Respiratory System Disorders 1
Lecture 23
Pathology and Clinical
Science 1 (BIOC211)
Department of BioscienceText Reference:
Porth’s Pathophysiology: Concepts of Altered Health States
Sheila C. Grossman & Carol Mattson Porth.
Ninth Edition.
Copyright © 2014 Lippincott, Williams & Wilkins Publishers, Inc.
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Session Learning Outcomes
This session aims to:
o Understand the use of various diagnostic tests and
procedures for the disorders of respiratory system
o Comprehend how and why the clinical features of
respiratory disorders appear
o Discuss the causes and management of respiratory
failure.
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RESPIRATORY SYSTEM
From Principles of anatomy and physiology, (12th ed.,), by Tortora, GJ & Derrickson, B, 2010, Hoboken, NJ. Wiley.
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RESPIRATORY SYSTEM
From Principles of anatomy and physiology, (14th ed., p888), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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FUNCTIONS OF RESPIRATORY
SYSTEM
Gaseous exchange – intake of Oxygen, elimination of
Carbon dioxide
Helps regulate the blood pH – by maintaining the CO2 levels
Contains receptors for the sense of smell
Filters, warms and moistens the inspired air to make it
suitable to enter the lungs.
Produces and modifies the speech and vocal sounds as the
air passes over the nose and vocal folds in larynx
Elimination of waste: Excretes small amounts of ketone
bodies, volatile molecules, heat and water
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FUNCTIONS OF RESPIRATORY
SYSTEM
From Principles of anatomy and physiology, (14th ed., p893), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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FUNCTIONS OF RESPIRATORY
SYSTEM
From Principles of anatomy and physiology, (14th ed., p898), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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PULMONARY VOLUMES
From Principles of anatomy and physiology, (12th ed.), by Tortora, GJ & Derrickson, B, 2010, Hoboken, NJ. Wiley.
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CLINICAL EXAMINATION
o Respiratory rate and rhythm effort
o Hands – clubbing, cyanosis
o Pulses – rate & rhythm
o BP
o Face, mouth eyes – anaemia, cyanosis
o Thorax – deformity, movements, breath
sounds
o Leg -oedema
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INVESTIGATION OF
RESPIRATORY DISEASE
Imaging
• Plain chest X ray
• CT/MRI
• Ultrasound
• Ventilation-perfusion imaging
• PET
• Pulmonary angiography
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INVESTIGATION OF
RESPIRATORY DISEASEo Endoscopic examination
• Laryngoscopy
• Bronchoscopy
• Mediastinoscopy
• Pleural aspiration and biopsy using
thoracoscopy
o Skin tests
• Tuberculin test
• Skin hypersensitivity test
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CHEST X RAY
www.southernhealth.com.au/.../general_xray.htm
Normal Lung
X-ray
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Ventilation-
perfusion
imaging
http://www.spectlung.com/is-admin/files/Case%20Studies/case_18_2.JPG
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http://www.diegori.it/InternetMedico/Bronchoscopy%20Atlas_file/cover_art.jpg
Normal airway Narrowed airway Inflamed airway
Foreign Body Dilated airway Bronchogenic carcinoma
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Pulmonary
Angiography
under
CT Scan
https://health.siemens.com/ct_applications/somatomsessions/wp-content/uploads/2013/05/Image-51.jpg
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Pulmonary
Angiography
CT Scan
http://web.stanford.edu/dept/radiology/radiologysite/images/Med%20students%201,%20chest/Pulmonary%20arteries%20+%20veins,%20CTA%20(1).png
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TUBERCULIN TEST
www.stanford.edu/group/parasites/ParaSites200...
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9991.htm
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INVESTIGATION OF
RESPIRATORY DISEASE
o Immunological and serological test
• Presence of antigens
• Antibody titres
o Microbiological investigations
• Sputum, pleural fluid, throat swab
o Histological and cytological examination
• Biopsy material
• Cytology of sputum, pleural fluid or bronchial washing
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Needle Biopsy
http://www.nytimes.com/imagepages/2007/08/01/health/adam/9761Lungbiopsy.html
o A needle lung biopsy is
performed when there
is an abnormal
condition that is near
the surface of the lung,
in the tissues
surrounding the lungs,
or on the chest wall.
o The test can be
performed to obtain a
sample for culture
when infection of the
lung is suspected, and
sputum or
bronchoalveolar
lavage cultures have
not identified the cause
of the infection.
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INVESTIGATION OF
RESPIRATORY DISEASE
oRespiratory function testing
• Peak flow metre
• Spirometer
oArterial blood gases and oximetry
oExercise tests
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Peak Flow Meters
http://www.giftag.com/clip/cheapekgmachines/
microlife-digital-peak-flow-meter-micro-medical-
spirometers-cheapekgmachinescom-clip.jpg
http://www.promed.ie/shop/assets/catalog/catego
ries/15361peakflow.jpg http://brimages.bikeboardmedia.netdna-cdn.com/wp-
content/uploads/2009/08/camelbak-flow-meter-with-tube.jpg
http://www.healthproductsforyou.com/prodimages/ProductIma
ge/27820072211801.gif
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Spirometers
http://www.priceit.in/wp-content/uploads/2011/01/Spirometer-2.jpg
http://i3.squidoocdn.com/resize/squidoo_images/-
1/lens17567779_1295954847Micro-GP-
spirometer.jpg
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Causes
• Viral lower respiratory tract infection
(common), post-nasal drip, inflammation
of the airways (usually upper)
Cough
• Most frequent symptom
• Characteristics of cough differ in
different disorders
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Causes
• Causes
– Respiratory causes
– Cardiac causes
– Others (muscular, psychological, GIT and traumatic)
• Chronic exertional dyspnoea in COPD
• Acute severe dyspnoea
Dyspnoea
• Feeling of an uncomfortable need to breathe (difficulty
in breathing)
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Causes
• Cardiac causes (refer session 19)
• Respiratory causes – peripheral chest pain
exacerbated by deep breathing or coughing
– Pulmonary infarct, pneumonia, pneumothorax,
malignancy, TB
• Other causes
– Musculoskeletal
– Neurological
Chest pain
Frequent manifestation of cardiac and respiratory diseases
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASEHaemoptysis
• Coughing up blood
Causes
• Common causes
–Carcinoma
–Bronchiectasis
–Acute bronchitis
–Tuberculosis
–Pulmonary infarction
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Bronchogenic
Carcinoma
http://images.radiopaedia.org/images/382214/a280a19796be7dc5ae90deec5887b7.jpg
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Tuberculosis
http://upload.wikimedia.org/wikipedia/commons/9/9c/Tuberculosis-x-ray-1.jpg
Ghon Lesion
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PRIMARY
TUBERCULOSIS
From Porth’s Pathophysiology: Concepts of Altered Health States.
(9th ed., p. 940), by Sheila C. Grossman & Carol Mattson Porth.
Philadelphia, U.S.A. Walters Kluwer Health - Lippincott, Williams
& Wilkins
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Secondary Tuberculosis
http://ivanlt.files.wordpress.com/2009/04/ind180.jpg
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Miliary Tuberculosis
Kumar, V., Cotran, R., & Robbins, S. (1997) Basic Pathology. 6th ed., p. 425). Philadelphia.
W B Saunders Company
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RESPIRATORY DISEASES
Common causes
– Bronchial carcinoma
– Single metastasis
– Localised pneumonia
– Lung abscess
– Tuberculoma
– Pulmonary infarct
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Lung
Metastases
http://library.med.utah.edu/WebPath/jpeg1/LUNG078.jpg
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Bronchopneumonia
(left)
Lobar pneumonia
(right)
From Pathophysiology for the Health Professions (2nd ed., p. 325), by B Gould, 2002. Philadelphia. W B Saunders Company.
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Causes
– Tuberculosis (infective)
– Malignant disease
– Cardiac failure (bilateral)
Pleural effusion
• Accumulation of serous fluid within the
pleural space
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Causes
• Sleep apnoea/ hypopnoea syndrome
– Due to recurrent occlusion of pharynx during sleep
– Apnoea followed by series of deep breath, sleep, snoring and apnoeic once more
– Predisposing factors – male, obesity, nasal obstruction, recessed mandible
Sleep-disordered breathing
• Many respiratory disorders manifest during sleep
– Nocturnal cough and wheeze in asthma
– Exacerbation of respiratory failure in patients with restrictive lung disease
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CLINICAL PRESENTATIONS IN
RESPIRATORY DISEASE
Respiratory failure
• Pulmonary gas exchange fails to maintain
normal arterial oxygen and carbon dioxide
levels
• Classification
– Type I - Hypoxia with normal or low PaCO2
– Type II - Hypoxia with hypercapnia (raised
PaCO2)
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RESPIRATORY FAILURE
Causes (many respiratory disorders)
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Pneumothorax
• Pulmonary emboli
• Airway obstruction
• Lung fibrosis
• Narcotic drugs
• Brain stem lesion
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RESPIRATORY FAILURE
Management
• Prompt diagnosis and treatment of underlying
cause
• Maintenance of airway
• Oxygen therapy
• Bronchodilators
• Antibiotics
• Mechanically assisted ventilation
• Lung transplantation
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RESPIRATION SOUNDS
It’s not often that you will be able to listen to abnormal
respiratory sounds during the course of your studies. Here
is a great link to not only listen to normal air intake sounds,
but also a bunch of abnormal sounds associated with
various lung pathologies.
Have a listen, then see how you go with the Quiz on the
same site.
I think this is a great link to keep, for later reference.
http://www.easyauscultation.com/lung-sounds
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Readings and ResourcesResources:
o Set Textbooks:
Colledge, N.R., Walker, B.R. & Ralston S.H. (2014). Davidson’s Principles and Practice of Medicine, (22nd ed.). Edinburgh.
Churchill Livingstone.
Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: concepts of altered health states, (9th ed.). Philadelphia,
U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins.
o Additional textbooks:
Davies, A. & Moores, C. (2010). The respiratory system: basic science and clinical conditions, (2nd ed.). Edinburgh. Churchill,
Livingstone, Elsevier.
Field, M., Pollock, C., Harris, D. (2010). Systems of the Body: The Renal System; Basic Science and Clinical Conditions. (2nd
ed.). United Kingdom: Churchill Livingstone.
Jamison, J.R. (2006) Differential Diagnosis for Primary Care: a handbook for health care practitioners. (2nd ed.). Edinburgh.
Churchill Livingstone.
Lee, G. & Bishop, P. (2013). Microbiology and Infection Control for Health Professionals, (5th ed.). Frenchs Forest, NSW.
Pearson Education.
McCance, K.L. & Huether, S.E. (2014). Pathophysiology: the biological basis for disease in adults and children, (7th ed.). St.
Louis, MO. Elsevier.
Murphy, K. (2011). Janeway’s immunobiology, (8th ed.). New York. Garland Science.
Noble, A., Johnson, R. & Bass, P. (2010). The cardiovascular system: basic science and clinical conditions, (2nd ed.).
Edinburgh. Churchill, Livingstone, Elsevier.
Pagana, K.D. & Pagana, T.J. (2013). Mosby’s diagnostic and laboratory test reference, (11th ed.). St. Louis, MO. Elsevier.
Smith, M.E. & Morton, D.G. (2010). The digestive system: basic science and clinical conditions, (2nd ed.). Edinburgh.
Churchill, Livingstone, Elsevier.
VanMeter, K.C. & Hubert, R. (2014). Gould’s pathophysiology for health professions, (5th ed.). St. Louis, MO. Elsevier.
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