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Respiratory System Diseases
Introduction to Human DiseasesChapter 11
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Respiratory System Anatomy
Upper respiratory tract From nasopharynx to trachea
Lower respiratory tract From trachea to alveoli
AlveoliRespirationVentilationOxygen & carbon dioxide
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Epistaxis (nosebleed)
HemorrhageMore common in childrenTreatment: Pressure, vasoconstricting meds, cautery
Etiology: Trauma, rhinitis, sinutitis, HTN,
coagulation diseases, anticoagulant medicines
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Sinusitis
Inflammation of the paranasal sinusesAcute (infection: viral or bacterial)Chronic (often allergic or hyperplastic)Treatment: Varies with type
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Acute & Chronic Pharyngitis
Inflammation of the pharynxMost common throat disorderAcute (viral, streptococcal bacteria, etc)Chronic (allergy, persistent cough, etc)Treatment: Varies with etiology
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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
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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.
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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
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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)
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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
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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
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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
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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)
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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
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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
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Pleural Effusion
Diagnostics & treatment: CXR, thoracentesis, treatment of
underlying cause, chest tube
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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
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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
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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
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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
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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
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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
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Pneumoconiosis
Pulmonary diseases caused by chronic dust inhalationOften occupational disordersS/S: chronic cough, shortness of breathMultiple types: Silicosis Asbestosis Berylliosis anthracosis
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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
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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)
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Respiratory Mycoses
Treatment: Long-term antifungal meds Valley fever may resolve
spontaneously
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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
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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
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Cor Pulmonale
Treatament: Oxygen, medicines to enhance
contractility of ventricle or vasodilate the pulmonary vessels
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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
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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
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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
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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
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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
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Respiratory Alkalosis
Much less common than respiratory acidosisTreatment: Slow respiratory efforts, try to relieve
hyperventilation according to mechanism
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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
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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
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Bronchiectasis
S/S: Chronic cough (productive), variable
dyspnea, increased infections
Treatment: Antibiotics, bronchodilators, etc.
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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
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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
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Lung Cancers
Often asymptomatic until lateTreatment: Surgery, radiation, chemotherapy,
often in combination Photodynamic therapy (laser therapy)
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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
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SIDS
Etiology: unknown Suspected: mechanical suffocation,
prolonged apnea, deficiency of part of vitamin B complex, immune problem, abnormal larynx
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Acute Tonsillitis
Tonsillar inflammationAcute or chronicMost common: infection Strep pyogenes, Staphylococcus
aureus
S/S: sore throat, hoarseness, fever, dysphagiaTreatment: antibiotics
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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
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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