respiratory system disorders 1 system disorders 1 lecture 23 pathology and clinical science 1...

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.

© endeavour.edu.au

© Endeavour College of Natural Health endeavour.edu.au 2

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.


RESPIRATORY SYSTEM

From Principles of anatomy and physiology, (12th ed.,), by Tortora, GJ & Derrickson, B, 2010, Hoboken, NJ. Wiley.


RESPIRATORY SYSTEM

From Principles of anatomy and physiology, (14th ed., p888), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.


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



SYSTEM



PULMONARY VOLUMES

From Principles of anatomy and physiology, (12th ed.), by Tortora, GJ & Derrickson, B, 2010, Hoboken, NJ. Wiley.


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


INVESTIGATION OF

RESPIRATORY DISEASE

Imaging

• Plain chest X ray

• CT/MRI

• Ultrasound

• Ventilation-perfusion imaging

• PET

• Pulmonary angiography


INVESTIGATION OF

RESPIRATORY DISEASEo Endoscopic examination

• Laryngoscopy

• Bronchoscopy

• Mediastinoscopy

• Pleural aspiration and biopsy using

thoracoscopy

o Skin tests

• Tuberculin test

• Skin hypersensitivity test


CHEST X RAY

www.southernhealth.com.au/.../general_xray.htm

Normal Lung

X-ray


Ventilation-

perfusion

imaging

http://www.spectlung.com/is-admin/files/Case%20Studies/case_18_2.JPG


http://www.diegori.it/InternetMedico/Bronchoscopy%20Atlas_file/cover_art.jpg

Normal airway Narrowed airway Inflamed airway

Foreign Body Dilated airway Bronchogenic carcinoma


Pulmonary

Angiography

under

CT Scan

https://health.siemens.com/ct_applications/somatomsessions/wp-content/uploads/2013/05/Image-51.jpg


Pulmonary

Angiography

CT Scan

http://web.stanford.edu/dept/radiology/radiologysite/images/Med%20students%201,%20chest/Pulmonary%20arteries%20+%20veins,%20CTA%20(1).png


TUBERCULIN TEST

www.stanford.edu/group/parasites/ParaSites200...

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9991.htm

http://www.stanford.edu/group/parasites/ParaSites2006/TB_Diagnosis/Current Diagnostic Techniques.html


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


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.


INVESTIGATION OF

RESPIRATORY DISEASE

oRespiratory function testing

• Peak flow metre

• Spirometer

oArterial blood gases and oximetry

oExercise tests


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


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


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



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)



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



RESPIRATORY DISEASEHaemoptysis

• Coughing up blood

Causes

• Common causes

–Carcinoma

–Bronchiectasis

–Acute bronchitis

–Tuberculosis

–Pulmonary infarction


Bronchogenic

Carcinoma

http://images.radiopaedia.org/images/382214/a280a19796be7dc5ae90deec5887b7.jpg


Tuberculosis

http://upload.wikimedia.org/wikipedia/commons/9/9c/Tuberculosis-x-ray-1.jpg

Ghon Lesion


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


Secondary Tuberculosis

http://ivanlt.files.wordpress.com/2009/04/ind180.jpg


Miliary Tuberculosis

Kumar, V., Cotran, R., & Robbins, S. (1997) Basic Pathology. 6th ed., p. 425). Philadelphia.

W B Saunders Company


RESPIRATORY DISEASES

Common causes

– Bronchial carcinoma

– Single metastasis

– Localised pneumonia

– Lung abscess

– Tuberculoma

– Pulmonary infarct


Lung

Metastases

http://library.med.utah.edu/WebPath/jpeg1/LUNG078.jpg


Bronchopneumonia

(left)

Lobar pneumonia

(right)

From Pathophysiology for the Health Professions (2nd ed., p. 325), by B Gould, 2002. Philadelphia. W B Saunders Company.



RESPIRATORY DISEASE

Causes

– Tuberculosis (infective)

– Malignant disease

– Cardiac failure (bilateral)

Pleural effusion

• Accumulation of serous fluid within the

pleural space



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



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)


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


RESPIRATORY FAILURE

Management

• Prompt diagnosis and treatment of underlying

cause

• Maintenance of airway

• Oxygen therapy

• Bronchodilators

• Antibiotics

• Mechanically assisted ventilation

• Lung transplantation


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

http://www.easyauscultation.com/lung-sounds


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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