Pathophysiology By Dr: HANA OMER Pathophysiology By Dr: HANA OMER

Review of Anatomy & PhysiologyReview of Anatomy & Physiology

UPPER RESPIRATORY TRACTUPPER RESPIRATORY TRACTRESPIRATORY MUCOSA

1. lined with ciliated mucus producing cells125cc/ day

2. purifies air

NOSE

1. paranasal sinusesfrontal, maxillary, sphenoid, ethmoid lighten skullsound resonant chambers

2. conchae (3 pairs)warm & humidify air

3. lacrimal ducts4. olfactory receptors

UPPER RESPIRATORY TRACTPHARYNX

1. 3 parts: Nasopharynx, Oropharynx, Laryngopharynx

2. Tonsils(3 pairs) pharyngeal (adenoids) palatine lingual

3. Eustachian (auditory) tubes open into nasopharynx equalizes pressure between middle ear & the

outsideLARYNX

1. composed of pieces of cartilage Thyroid cartilage= Adam’s apple

2. epiglottis & glottis

1. TRACHEA1. composed of C- shaped cartilaginous rings

LOWER RESPIRATORY TRACTLOWER RESPIRATORY TRACTBRONCHI, BRONCHIOLES, ALVEOLAR DUCT,

ALVEOLI1. Gas exchange occurs in alveoli

occurs via Passive Diffusion2. Respiratory Membrane

2 cell thick layersurfactant = reduces surface tension to keep alveoli

distendedlining of alveolus (alveolar epithelium)lining of capillary ( capillary endothelium)

LOWER RESPIRATORY TRACT

LOWER RESPIRATORY TRACTLOWER RESPIRATORY TRACTLungs & Pleura

1. Right Lung = 3 lobes; Left Lung = 2 lobes2. lower part of lung resting on diaphragm =

Base of lung3. upper part of lung under clavicle = Apex of

lung 4. Pleura = serous membrane (i.e. secretes

some fluid)Parietal Pleura lines thoracic cavityVisceral Pleura lines organs (viscera)

Respiratory System DiseasesRespiratory System Diseases General Outline General Outline1) INFECTIOUS DISEASES

Upper Upper respiratory infection Croup Epiglottitis Flu (Influenza)

Lower Bronchiolitis Pneumonia TB Fungal diseases

RESPIRATORY SYSTEM DISEASES

RESPIRATORY SYSTEM DISEASESRESPIRATORY SYSTEM DISEASES GENERAL OUTLINE GENERAL OUTLINE2) COPD (chronic obstr. pulm. dis)

EmphysemaChronic bronchitis

3) Restrictive lung diseasesChest wall abnormalitiesConnective tissue abnormalities

Pneumoconioses

4) Obstructive lung diseasesCystic fibrosisCancerAspiration pneumoniaAsthma

RESPIRATORY SYSTEM DISEASESRESPIRATORY SYSTEM DISEASES GENERAL OUTLINE GENERAL OUTLINE

5) Vascular disordersPulmonary edemaPulmonary embolism

6) Expansion disordersAtelectasisPleural effusionPneumothoraxResp. distress syndrome

Infantadult

Manifestations of PulmonaryManifestations of Pulmonary DiseaseDisease1. Sneezing = reflex response to irritation of upper

respiratory tract

2. Coughing = reflex response to irritation of lower respiratory tract

3. Sputum productionIf yellowish- green ------ infectionIf rusty ------- blood + pus = pneumococcal pneumoniaIf bloody , called “hemoptysis” ---- usually frothy --- seen

in pulm. EdemaAlso seen in pulm. TB & cancer

Large amounts & foul = bronchiectasisThick & sticky = asthma, cystic fibrosis

Manifestations of PulmonaryManifestations of Pulmonary DiseaseDiseaseBreathing patterns

Labored (dyspnea) , wheezing, stridorBreath sounds

Normal, rales, rhonchi, decreased breath sounds

Dyspnea --- discomfort feeling when can’t get enough airOrthopnea = dyspnea lying down

Cyanosis --- not a reliable early indicator of hypoxia

UPPER RESPIRATORY TRACT INFECTIONSUPPER RESPIRATORY TRACT INFECTIONSDefinition

Acute inflammatory process that affectsmucus membrane of the upper respiratorytract

Includes one or more of the followingProblems

Rhinitis also called CoryzaPharyngitisLaryngitisSinusitis

Upper Respiratory Infection (URI)

S/S = low-grade fever, malaise, sore throat, & discharge

INFLUENZA

1) Viral types---- A,B, &C

They mutate constantly thus preventing effective immune defense for prolonged time periods

2) Short incubation ---- 3 days

Pneumonia

Definition

It is an inflammatory process of the lung parenchyma that is commonly caused by infectious agents.

Classification of pneumoniaAccording to causes Bacterial (the most common cause of pneumonia)

Streptococcus pneumoniae, Haemophilus influenzae

Viral pneumonia

Respiratory syncytial virus, parainfluenza viruses

Fungal pneumonia

Candida species, Aspergillus species

Chemical pneumonia (ingestion of kerosene or inhalation of

irritating substance)

Inhalation pneumonia (aspiration pneumonia)

Classification of pneumoniaAccording to areas involved

Lobar pneumonia; if one or more lobe is

involved

Broncho-pneumonia; the pneumonic process

has originated in one or more bronchi and

extends to the surrounding lung tissue.

Mode of transmissionWAYS YOU CAN GET PNEUMONIA INCLUDE:

Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.

You may breathe some of these germs directly into your lungs (droplets infection).

You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).

Predisposing factors1. Immuno-suppresed patients

2. Cigarette smoking

3. Difficult swallowing (due to stroke, dementia,parkinsons disease, or other neurological conditions)

4. Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)

Predisposing factors

5. Chronic lung disease (COPD, bronchostasis)

7. Other serious illness such as heart disease, liver cirrhosis, and DM

8. Recent cold, laryngitis or flu.

PATHOPHYSIOLOGY OF PNEUMONIA

CLINICAL MANIFESTATION OF PNEUMONIA

Shaking chills

Rapidly rising fever ( 39.5 to 40.5 degree)

Stabbing chest pain aggravated by respiration and coughing

CLINICAL MANIFESTATION OF PNEUMONIA

Tachypnea, nasal flaring

Patient is very ill and lies on the affected side to decrease pain

Use of accessory muscles of respiration e.g. abdomen and intercostals muscles

CLINICAL MANIFESTATIONS…..

Cough with purulent, blood tinged, rusty sputum

Shortness of breath

Flushed cheeks

Loss of appetite, low energy, and fatigue

Cyanosed lips and nail beds

DIAGNOSTIC TESTS FOR PNEUMONIA

History takingPhysical examinationChest x-rayBlood testSputum culture

MEDICAL MANAGEMENT OF PNEUMONIA

Antibiotic, depending on sputum and blood culture

Oxygen therapy

Chest physiotherapy

COMPLICATIONS

Acute respiratory distress syndrome (ARDS)

Pleural effusion

Lung abscesses

Respiratory failure (which requires mechanical ventilator)

Sepsis, which may lead to organ failure

BRONCHITISLOWER RESPIRATORY TRACT

INFECTION

BRONCHITIS

DEFINITION Bronchitis is defined as the inflammation or

infection of bronchi and bronchioles.

Depending on the duration of disease , it can be

1. Acute (lasts for few days)2. Chronic (for prolonged time)

BRONCHITISCAUSES FOR ACUTE TYPE

1. Viral infections 90% Influenza virus A,B ,adenovirus ,

respiratory syncytial virus. 2. Bacterial infections 10% Mycoplasma pneumoniae,

streptococcus pneumoniae

BRONCHITIS

PREDISPOSING FACTORS

1. Chronic sinusitis2. Chronic obstructive pulmonary disease3. Asthma4. Bronchiectasis5. Smoking and second hand smoke.6. Alcoholism

BRONCHITISClinical manifestations SYMPTOMS

History of dry or productive cough 5- 10 days

Body aches Chest pain on coughing Soar throat

BRONCHITIS

SIGNS

1. Mild to moderate fever2. Increased respiratory rate3. Increased heart rate4. Wheezing on auscultation

BRONCHITISMANAGEMENTGoals of management are

1. To releive the symptoms2. To prevent the PneumoniaTreatment

1. Symptomatic treatment to relieve the pain, fever and cough

2. Increase the rest time3. Increase the hydration(8-10 glasses of water)4. Avoid the aggravating factors