesS/S: nonproductive cough at first, then grayish sputumTreatment: antibiotics

Lung Abscess

Area of necrotic & purulent lungMore common in dependent areas of lungs and in right lungMay be caused by pneumonias or by spread of infection by blood from other areas of the bodyTesting & treatment: Often seen on CXR, antibiotics & possible excision

Pneumothorax

Abnormal collection of air between the two pleural layersThis implies that the lung is collapsed to some degree on that sideS/S: pleuritic chest pain, dyspnea, decreased audible breath sounds Etiology: Trauma, bleb rupture, iatrogenic, asthma

Pneumothorax

Types: simple, open, tension, spontaneousIn tension PTX: shock (hypotension) developsTesting: seen on CXRTreatment: varies with severity Small: observation, will reabsorb Others: tube thoracostomy (chest

tube)

Pleurisy/ Pleuritis

Inflamation of parietal & visceral pleuraMay be primary or secondaryEtiology: Infection, SLE, traumatic, etc

S/S: Pleuritic or sharp chest painTreatment: pain relief and treatment of underlying cause

Pleural Effusion

Excess fluid in the pleural space (in between the parietal & visceral pleura)Types of effusion: Transudate-more watery Exudate-contains more protein, cells

S/S: Pleuritic pain, dyspnea, decreased breath

sounds on that side of the chest, abnormal percussion testing

Pleural Effusion

Diagnostics & treatment: CXR, thoracentesis, treatment of

underlying cause, chest tube

Chronic Obstructive Pulmonary Disease (COPD)

Chronic, often progressive pulmonary disease with three components Emphysema (alveolar wall breakdown) Chronic bronchitis (chronic irritation, cough) Wheezing or reactive airways

Etiology: Smoking, chronic dust or irritant inhalation,

alpha-1 antitrypsin deficiency, prolonged respiratory infections or allergy

COPD

S/S: variable shortness of breath, cyanosis, decreased exercise tolerance, chronic hypoxia, increased risk of pulmonary infections or Ca, chronic coughDiagnosis: pulmonary function testing, CXR

Treatment: bronchodilators, steroids, antibiotics when

needed

Asthma

Chronic respiratory disease characterized by episodes of reversible wheezing and dyspnea. In between episodes, lungs appear normalThree components: Bronchospasm Airway inflammation Increased mucous production

Asthma

S/S: audible wheezing, cough, shortness of breath, increased risk of pulmonary infectionsDiagnosis: pulmonary function testing, CXR, response to bronchodilatorsTreatment: Inhaled bronchodilators, some steroid

use(oral or inhaled), some antiinflammatories

Pulmonary Tuberculosis

Slow-growing bacterial infection that initially infects the lungs and may become chronic multisystemic illness Caused by Mycobacterium tuberculosisCharacterized by granulomas (granular appearing tissue)Diagnosis: via CXR, Mantoux skin test

TB

S/S: chronic cough, hemoptysis, rales, wheezing, weight lossTreatment: long term (at least 6 months) of antibiotics, often multiple antibiotics required for several years

Pneumoconiosis

Pulmonary diseases caused by chronic dust inhalationOften occupational disordersS/S: chronic cough, shortness of breathMultiple types: Silicosis Asbestosis Berylliosis anthracosis

Pneumoconiosis

Silicosis Most common, inhalation of quartz dust

Asbestosis Inhalation of asbestos fibers, “ground glass

appearance” on CXR

Berylliosis Berylium metal dust inhalation

Anthracosis Coal workers “black lung” disease

Respiratory Mycoses

Deep fungal infections of the lungsDiagnosis: via CXR & serologic or skin testingTypes: Histoplasmosis (Ohio Valley Disease) Coccidiodomycosis (Valley Fever) Blastomycosis (North American

blastomycosis)

Respiratory Mycoses

Treatment: Long-term antifungal meds Valley fever may resolve

spontaneously

Pulmonary Edema

Excess fluid (transdate type) in the pulmonary tissues and alveoliDue to cardiac diseases usually (left sided heart failure most commonly)S/S: like those of CHFDiagnosis: CXRTreatment: Oxygen, diuretics, bronchodilators, contractility enhancers

Cor Pulmonale

Right ventricular failureDifficulty pumping blood into pulmonary circulationEventual development of pulmonary hypertension due to chronic hypoxiaEtiologies: Any cardiac, pulmonary, congenital, or

chest wall disease that impedes RV outflow

Cor Pulmonale

Treatament: Oxygen, medicines to enhance

contractility of ventricle or vasodilate the pulmonary vessels

Pulmonary Embolism

Embolus (thrombus from elsewhere in the body) that traversed bloodstream to become lodged in a pulmonary blood vessel.Usual source is thrombi from the legsMay be small or large, multiple or singleS/S: dyspnea, often pleuritic chest pain, unexplained tachycardia, cardiac arrest (if large embolism), hypoxia

Pulmonary Embolism

Diagnosis: arterial blood gases (to check oxygen in arterial blood), CXR, CT scan of the chestTreatment: Oxygen, anticoagulants,

hospitalization if large embolism, may use

fibrinolytics/thrombolytics

Respiratory Acidosis (Hypercapnia)

Excess carbon dioxide in the bloodDue to inability of lungs to dispose of the usual carbon dioxide products of metabolismAcid (hydrogen ions) increases, so pH falls (less than 7.4)Etiology: respiratory insufficiency or failure, may be due to many etiologies

Respiratory Acidosis

May be due to neurological illness and decreased level of consciousnessTreatment: Manual or mechanical ventilation with

oxygen Find and treat the underlying source

Respiratory AlkalosisHypocapnia

Carbon dioxide in the blood is at a lower than normal levelExcessive removal of CO2 by the lungsThe blood is now alkaline (more base, less acid) and pH is high (above 7.4)Etiology: Hyperventilation due to disease, incorrect

mechanical ventilation, overdoses, anxiety

Respiratory Alkalosis

Much less common than respiratory acidosisTreatment: Slow respiratory efforts, try to relieve

hyperventilation according to mechanism

Atelectasis

Collapse of an area of smaller, distal airways in a part(s) of the lungsResults in hypoxia, increased temperatureMay be seen on CXREtiology: numerousTreatment: Chest PT, spirometry, oxygen as needed, postural drainage

Bronchiectasis

Permanent abnormal dilation of small and medium-sized bronchiDue to destruction of muscular & elastic components of bronchial wallsGreatly decreased over last few decadesEtiology: CF, inhalation injury, infections, smoking

Bronchiectasis

S/S: Chronic cough (productive), variable

dyspnea, increased infections

Treatment: Antibiotics, bronchodilators, etc.

Lung Cancers

Leading cause of cancer deaths in men and womenMultiple types: Non-small cell

More common, slower to grow & metastasize Squamous cell Ca, adenoca, large cell Ca

Small cell Oat cell cancer Less common, quicker growing & metastatic

Lung Cancers

Etiology: Associated with smoking directly or

indirectly 87% of the time Radon gas inhalation (odorless,

tasteless, radioactive gas) Asbestos, uranium, arsenic, some

petroleum products

Lung Cancers

Often asymptomatic until lateTreatment: Surgery, radiation, chemotherapy,

often in combination Photodynamic therapy (laser therapy)

Sudden Infant Death Syndrome (SIDS)

Unexplained death of normal-appearing infantsUsually 10-12 weeksTypically during sleepMore risk in: Males, premature infants, during

winter months Leading COD in first 6 months of life

SIDS

Etiology: unknown Suspected: mechanical suffocation,

prolonged apnea, deficiency of part of vitamin B complex, immune problem, abnormal larynx

Acute Tonsillitis

Tonsillar inflammationAcute or chronicMost common: infection Strep pyogenes, Staphylococcus

aureus

S/S: sore throat, hoarseness, fever, dysphagiaTreatment: antibiotics

Adenoid Hyperplasia

Enlargement of the lymphoid tissues in the nasopharynxCauses partial obstruction to breathing Snoring, nasal quality to speech

More obvious during sleep and URI’sEtiology: unknownTreatment: surgical removal

Croup

Inflammation of the upper airways (the subglottic area)Viral etiologyWinter illnessUsually in infants & up to 3 YOAS/S: barking (seal-like) cough, worse when supineTreatment: humidified air, cool air