Chapter 19: Neoplastic and Infectious Disorders of the Pulmonary System PDF
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This chapter covers neoplastic and infectious disorders of the pulmonary system. It details various types of pneumonia, including bacterial and viral pneumonia, as well as ventilator-associated pneumonia. Information is also presented on the majority of lung cancers, including subtypes and symptoms. The chapter also explores other respiratory disorders and infectious diseases.
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CHAPTER 19: NEOPLASTIC AND INFECTIOUS DISORDERS OF THE PULMONARY SYSTEM Influenza is a highly contagious virus the has a short incubation period, influenza with pneumonia is the 8th leading cause of death in the US Pneumonia is an acute infection of the lung parenchyma that commonly impair...
CHAPTER 19: NEOPLASTIC AND INFECTIOUS DISORDERS OF THE PULMONARY SYSTEM Influenza is a highly contagious virus the has a short incubation period, influenza with pneumonia is the 8th leading cause of death in the US Pneumonia is an acute infection of the lung parenchyma that commonly impairs gas exchange Classification can be done by origin (viral, bacterial, fungal, protozoal), location (bronchopneumonia (distal airways and alveoli) o lobar (either part of a lob or all), and type (primary or secondary) Risk factors include chronic illness and debilitation, cancer (primarily lung), abdominal and thoracic surgery, atelectasis, cold of viral respiratory infections, chronic respiratory disease like COPS, bronchiectasis, cystic fibrosis acterial B pneumonia Viral pneumonia ospital acquired H pneumonia (HAP) ealthcare associated H pneumonia (HCAP) entilator associated V pneumonia an occur in any C part of the lung Trigger alveolar inflammation and edema Produces an area of low ventilation with normal perfusion Capillaries become engorged with blood irus first attacks V bronchiolar epithelial cells and also invades bronchial mucus glands and goblet cells then spread to alveoli Fills with blood and fluid L ower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization neumonia in P nonhospitalized patients who had significant experience with the healthcare system Such contact could include 1) intravenous therapy for wound care within the preceding 30 days 2) residence in a long-term care facility 3) hospitalization in an acute-care hospital within the preceding 90 days, and/or 4) outpatient treatment in a hospital or hemodialysis clinic within the preceding 30 days F orma od nosocomial pneumonia that occurs in about 22.8 patients patients receiving mechanical ventilation for longer than 48 hours Associated with increases in morbidity and mortality, hospital length stay, and costs The mortality rate attributable to VAP is 27% and has been as high as 43$ when the causative agent was antibiotic resistant igarette smoking is responsible for 85 - 90% of lung cancers, cigarette smoker are 15 times more likely to die that lifelong non C smokers, when comparing by gender, male smoker have a 23 fold increase in likelihood to develop while female smoker are 13 times more likely to develop Small cell lung cancer (oat cell cancer) Non small cell cancer ost aggressive form of lung cancer that usually M starts in the bronchi and grow very quickly creating large tumors and also metastasize quickly Accounts for 10-15% of lung cancer ajority of lung cancers (85 - 90%) comprised of M three primary subtypes Adenocarcinoma Squamous cell carcinoma Large cell carcinoma *further classified as well differentiated or not S ymptoms of lung cancer include: persistent cough with or without production(common), sputum streaked with blood, obstructive pneumonia, dyspnea, chest pain, hoarseness if recurrent laryngeal nerve is compressed/invaded by tumor, paraneoplastic syndromes with advanced lung cancer In the US TB transmission primarily between infected person and susceptible person by inhalation of aerosolized droplets contaminated with mycobacterium TB About 3-4% of ppl with primary TB infection develop disease during first year after exposure and then up to 15% after first year Active stage - air bone precautions, latent stage - can become active if immune system is compromised, exposed - positive PPD without signs of disease Symptoms include: cough, weight loss and anorexia, fever, night sweats, dull aching chest pain, hemoptysis, 20% are asymptomatic Diagnosis of active TB includes chest x ray, sputum culture for acid fast bacteria, quanti feron gold assay Bacilli calmette guerin BCG, is vaccine for TB and many foreign born person have been BCG vaccinated, especially in countries with high prevalence of TB to prevent childhood TB meningitis Core of each treatment regimen is a combination of four medications: isoniazid, rifampin, pyrazinamide, ethambutol Initial 2 month treatment phase is followed by a continuation treatment phase of 4 to 7 months alley fever is a fungal lung infections characterized by fever, cough, chest pain, chills, night sweats, headache, fatigue, joint aches, V red spotty rashes Diagnosis required sputum culture for presence of coccidioides organisms and blood tests checking for antibodies against the fungus that causes valley fever Treatment is antifungals Oral for serious and IV for life threatening A single bout of valley fever results in lifelong immunity, but relapse is possible, especially if the body's immune system become significantly weakened (same for TB) If progresses can become chronic from of pneumonia most common in ppl with weakened immune system characterized by low grade fever, weight loss, cough, chest pain, blood tinged sputum, nodules in lungs ulmonary embolism is the occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, P and or air bubbles commonly arising femur the deep vein in the thigh Virchow traid? Disorder of the upper respiratory tract - children roup is acute laryngotracheobronchitis common in children 6 months to 5 years caused by a virus (parainfluenza, influenza a or C RSV) and causes subglottic edema Usually occurs after an episode of rhinorrhea, sore throat, low grade fever, inspiratory stridor, hoarse voice Causes a seal like barking cough Usually resolves within 24 to 48 hours but severe cases are treated with nebulized epinephrine cute epiglottitis is a server rapid progressive life threatening infection of the epiglottis and that surrounding areas historically A caused by haemophilus influenzae type B but 80-90% decreased incidence due to the HIB vaccine S ymptoms include: high fever, irritability, sore throat, inspiratory stridor, muffled voice, severe respiratory distress Treatment is emergency airway and antibiotics/steroids T he epiglottis is a flap made of elastic cartilage covered with mucous membrane attached to the entrance of the larynx that stands open during breathing, allowing air into the larynx but during swallowing it closes to prevent aspiration forcing the liquids or food to go down the esophagus instead - Controls if something goes into the trachea or esophagus Disorder of lower respiratory tract - children neumonia in children primary cause is viral usually in kids less than 3 weeks to 4 years as younger children are unable to increase P cardiac stroke volume to increase oxygenation to tissues First signs in children will be tachypnea ronchitis is most commonly caused by the pathogen respiratory syncytial virus RSV, and is the major reason for hospitalization of B infants and younger children Manifestations include rhinorrhea, tigh cough, decreased appetite, lethargy, fever, wheezing ertussis whooping cough is a highly contagious respiratory infection that is usually caused by bordetella pertussis directly P transmitted by inhalation of contaminated droplet or indirectly by touching fomites contaminated by secretion for a person in the acute stage of the illness This pathogen attaches to and damaged ciliated respiratory epithelium Symptoms include uncontrollable spasmodic cough that end in a loud crowing inspiratory whoop, cough may be so hard it induces vomit Myalgias, fever also common As progresses, sputum become more tenacious, pneumonia become a common complication Infection lasts about 6 weeks but cough can persist for 3 to 4 months
