introduction these respiratory diseases include: 1. infections such as pneumonia. 2. obstructive...
TRANSCRIPT
AIRWAY
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INTRODUCTION
These respiratory diseases include:
1. Infections such as pneumonia.
2. Obstructive disorders that obstruct airflow into and out of
the lungs such as asthma, bronchitis and emphysema.
3. Restrictive disorders are conditions that limit normal
expansion of the lungs such as pneumothorax,
atelectasis, respiratory distress syndrome and cystic
fibrosis.
4. Cancers or exposure to Inhaled particles alter the
pulmonary function.
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GENERAL SYMPTOMS OF RESPIRATORY DISEASE
Hypoxia : Decreased levels of oxygen in the tissues
Hypoxemia : Decreased levels of oxygen in arterial blood
Hypercapnia : Increased levels of CO2 in the blood
Hypocapnia : Decreased levels of CO2 in the blood
Dyspnea : Difficulty breathing
Tachypnea : Rapid rate of breathing
Cyanosis : Bluish discoloration of skin and mucous
membranes due to poor oxygenation of the blood
Hemoptysis : Blood in the sputum
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RESPIRATORY INFECTIONS
Infections of the respiratory tract can occur in:
1. The upper respiratory tract or
2. The lower respiratory tract, or
3. Both.
Organisms capable of infecting respiratory structures include:
4. bacteria.
5. viruses: the majority of upper respiratory tract infections are caused by viruses as rhinovirus and Para-influenza virus.
6. fungi.
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THE COMMON COLD
The most common viral pathogens for the “common cold” are rhinovirus, parainfluenza virus, respiratory syncytial virus, adenovirus and corona virus.
• Manifestations of the common cold include:Rhinitis: Inflammation of the nasal mucosaSinusitis :Inflammation of the sinus mucosaPharyngitis : Inflammation of the pharynx and
throatHeadacheNasal discharge and congestion
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INFLUENZA
• Influenza is a viral infection that can affect the upper or
lower respiratory tract.
• Three distinct forms of influenza virus have been
identified: A ( the most common and causes the most
serious illness) B and C.
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Symptoms of influenza infection: HeadacheFever, chillsMuscle achesNasal dischargeUnproductive coughSore throat
Treatment of influenza: Bed rest, fluids, warmth Antiviral drugs Influenza vaccine :Provides protection against certain
A and B influenza strains that are expected to be prevalent in a certain year.
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ATELECTASIS
Atelectasis is a condition in which there is incomplete expansion of lung tissues due to blockage of the airways or compression of the alveolar sacs.
Manifestations of atelectasis:
• Dyspnea, cough.
• Reduced gas exchange.
• Shunting of blood to areas of the lungs that are inflated.
Treatment of atelectasis:
• Removal of airway blockage
• Removal of air, blood, fluids, tumors, etc. that are compressing lung
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ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)
• ARDS is a syndrome associated with destruction of alveolar membranes and their related capillaries
• It may occur as a result of direct injury to the lungs or as a result of dramatic decreases in blood flow to the lung (“shock lung,”)
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Causes:• Septicemia, uremia• Trauma• Near drowning• Inhalation of toxic gases or agents• Aspiration of gastric contents• Widespread pneumonia• Drug overdose• Systemic shock• Dyspnea, tachypnea.• Hypoxemia/ Hypocapnia• Accumulation of fluids in alveoli and around alveolar
spaces.• Changes in blood pH due to altered blood levels of CO2.
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Treatment:• Oxygen therapy• Anti-inflammatory drugs• Diuretics to reduce edema• Correction of acid–base balance
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SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES
Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain
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Other presenting symptoms
Apnea
Hoarseness
Stridor
Snoring
Fever
Night sweating
Weight loss
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a) Acute cough Acute bronchitis Pneumonia Pulmonary Embolism
b) Chronic cough (>2 weeks) Bronchial asthma Chronic bronchitis Lung cancer
c) Sputum Lung abscess ( Foul smelling, more on lying on
the other side of lesion) Pneumonia ( yellowish, streaks of blood) Pulmonary edema ( Pink frothy)
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d) Hemoptysis Lung cancer ( clots) Tuberculosis Pneumonia
e) Dyspnea
Acute dyspnea (hours to days) Bronchial asthma Pneumonia Massive pleural effusion Pulmonary edema
Chronic dyspnea (months to Years) Chronic bronchitis Emphysema
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f) Wheezes (Rhonchi) Bronchial asthma COPD Pulmonary embolism Lung cancer
g) Chest pain Pulmonary infarction Pneumonia Angina pectoris
h) Cyanosis (>5gm% of Hb deoxygenated)• Central (blue hands & tongue) COPD, Asthma,
Pneumonia, PE• Peripheral (blue hands & red tongue) Cold weather
DISEASES OF THE RESPIRATORY SYSTEM• Chronic Bronchitis results from irritation of the bronchi
and bronchioles. This causes more tissues to secrete excess mucous. In chronic bronchitis, the air passages clog with mucous. This causes a constant cough. This disease can result from cigarette smoking.
• Chronic Obstructive Pulmonary Disease (COPD) is a combination of asthma, emphysema, and chronic bronchitis. It usually results from exposure to cigarette smoke.
• Lung cancer It usually results from smoking or prolonged exposure to dangerous materials in the air.
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PNEUMONIA
• Pneumonia is an infection of the alveoli. Bacteria or viruses can cause it. Fluid collects in the alveoli. This means they cannot exchange oxygen and carbon dioxide efficiently.
Signs/symptoms:• High fever• Chills• Shortness of breath• Increased breathing rate• A worsening cough that may produce discolored or bloody
sputum (phlegm)• Sharp chest pains – caused by inflammation of the
membrane that lines the lungs.
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Types:
a. Community acquired pneumonia (CAP)
b. Aspiration pneumonia
c. Hospital
–Hospital acquired pneumonia (HAP)
–Ventilator associated pneumonia (VAP)
–Healthcare associated pneumonia (HCAP)
Treatment of pneumonia:
• Antibiotics if bacterial in origin.
• Oxygen therapy for hypoxemia.
• A vaccine for pneumococcal pneumonia is currently available and highly effective.
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TUBERCULOSIS
• The most common symptoms and signs of TB are:•Fatigue •fever• weight loss•coughing•hemoptysis•night sweats
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ACUTE PULMONARY OEDEMA
• It occurs when fluid quickly accumulates in the lungs and fills the alveoli
• This can cause problems with the exchange of gas (oxygen and carbon dioxide), resulting in breathing difficulty and poor oxygenation of blood.
• Treatment: oxygen, digitalis, diuretics
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE( COPD)
• It is a chronic, progressive disorder characterized by airway obstruction and little/no reversibility.
Comprises of:• chronic bronchitis• emphysema• asthma
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Chronic Bronchitis:
It is defined clinically as cough, productive of sputum, on most days for 3 months of 2 successive years.
Emphysema:
Is defined histologically as enlargement of the air spaces distal to the terminal bronchioles, with destruction of the alveolar walls
Asthma:
Characterized by recurrent episodes of dyspnea, cough(often nocturnal) and wheeze caused by reversible airway obstruction
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Chronic bronchitis EmphysemaMild Dyspnea Dyspnea that may be
severe
Productive cough Dry or no cough
Cyanosis common Cyanosis rare
Respiratory infection common
Infrequent infections
Onset usually after 40 years of age
Onset usually after 50 years of age
History of cigarette smoking
History of cigarette smoking
Cor pulmonale common Cor pulmonale in terminal stages
Comparison of Symptoms for Chronic Bronchitis and Emphysema
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CATEGORIES OF COPD• Type A - “Pink Puffer”- predominantly emphysema• Type B - “Blue Bloaters- predominantly chronic bronchitis.
Investigations:• ABG• CXR to exclude infection and pneumothorax• FBC, U&E, ECG• blood cultures( if pyrexial)
Management:• Controlled oxygen therapy• Nabulized bronchodilators e.g. albuterol (ventolin)• Antibiotics if evidence of infection (amoxicillin)
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EMPHYSEMA
• Emphysema is a respiratory disease that is characterized by destruction and permanent enlargement of terminal bronchioles and alveolar air sacs
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Signs and symptoms of emphysema• barrel-chest appearance• non productive cough• severe exertional dyspnea• pink skin color(pink puffer)• wheezing and ronchi• pursed-lip breathing(prolonged inspiration)
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Asthma
It is characterized by recurrent episodes of dyspnoea, cough and wheeze caused by reversible airways obstruction.
Contributing factors:
Bronchial muscle contraction, mucosal swelling/inflammation, increased mucosal production
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Manifestations of asthma :
Coughing, wheezing Difficulty breathing Rapid, shallow breathing Increased respiratory rate Excess mucus production Significant anxiety Hyper inflated chest Hyper resonant percussion note
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Common Asthma causes:• Animals (pet hair or dander) • Dust • Changes in weather (most often cold weather) • Chemicals in the air or in food • Exercise • Mold • Pollen • Respiratory infections, such as the common cold • Strong emotions (stress) • Tobacco smoke
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Management:
Beta 2 receptor agonist(Salbutamol)
Corticosteroids
Aminophylline (decreases bronchoconstriction)
Anticholinergics(e.g. Ipratropium) may decrease muscle spasm
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Manifestations of chronic bronchitis:• Productive, chronic cough• Production of purulent sputum• Frequent acute respiratory infections• Dyspnea, shortness of breath, wheezing, fatigue• Hypoxia, cyanosis• Fluid accumulation (edema) in later stages
BRONCHITIS
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• Chronic inflammation and swelling of the peripheral airways
• Excessive mucus production and accumulation• Partial or total mucus plugging• Hyperinflation of alveoli (air-trapping)• Smooth muscle constriction of bronchial airways
(bronchospasm)
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