المحاضرة الرابع pathophysiology (1).pdf

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‫ﺔ‬ ‫ﻴ‬‫ﻨ‬‫ﻤ‬ ‫ﻴ‬‫ﻟ‬ ‫ﺍ‬‫ﺔ‬‫ﻳ‬ ‫ﺭ‬‫ﻮ‬‫ﻬ‬ ‫ﻤ‬‫ﻟﺠ‬ ‫ﺍ‬ ‫ﻟﻲ‬ ‫ﺎ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬ ‫ﻴﻢ‬‫ﻠ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬ ‫ﺍ‬‫ﺯ‬ ‫ﻭ‬ ‫ﺰ‬ ‫ﻌ‬‫ﺔﺗ‬ ‫ﻌ‬‫ﻣ‬‫ﺎ‬ ‫ﺟ‬ Pat hophy siol ogy Phar macydepar tment Thi rdl evel T.Shawqi yaseenRadmanAl _At hur i 2024  RESPI RATORYPHYSI OLOGY Themai nfuncti onsofthel ungsaretopr ovi deconti nuousgasexchangebet ween i nspiredairandthebl oodinthepul monaryci rcul ati on.Dal ton’ sLawofParti al Pressures(PP) ∎21%ofai risoxy gen ∎Cont ent sofai r: ∎Ni tr ogen78. 6%ofai r ∎Oxy gen20. 9%ofai r ∎Car bondi oxi de0. 04%ofai r ∎Wat erv apour0. 5% ∎Par ti alpr essur eofoxy gen( O2)i nat mospher icai ris: TheRespi rat orySy stem ( Rev isi on) I scomposedoft hreepar ts: Theupperr espi rat oryt ract nose, par anasal sinuses, Phar ynx, lar ynx  Pr ovi desent ryf ori nhal edai r  Mucuspr oduci ngcel l s-t rapsbact eri aandpar ti cl es  War msandmoi stenst heai r  Lar ynxwor ksasspeechor gan Themi ddl erespi rat oryt ract: Tr achea–cart il agi nousr ings pr ovi desuppor t Thel owerr espi rat oryt ract: Ri ghtandl eftmai nbr onchi Br onchiol i–al veol arduct s– al veol i Al laremucousl i ned–except al veol i TheAl veol i Pr oducepul monar ysur fact ant  Mixt ureofli pids,pr otei ns, andcarbohy dr at es.  Surf actantt hinl ycoat sthe al veoli andkeepsthem openandpreventt hem fr om coll apsi ng. Alveoliar everyt hinandcanbe easil yruptur edanddestroy edas oftenoccursi nchroni clung disease. TheLungs Eachl ungi smadeupofl obes Thr eeont her ightandt woont he l eft Lungsar ecov er edbyt hepl eura (vi sceralpleuraagainstt helungs, pari etalpleurathatcoverst he i nsideoft hethoraci ccage) Bothsurf acesaremoistandslide overeachotherwi thr espirat ions TheLungs…cont inued Dual cir cul ati on: Pul monar yar ter ybr ingsdeoxy genat edbl oodf rom t heRV Pulmonar yvei nst akeoxy genat edbl oodt otheLAt henLVf ordi str ibut iont othe body Oxygenandnutr ient sfort hel ungi tsel fcomesf rom t hebr onchi alar ter ies– br anchesofft horaci caort a Pr imar yfunct ionoft heLungsi srespi rat ion Tr ansf erofoxy geni ntobl oodandr eleaseofcar bondi oxi dei ntot heai r UpperRespi rat oryI nfect ions Commoncol d Causedbyv iral inf ect ionofnasophar ynx Phar yngi ti s Causedbyv irusesorst rept ococcus( str ept hroat ) Ot it ismedi a Vi ral URIspr eadst omi ddl eearcausi ngedemaandobst ruct ionofEust achi ant ube. Fl uidaccumul atesi ninnerear. Maybecomesuper inf ect edwi thbact eri a. LowerRespi rat oryI nfect ions Pneumoni a Acut einfect ionoft hel ungsbybacter iaorvi ruses(l esscommonlyfungi, prot ozoaorpar asi tes). Mostoft encausedbyStr ept ococcus,H.i nfl uenzae,andst aphy lococcus. Br onchi ti s I nfl ammat ionoft het racheobr onchi alt ree. Acut ebr onchi ti s-usual l yvi ral ,maybebact eri al. Tuber cul osi s Acut eorchronicbact eri ali nfect ioncausedbyM.t uber cul osi sthatcausesgr anul omas, fibr osi s andcav itat ion. Pneumoni a-Ter minol ogy  Dy spnea–Shor tnessofBr eat h(SOB)  Tachy pnea–r api dbr eat hing  Expect orat ion–coughi ngoutofphl egm, “wetcough  Pr ost rat ion–weakness, fat igue, apat hy  Hemopt ysi s–bl oodi nthesput um  Debi l itat ed–weak, chr oni cal l yil l  Vi rul ent–ast rongpat hogen  1-Pneumoni a Canbecl assi fi edbyt he mi crobi ologi cal agentt hatcausedi t v iral ,bact eri al, fungal l ocat ion Br onchopneumoni a(di stal air way s&al veol i ) Lobul arpneumoni a(par tofal obe) Lobarpneumoni a(anent ir elobeoft hel ung) Ty pe Pr imar y(i nhal ati onoraspi rat ionofapat hogen) Secondar y(f oll owi ngchemicali nhalat ion,dr owni ngorot heri nfect iont hathasspr eadt othe l ung,maybenosocomi al=hospi tal acquired) Di agr ammat icr epr esent ati onofpneumoni a.A,Al veol arA.bact eri alpneumoni a.B.I nter sti ti al vi ral pneumonia. l ocal i zed( lobul arpneumoni aorbronchopneumoni a)or(B)dif fuse(l obarpneumoni a).C, I nter sti ti alv iral pneumoniaisof tenbi lat eralanddif fuse. Pneumoni a-Pat hogenesi s Pat hogensr eacht hel ungi ndi ff erentway s: I nhal ati on=br eat hingi nger mswi thai r t ypi cal forv iruses( alsof orM.t uber cul osi s) Aspi rat ion=br eat hingi nger mswi thf lui d ofinfect edsecr eti onsf rom t heupperai rway s(t ypi cal forst rept ococcal andst aphy lococcal bacteri a) ofinf ectedgast ricjui ces, foodsordr inks( typi cal int heunconsci ous, vomi ti ng, ort hosewi thout contr oloffunct ions) Hemat ogenous t ransf erf rom t hebl ood–I V,orwi thur inar y,sept icemi a,GIi nfect ions Pneumoni a-Pat hol ogy  Exudat eresul tsf rom pat hogeni cinv asi on.  Exudat eaccumul atesi nthel umenoft heai rway s,al veol i.  Exudat erepl acesai randt hel ungsbecomeconsol i dat ed( thi sisdensert hanai randcan beseenonanX-ray ). Pneumoni a–Si gnsandSy mpt oms 1.Sy stemi csi gnsofi nfect ion -Hi ghf ever ,chi l ls, prost rat ion 2.Local signsofi nfect ion -Secr eti onofmucous, cough, chest pai n 3.Ai rwayobst ruct ion -Dy spnea, tachy pnea 4.I nfl ammat ionandt issuedest ruct ion -Exudatecausest issuedest ruct ion andbleedi ng -Pur ulentmucous, bloodti nged sput um (rust ysput um),hemoptysi Di agnost ict est s Chestx- ray I dent if yar easofhi ghexudat elev el Sput um gr am st ain&cul tur e I dent if iesbact eri aorv irus Bl oodt est s Hi ghWBCi nbact eri alpneumoni a Pneumoni a-compl i cat ions I fthepati enti sdebi l itat edoriftreat menti sdel ayed( andt her efor einef fect ive)ori fthe pat hogensarehi ghl yv i rul ent ,theremaybe: Pl eur it is: pleur alsur facesar einf lamedandcanf il lwi thpus. Abscess: thewal l soft hebr onchi aredest roy edanddi l atedbypus. Chr oni clungdi sease: lungt issuei sdest roy edandbecomesf ibr ous( honey -combl ungs) Pneumoni a-Tr eat ment Theaimi stodest roythebact eri ali nfect ionwi thant ibi oti csandt osuppor tlungf unct ionunt il thel unghasr ecov ered. Ant ibi oti csar egi venf orspeci fi cbact eri a. Suppor tofl ungf unct ion  Humi dif iedoxy gen  Mechani cal vent il ati onf orr espi rat oryf ail ure  Hi ghcal ori edi etf orheal i ng  Hi ghf lui dint ake  Bedr est  al sopr ovi deacal m,qui etenv ironment.Encour agedeepbr eat hingandcoughi ng  Anal gesi cforpai n(pai n-ki l ler s)  Handwashi ngandcl eanenv ironmentt opr eventspr ead  Pneumoniacausepleuri ti s( pl eur alf ibrosi s).Empyema(pus).Abscessf ormat ion. Br onchiect asisisaconsequenceofchr oniclunginf ecti on.I nterst it ialfi brosiswit hcysts accountsfort hehoney combappearanceofl ungsinchroniclungdisease. 2-Pul monar yTuber cul osi s Achr oni cinf ect iousdi seasecausedbyMy cobact eri um Tuber cul osi s Pul monar yTB–Tuber cul ouspneumoni a Ext rapul monar yTB  Spr eadt hroughl ymphat icst opl eur aandl ungs  Spr eadt hroughbl oodt oBones, Brai n,Ki dney s  Spr eadt hroughai rway stol ary nx–swal l owedi ntoGIt ract–i ntest inal TB Spreadoftubercul osi s(TB).React ivat edbaci l licanspr eadt hrought hel ymphat ics, blood vessel s,orbronchi. Hematogenousspreadusual l yaccount sfort uber cul osi sindi stal sit es, suchast heur ogeni tal t ractort hebrain. Expect orat edbaci l limaybeswal l owedandcausei ntest inal tuber cul osi s. Si gns&Sy mpt oms:  95%mayhav enosy mpt omsatf ir st  Lowgr adef ever  Dr ycough( ear ly)  Anor exi a(l ossofappet it e)  Ni ghtsweat s  Wei ghtl oss  Dy spnea&hemopt ysi s(l ater ) Test sandI nvest igat ions:  CXR  ChestCTscan  Sput um exam f orMy cobact eri um  Tuber cul i ntest( ski ntest )–notconcl usi ve Tr eat ment Mul ti pledr ugs  I sonai zi d(I NH)  Ri fampi n  Et hambut ol  Py raz inami de Longt ermt reat ment6mont hst o2y ear s Resi stantf ormsofTBar ever ydi ff icul ttot reat 3-Chr oni cObst ruct iveLungDi sease( COPD) 1.Chr oni cBr onchi ti s 2.Emphy sema 3.Ast hma 1-Chr oni cBr onchi ti s Pr oduct ivecoughf or3mont hsofy earf oratl east2y ear s Hy per act ivi tyofmucus- secr eti nggl andscausi ngi nfl ammat ionandnar rowi ngofai rway s. Smoki ngcont ri but est o90%ofcases Ai rpol l uti onandcol dwetcl i mat emaycont ri but e. Maydev elopi nfect ionandpr ogr esst opneumoni a. Di agnost icTest s:  Phy sical Exam  CXR  Sput um cul tur e Tr eat ment : Mayneedant ibi oti cs( ifbact eri ali nfect ion) Phy siot her apyt oassi stexpect orat ion 2-Emphy sema Chr oni clungdi seaseusual l ycausedbysmoki ng Acut eexacer bat ionsandr emi ssi ons, wor sensov ert ime Si gns&Sy mpt oms:  Chr oni ccough  Dy spnea  Or thopnea  Tachy pnea Emphy semaPat hophy siol ogy Br onchoconst ri cti on-ai rf lowobst ruct ion, sput um pr oduct ion, cough Dest ruct ionofal veol i  I mpai redgasexchange( CO2r etent ion)  Lossofel ast ici tymakesexhal ati ondi ff icul t  Hy per inf lat ionofl ungs Di agnost ict est s: CXRshowshy per inf lat ion Pul monar yFunct ionTest s Management : Tr eatsy mpt oms St opsmoki ng( sympt omsar eli kel ytocont inue) 3-Ast hma -Ai rf lowobst ruct ion, bronchoconst ri cti on -Duet oal l ergi corhy per sensi ti veai rway s St imul i :  Pl antpol l ens, chemi cal s  Exer cise  Psy chol ogi cal str ess  Br onchi ali nfect ion  Aspi ri nsensi ti vi ty Si gns&Sy mpt oms:  Usual l yst art sbef oreage10y ear s  Wheezi ng( duet obr onchospasm)  Dy spnea  Cough Di agnost ict est s:  CXR  Pul monar yFunct ionsTest s  Tr eatsy mpt oms  Br onchodi l ator s(i nhal er) St atusAst hmat icus– -Repeat edat tacksofbr onchospasm ov ershor tti meper iod -I fnott reat ed, mayl eadt odeat h