Respiratory System PDF

THE RESPIRATORY SYSTEM THE RESPIRATORY SYSTEM RESPIRATORY INFECTIONS MORE FREQUENT THAN INFECTIONS OF ANY OTHER ORGAN ACCOUNT FOR THE LARGEST NUMBER OF WORKDAYS LOST IN THE GENERAL POPULATION MAJORITY INVOLVE ONLY THE UPPER RESPIRATORY TRACT AND ARE CAUSED BY VIRUSES - TRIVIAL...

THE RESPIRATORY SYSTEM THE RESPIRATORY SYSTEM RESPIRATORY INFECTIONS MORE FREQUENT THAN INFECTIONS OF ANY OTHER ORGAN ACCOUNT FOR THE LARGEST NUMBER OF WORKDAYS LOST IN THE GENERAL POPULATION MAJORITY INVOLVE ONLY THE UPPER RESPIRATORY TRACT AND ARE CAUSED BY VIRUSES - TRIVIAL OR MILD DISEASES UPPER RESPIRATORY TRACT - NOSE, LARYNX, TRACHEA, MAIN BRONCHI LOWER RESPIRATORY TRACT - BRONCHI, LUNGS, TERMINAL BRONCHI 2  PATHOLOGY OF PULMONARY SEPSIS UPPER RESPIRATORY TRACT NOSE COMMON – TIME OFF SINUSES WORK LARYNX TRIVIAL OR MILD TRACHEA TRANSIENT VIRAL 3  PATHOLOGY OF PULMONARY SEPSIS SERIOUS MORBIDITY LOWER RESPIRATORY TRACT /MORTALITY BRONCHI TERMINAL BRONCHI BACTERIA, VIRUSES, LUNG PARENCHYMA ATYPICAL, FUNGI SECONDARY TO IRRITANTS 4  5 5 DEFENCES OF RESPIRATORY TRACT PNEUMONIA RESULTS WHEN THE DEFENCE MECHANISMS ARE IMPAIRED: COUGH REFLEX - COMA, ANAESTHESIA, DRUGS - ASPIRATION POSSIBLE NASAL HAIRS, TURBINATES, FILTERING FUNCTION OF NASOPHARYNX CILIARY APPARATUS - ACTION TOWARDS MOUTH - CIGARETTE SMOKE, HOT GASES, CORROSIVES, VIRUSES SECRETION OF IGA ANTIBODIES (IN LAMINA PROPRIA) PHAGOCYTIC ACTIVITY BY ALVEOLAR MACROPHAGES - ALCOHOL, TOBACCO , SMOKE, EXCESS OXYGEN ACCUMULATION OF SECRETIONS - CYSTIC FIBROSIS, BRONCHIAL OBSTRUCTION ALVEOLAR FLUID - SURFACTANT, IGS, COMPLEMENT CELL MEDIATED IMMUNITY PATIENTS WITH CHRONIC DISEASE CANCER PATIENTS /TREATMENT WITH CHEMOTHERAPY IMMUNE DISEASES / HIV INFECTION VIRULENT INFECTIONS 6 THE RESPIRATORY SYSTEM INFECTION MAY BE: PRIMARY - VIRAL, BACTERIAL, MYCOPLASMAL, FUNGAL SECONDARY BACTERIAL - FOLLOWING A VIRAL INFECTION SECONDARY TO IRRITANTS 7 UPPER RESPIRATORY TRACT SEPSIS VIRAL COMMON COLD - COMMONEST - CAUSED BY DIFFERENT SEROTYPES OF RHINOVIRUS ACUTE INFLAMMATION OF EYES AND THROAT WITH CONGESTION AND WATERY EXUDATE SECONDARY BACTERIAL INFECTION → PURULENT GREEN DISCHARGE VIRAL SORE THROAT - ADENOVIRUS - 30 SEROTYPES PHARYNGITIS, CONJUNCTIVITIS - CONGESTION AND WATERY EXUDATE SECONDARY INFECTION – PURULENT INFLUENZA CAUSED BY THE INFLUENZA VIRUS INVOLVES MAINLY UPPER RESPIRATORY TRACT ACCOMPANIED BY FEVER, LASSITUDE AND DEPRESSION IN A SMALL PROPORTION, PROGRESSES TO PNEUMONIA 8 UPPER RESPIRATORY TRACT SEPSIS BACTERIAL HEALTHY INDIVIDUALS - UNCOMMON IN DEVELOPED COUNTRIES SECONDARY TO CONDITIONS WHICH DEPRESS RESISTANCE VIRAL INFECTIONS / CHRONIC BRONCHITIS AND BRONCHIECTASIS BACTERIA COLONISING NOSE AND THROAT STREPTOCOCCUS PYOGENES AND OTHER BACTERIA IN NOSE AND THROAT ACUTE LARYNGITIS / EPIGLOTTITIS HAEMOPHILUS INFLUENZAE TYPE B OR STREPTOCOCCUS PYOGENES SWELLING AND MECHANICAL INABILITY IN BREATHING IRRITATION BY POLLUTANTS INCLUDING SMOKE AND CORROSIVES AND NOXIOUS GASES 9  LOWER RESPIRATORY TRACT SEPSIS PNEUMONIA INFECTION OF ALVEOLAR SPACES HOST REACTION- ALVEOLAR EXUDATES POLYMORPHS, FIBRIN, OEDEMA FLUID RESULTING IN CONSOLIDATION CLASSIFICATION MORPHOLOGY BRONCHOPNEUMONIA, LOBAR PNEUMONIA MANY ORGANISMS PRESENT WITH EITHER PATTERN RADIOLOGICALLY IS CONFLUENT / IS IT BRONCHOPNEUMONIA OR LOBAR AETIOLOGY CLINICAL SETTING 10 BRONCHOPNEUMONIA STREPTOCOCCUS PNEUMONIAE HAEMOPHILUS INFLUENZAE MORAXELLA CARTARRHALIS STAPHYLOCOCCUS PNEUMONIA KLEBSIELLA PSEUDOMONAS AERUGINOSA COLIFORM BACTERIA 11 BRONCHOPNEUMONIA INFLAMMATION STARTS IN BRONCHI POLYMORPHS, FIBRIN SPREADS TO ADJACENT ALVEOLI PATCHY FOCI COALESCE CONSOLIDATION FREQUENTLY WIDESPREAD AND BILATERAL RARELY HEALS WITH FIBROSIS 12 LOBAR PNEUMONIA VIRULENT ORGANISM HOST VULNERABILITY 90-95% STREPTOCOCCUS PNEUMONIAE INFLAMMATION STARTS IN ALVEOLI EXUDATE FLOWS TO BRONCHIOLES AND ALVEOLI - SPREADS LUMINALLY POLYMORPHS, FIBRIN, OEDEMA FLUID IN ALVEOLI ALL LOBE CONSOLIDATION RESOLUTION IN MAJORITY 13 PNEUMONIA X-RAYS Respiratory System 2016-2017 14 14  IMPORTANT IDENTIFY THE ORGANISM: CULTURE AND SENSITIVITY TREAT APPROPRIATELY 15 AETIOLOGY BACTERIAL FUNGAL VIRAL – SEE BELOW ASPIRATION RADIATION ALLERGIC MECHANISMS 16 16 IMPORTANT IDENTIFY THE ORGANISM CULTURE AND SENSITIVITY TREAT APPROPRIATELY 17  PNEUMONIA : CLINICAL SETTING ❑ COMMUNITY ACQUIRED ACUTE PNEUMONIA ❑STREP. PNEUMONIAE, H. INFLUENZAE, MORAXELLA CATARRHALIS, ❑ NOSOCOMIAL PNEUMONIA - PNEUMONIA ACQUIRED IN HOSPITAL ❑GRAM NEGATIVE RODS (KLEBSIELLA, E. COLI, PSEUDOMONAS) ❑STAPHYLOCOCCUS AUREUS (USUALLY MRSA) ❑ RESISTANCE TO ANTIBIOTICS E.G. METHICILLIN RESISTANT STAPHYLOCOCCAL AUREUS (MRSA) ❑INVASIVE PROCEDURES INCREASE THE RISK OF ENTRY OF INFECTION ❑ PNEUMONIA IN IMMUNOCOMPROMISED HOST ❑CMV, PNEUMOCYSTIS CARINII, MYCOBACTERIUM AVIUM- INTRACELLULARE, ASPERGILLOSIS, CANDIDIASIS 18 COMMUNITY ACQUIRED PNEUMONIA STREPTOCOCCUS PNEUMONIAE - PNEUMOCOCCAL PNEUMONIA COMMON GENERALLY FOLLOWS A VIRAL INFECTION ONSET ABRUPT - HIGH FEVER, CHILLS, PLEURITIC CHEST PAIN, MUCOPURULENT COUGH OCCURS MORE OFTEN IN CHRONIC DISEASE – HEART FAILURE, COPD, DIABETES IMMUNODEFICIENCY SYNDROMES LOBAR OR BRONCHOPNEUMONIA SPUTUM - GRAM-POSITIVE DIPLOCOCCI, NUMEROUS NEUTROPHILS BLOOD CULTURES - MAY BE POSITIVE IN 20-30% RESPOND TO PENICILLIN BUT INCREASING RESISTANCE 19 COMPLICATIONS COMPLETE RESOLUTION IF CORRECT ANTIBIOTIC UNCOMMON PLEURAL ADHESIONS BEING THE MOST COMMON COMPLICATIONS COMMONER WITH LOBAR PNEUMONIA BUT