CHI335 Respiratory System Lecture II PDF

CHI335 Diagnosis I Respiratory System Lecture II Inflammation and swelling of the mucous membrane of the nose  Aetiology  Seasonal: hay fever  Continual: dust, moulds, colognes, cigarette smoke, animal dander, and mites  Presentation  Sneezing; itchy, watery eyes; red, swolle...

CHI335 Diagnosis I Respiratory System Lecture II Inflammation and swelling of the mucous membrane of the nose  Aetiology  Seasonal: hay fever  Continual: dust, moulds, colognes, cigarette smoke, animal dander, and mites  Presentation  Sneezing; itchy, watery eyes; red, swollen eyelids; congested nasal mucus membranes; and nasal discharge  Management  Avoiding known allergens whenever possible  Air filters and air conditioners will assist in keeping down allergen counts  Nasal corticosteroids/antihistamines sprays  Oral antihistamines (?) and decongestants (?)  An allergist may be able to help by giving desensitization injections for long-term management Acute or chronic inflammation of the membranes lining the sinuses  Aetiology  Acute sinusitis is mostly viral (viral sinusitis), which is common after a common cold  Bacterial sinusitis often follows a viral sinusitis  If symptoms exceed 10 days or worsen, viral sinusitis has most probably become bacterial  Presentation  Headache, facial pain, tooth pain, nasal congestion, fever, postnasal discharge (PND), as well as pharyngitis and cough  Management  Nasal corticosteroids/decongestants sprays  Analgesics for pain, antibiotics for infection  Sinus lavage  Endoscopic sinus surgery may be required A Self-limiting condition of approximately one week’s duration  Aetiology  Viral or bacterial  Streptococci, adenovirus, rhinovirus, influenza A or B, coronavirus  Rheumatic heart disease can be a consequence of streptococcal infection  Presentation  Sore throat, cough, fever, nasal congestion, rhinitis, rhinorrhoea, headache, and malaise  Management  Plenty of rest and (warm) fluids  Nasal saline drops/wash  Antipyretics, analgesics, decongestants, and antitussives An infection of both the upper and lower respiratory tracts  Aetiology  Caused by influenza virus  A yearly flu vaccination can help prevent or minimize the severity of the flu  Presentation  Headache, fever or chills, a dry/productive cough, malaise, myalgia, fatigue, anorexia, rhinorrhoea, pharyngitis, and possibly diarrhea  Management  Analgesics and antipyretics can alleviate the aches, pains as well as the fever  Other treatment recommendations are similar to cold  Antiviral medications might be necessary Inflammation of the larynx and vocal cords  Aetiology  Viral or bacterial infections  Non-infection causes  Laryngeal polyps, excessive talking, shouting, or singing, allergic, smoking, GORD, damage to nerves that supply the larynx, e.g. a stroke paralysing vocal cord muscles  Presentation  Dysphonia and tickling sensations in the throat, dry cough, and pharyngitis may be present  Management  Voice rest, management of GORD, avoidance of cigarettes and alcohol, and antibiotics if needed  Surgical removal of laryngeal polyps and surgery to tighten the vocal cords Acute inflammation of bronchi  Aetiology  Generally, follows a URTI such as the common cold  Non-infectious cause of bronchitis  Gastroesophageal reflux disease, exposure to cigarette smoke, pollutants, and the fumes of household cleaners  Presentation  Malaise, myalgia, fever/chills, productive cough, and dyspnoea  Lasts about 3 weeks or so  Management  Rest, fluids, medications, and antibiotics (if needed) It is one of the most common COPDs (next slide)  Aetiology  Continuous bronchial irritation generally caused by smoking  This irritation causes a chronic inflammatory response  Presentation  Clinical manifestations of acute bronchitis, plus possibly  Dyspnoea, tachypnoea, chronic productive cough, accessory respiratory muscle use, cyanosis, hepatomegaly, ascites, heart failure, peripheral oedema, cor pulmonale, pulmonary hypertension  Lasts longer than 3 months a year for two consecutive years  Management  Quit smoking, prevention of RTIs, medications, supplemental O2 and antibiotics (for secondary bacterial infections) A progressive chronic inflammatory response in the airways and lungs  Persistent airflow limitation to the lungs  Usually no reversibility  Features  Long-time/heavy smoker (and/or occupational dust/pollution)  >40 – 50 years of age  Chronic productive cough with (generally) clear/white sputum worse in the morning  Wheeze  Dyspnoea  (Often in emphysema)  appetite, fatigue and weight loss Blue Bloater Pink Puffer  Investigation  Lung function tests (pattern of obstruction)  CXR and CT scan (hyperinflation)  Blood gases  Management  Smoking cessation  Medications  Bronchodilators (short- or long-acting β2-agonist)  Anticholinergics  Corticosteroids  Antibiotics  Oxygen therapy  A chronic inflammatory condition of the airways  It is the most common chronic disease in childhood  Usually starts in childhood (3-5 yrs) and may either worsen or improve during adolescence  Cardinal symptoms: wheeze, SOB, cough, chest tightness (they get worse at night)  Adult-onset asthma is also probable  Asthmatic episodes have 3 inflammatory characteristics  Airway hyperresponsiveness (leads to bronchoconstriction)  Mucus hypersecretion (leads to airway limitation)  Vasodilation &  capillary permeability (leads to airway oedema)  Diagnosis  Compatible clinical history plus either/or  Increase in expiration force following administration of a bronchodilator/trial of corticosteroids  Decrease in expiration force after 6 mins of exercise  First, Avoid aggravating factors  Asthma is strongly linked with allergies  Knowing allergens that trigger asthma helps avoid them and manage asthma better  Then, Medications (inhalers or oral)  Blue – Reliever  Orange – Preventer  Green – Symptoms controller  Purple – Combination medications  First aid for Asthma  4 puffs of blue reliever (Give 1 puff at a time with 4 breaths after each puff)  Wait for 4 minutes and repeat the process (if needed)  If no improvement after the 2nd round → call an ambulance! https://www.nationalasthma.org.au/asthma-first-aid https://www.nationalasthma.org.au/health-professionals/asthma-action-plans https://www.nationalasthma.org.au/health-professionals/how-to-videos Inflammation & infection of the parenchyma of the lungs  Aetiology  Commonly bacterial also caused by viruses and fungi  About 50% of pneumonia is pneumococcal  Presentation  An acute illness presents with fever, productive cough, SOB and pleuritic chest pain, myalgia, headache, etc…  However, it can present with more subtle symptoms, particularly in the elderly  Is classified by  Causative microorganism involved (viral, bacterial or atypical)  Pattern of lung involvement (lobar or bronchopneumonia)  Setting in which it was acquired (community or hospital- acquired) Bronchopneumonia Lobar pneumonia A symptom characterised by localised chest pain due to the inflammation of the pleura  Aetiology  Can be caused by a primary pleural disease or secondary to a systemic illness  Pneumothorax, acute coronary syndromes, pulmonary embolism, acute pericarditis, viral or bacterial infection, post-pneumonia, autoimmune diseases such as lupus or rheumatoid arthritis, malignancy, tuberculosis, and chest wall trauma  Presentation  Sharp and localised chest, thoracic back or shoulder pain, which is exacerbated by respiratory movements, coughing, sneezing  Acute and hyperacute causes generally present with tachypnoea and dyspnoea The collection of air between the visceral and parietal pleura due to a breach of either the visceral or parietal pleura  Aetiology  Primary pneumothorax  Occurs without an apparent cause or a significant lung disease  Most often happens spontaneously  RFs: smoking, male sex, tall thin body, pregnancy and a family history of pneumothorax (familial pneumothorax), Marfan syndrome  Secondary pneumothorax  Occurs in the presence of existing lung pathology: COPD, asthma tuberculosis, sarcoidosis, CF, lung cancers, severe ARDS, etc.  Iatrogenic pneumothorax  Pleural or lung biopsy, tracheostomy, intercostal nerve block, CPAP ventilation  Traumatic pneumothorax  Penetrating or blunt trauma, rib fracture, diving or flying The accumulation of fluid in the pleural space (between the visceral and parietal pleura)  Aetiology  Transudative: Congestive heart failure, liver or kidney failure  Exudative: infection (e.g. pleuritis, tuberculosis), cancers  As the fluid builds in the pleural space, the lungs begin to compress, affecting the gas exchange  Effusion which contains pus (due to an Infective process) is known as empyema  Blood effusion is seen in trauma or rupture of blood vessel(s) A form of cancer primarily arising within the pleura  Aetiology  It is believed that it is associated with exposure to asbestos fibres in the workplace or home  Presentation  Dyspnoea, cough, chest pain, haemoptysis, pleural effusion, fatigue, and weight loss  Management  Surgery, chemotherapy, and/or radiation therapy Lung diseases that result from years of exposure to different environmental or occupational dust, such as  Coal dusts  Anthracosis  Asbestos  Asbestosis  silica sand  Silicosis Fibrous tissue takes over healthy lung tissue, which destroys the alveoli and, eventually the bronchioles The presentation is consistent with a restrictive lung (respiratory) disorder pattern  The accumulation of fluid within pulmonary interstitial spaces and the alveoli  Fluid makes gas exchange difficult or impossible  Aetiology  Cardiogenic  Left heart failure, massive myocardial infarction, cardiomyopathies, heart valve disorders ( left atrial pressure)  Non-cardiogenic  Lung infections e.g. ARDS, high altitudes, opioid overdose, pulmonary embolism, smoke inhalation, etc.  Presentation  Dyspnoea, tachypnoea, tachycardia, pink frothy sputum, cyanosis, crackles on auscultation An occlusion of a pulmonary artery that prevents blood flow to the lung parenchyma, resulting in lung hypoxia and tissue damage or death (in severe cases)  Aetiology  Thrombotic causes  DVT: Blood clot dislodged from a vein in the legs (thromboembolism)   Coagulation: dehydration, coagulopathies, OCPs, pregnancy, cancers  Non-thrombotic causes  Fat embolism e.g. long bones fracture  Tumour fragments  Foreign bodies  Amniotic fluid  Air bubbles (embolism) e.g. chest trauma  Presentation  Sudden dyspnoea  Tachypnoea  Tachycardia  Fever  Diaphoresis  Chest pain (pleuritic) Indicate lung tissue necrosis  Haemoptysis Pulmonary CT angiography is the gold standard for diagnosis  Not examinable  A simplified Wells score is used to estimate the probability of PE Clinical Criteria Score Symptoms of DVT 3 points No alternative diagnosis better explains the illness 3 points Tachycardia with pulse > 100 1.5 points Immobilization (>= 3 days) or surgery in the previous 4 weeks 1.5 points Prior history of DVT or PE 1.5 points Presence of haemoptysis 1 point Presence of malignancy 1 point Score > 6 High probability Score ≥ 2 and ≤ 6 Moderate probability Score < 2 Low probability  The 5th leading cause of death in Australia in 2022  A major risk factor is cigarette smoking  Two types of lung cancer  Small cell carcinoma (20%)  Non-small cell lung cancer (NSCLC, 80%)  Primary lung cancer originates in the lung, whereas secondary lung cancer is deposited in the lung from a distant location via either the lymph or blood  Lungs are a common site of metastasis in breast, prostate, bladder, and colon cancers  Presentation  Cough that worsens over time, haemoptysis, dyspnoea, chest pain, unexplained weight loss, fatigue, and pleural effusion  Asthma  Pharmacotherapy and stages of management  Hospital acquired pneumonia (HAP)  Predisposing factors  Tuberculosis  Aetiology, S & S, image findings