LUNEX University CC Pathology WS23 PDF

Copyright statement ALL Study materials provided by LUNEX University are intended for personal use by LUNEX students only and, as such, are owned or controlled by LUNEX University and protected by copyright and trademark laws and regulations, and any other ap...

Copyright statement ALL Study materials provided by LUNEX University are intended for personal use by LUNEX students only and, as such, are owned or controlled by LUNEX University and protected by copyright and trademark laws and regulations, and any other applicable intellectual property rights. You may use the contents solely for your own personal and individual non-commercial and information/ studying purposes. Sharing study documents or making them publicly accessible, in whole or in parts, is strictly prohibited without the express prior written consent of LUNEX University. Contraventions will be subject to civil and criminal prosecution. LUNEX University International University of Health, Exercise and Sports S.A. 50, avenue du Parc des Sports 4671 Differdange Tel. +352 288494 - 40 www.lunex-university.net M03 –Pathology RESPIRATORY CONDITIONS Camilo Corbellini , HTBH [email protected]  A type of disease, acute or chronic, that affects the airways, parenchyma and and other parts of the respiratory system. Respiratory diseases may be caused by infection, smoking tobacco, or breathing in second hand tobacco smoke, radon, asbestos, or other forms of air pollution. Respiratory diseases include asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, and lung cancer. Also called lung disorder and pulmonary disease. Respiratory When chronic are not curable; however, various forms of treatment that help Diseases- open the air passages and improve shortness of breath can help control symptoms and improve daily life for people living with these conditions. When acute are curable depending on the setting and aetiology. Overview Respiration Respiratory pathology: Location Ø Airway diseases: affect tubes (airways) within lungs è airflow limitation è obstructive Ø Lung tissue diseases: affect structure of lung tissue (eg. alveoli) Ø Pleural and Mediastinum è restrictive Ø Lung circulation diseases: affect blood vessels in lungs (eg. pulmonary hypertension) https://medlineplus.gov/ency/article/000066.htm Respiratory Patho-physiology Copyright © 2005 - 2019 · Rishi Kumar, MD Respiratory pathology- basic concepts HYPOXEMIA: Is refered to low oxygen levels in the arterial blood. HYPERCAPNIA: abnormal elevated carbon dioxide levels in the arterial blood. HYPOXIA: condition where the hypercapnia body or a region is deprived of adequate oxygen supply (high altitudes, preterm birth. When there is complete deprivation of oxygen is ANOXIA. Respiratory pathology- basic concepts HYPOXEMIA: Is refered to low oxygen levels in the arterial blood. HYPERCAPNIA: abnormal elevated carbon dioxide levels in the arterial blood. HYPOXIA: condition where the body or a region is deprived of adequate oxygen supply (high altitudes, preterm birth. When there is complete deprivation of oxygen is ANOXIA. Respiratory pathology- basic concepts Level of oxigenation: Consider the arterial oxigen pressure (PaO2) NORMAL VALUES: 80- 100 mmHg (ABGA) Consider the inspired oxigen (FiO2) NORMAL VALUES: 0.21 (21% room air) PaO2/FiO2= 80/0.21= 380 PaO2/FiO2= 100/0.21= 475 ARDS: Acute respiratory Distress Syndrome Respiratory physiology- basic concepts Ventilation X respiratory rate Hyperventilation: incresing of the exhaled volume (VE) that eliminates carbon dioxide Tachypnoea: increased RR > 20 leading to hypocapnea breaths/min Bradypnoea: decreased RR 40 y): 15–20 % men > women GOLD document 2018 Rycroft et al., Int J Chron Obstruct Pulmon Dis. 2012, Atsou et al., BMC Med. 2011 COPD COPD - 2 conditions: Chronic inflammation è structural changes: AIRWAYS/ALVEOLI /BOTH 1) Chronic bronchitis: presence of cough and sputum production for at least 3 months in each of 2 consecutive years è enlargement of mucosal glands + hyperplasia of goblet cells + muco-ciliary dysfunction + bronchospasms ènarrowing of airways èdyspnea, chronic cough, sputum production, wheezing èdisturbance ventilation/perfusion http://healthflexhhs.com/specialty-programs/pulmonary-care-management/ COPD COPD - 2 conditions: 2) Emphysema: destruction of the gas-exchanging surfaces of the lung (alveoli) èlarge air spaces (bullae) èloss of support for airways (collapse during expiration) èhigh compliance, ↓ lung elastic recoil èair trapping during expiration èhyperinflation ( lowering + inefficiency diaphragm) èdyspnea, chest tightness, cyanosis,… http://healthflexhhs.com/specialty-programs/pulmonary-care-management/ COPD Risk factors 1) Long-term exposure to lung irritants that damage the lungs and the airways: Most common: cigarette smoke (90%) Others: Breathing in secondhand smoke; air pollution; chemical fumes/dusts from the environment or workplace; biomass fuel; diagnosis of asthma, childhood respiratory infections 2) Alpha-1 antitrypsin deficiency (needed to protect vs neutrophil elastase)  COPD Classification https://pulmccm.org/copd-review/new-2017-gold-guidelines-copd-released/ COPD N Eng J Med 1991. 26;325(13):917-23 Modified from Hogg 2004 GOLD document 2018 Rycroft et al., Int J Chron Obstruct Pulmon Dis. 2012, Atsou et al., BMC Med. 2011 COPD Etiology COPD Flow limitation Air Trapping Exacerbations Hyperinflation ↑ Ve nt i l ato r y Requirements Dyspnea Deconditioning Inactivity ↓ Quality of life Reduced Exercise Capacity Adapted from Cooper CB et al., AJM, 2009. Callahan et al., Journal of neurologic physical therapy, 2006. COPD Diagnosis - symptoms Dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease. Lung function test. X-Ray. Other common features of COPD (not diagnostic): Hyperinflated chest Resting tachypnea COPD Other common features of COPD Decreased breath sound due to hyperinflation and alveolar destruction, coarse crackles when sputum is present Oxygen desaturation during exercises Accessory muscle use Arterial blood gas analysis abnormalities: PaO2 Value ↓ (Hypoxemia) PaCO2 ↑ (Hypercapnia) Arterial pH value ↓ (respiratory Acidosis) Adapted from Cooper CB et al., AJM, 2009. Callahan et al., Journal of neurologic physical therapy, 2006.  Lung Hyperinflation and its Clinical Implication in COPD STATIC LUNG HYPERINFLATION – During rest breathing – Is the increase in end expiratory lung volume (EELV) above the predicted normal value. Reset the respiratory system’s relaxation volume to a higher level – Is the result of the permanent parenchymal destruction, which increases lung compliance. (air trapping)  Lung Hyperinflation and its Clinical Implication in COPD DYNAMIC HYPERINFLATION – is determined by the variation of the TIME constant for EMPTYING the respiratory system, the inspired volume, and the expiratory time available. Refers to the increase in EELV above the “static” value. – In flow-limited patients, EELV is a continuous dynamic variable, which can fluctuate widely Thorax. 2006;61(4):354-361. depending on the pre- vailing level of expiratory flow limitation and breathing pattern.  Pressure (P)–volume (V) relationships of the total respiratory system a) in normal and b) in chronic obstructive pulmonary disease (COPD). D. E. O'Donnell, and P. Laveneziana Eur Respir Rev 2006;15:61-67 ©2006 by European Respiratory Society Spirometry Major diagnosis tool: spirometry Image: “Doing a Spirometry” by Jmarchn.  Respiratory pathology Major diagnosis tool: spirometry Accessed by spirometry Plethismographic cabin COPD Treatment PULMONARY REHABILITATION Patient education Expiration techniques (pursed lip breathing: prevent collapse) Airway clearance techniques Physical activity training/coaching Optimization pharmacotherapy + check inhalation technique Long Term Oxygen therapy, if possible (MEDICAL DECISION AND PRESCRIPTION) Non-Invasive Mechanic Ventilation Lung volume reduction surgery Lung transplantation Pneumonia Definition Infection that inflames the air sacs (alveoli) filled with fluid or pus (purulent material) Prevalence Largest infectious cause of death in children worldwide (WHO, 2019) 6th largest cause of death in US Pneumonia Etiology 1) Community acquired: Bacterial Viral Fungal (not contagious person-person) Various germs: Streptococcus pneumoniae, Staphylococcus aureus 2) Hospital acquired (Nosocomial infection) 48h after hospital admission èbacteria more resistant to antibiotics High risk in ventilated patients Copyright © 2019 | MH Magazine WordPress Theme by MH Themes Pneumonia Symptoms Risk factors Fever 65y Shivering Being hospitalized Cough first dry then productive and purulent Chronic (cardiorespiratory) disease Dyspnea Smoking Tachycardia Weakened immune system Chest wall pain Confusion Fatigue Pneumonia Diagnosis Chest X-ray Blood tests Sputum test (yellow/green) Treatment Antibiotics Oxygen supplementation Physiotherapy Prevention! èvaccination Smoking cessation Copyright © 2014-2019 Chest Heart & Stroke Scotland. Cystic Fibrosis (Mucoviscidosis) Cystic fibrosis is a progressive genetic disease that affects the lungs, pancreas, and other organs, affecting cells that produce mucus, sweat and digestive juices. The cystic fibrosis transmembrane conductance regulator (CFTR) protein helps maintain the balance of salt and water on many surfaces in the body, such as the surface of the lung airways. When this protein becomes dysfunctional, it’s unable to move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. Incidence 1:2500 newborns (high levels of salt in sweat) Survival rate: ????? Family history https://youtu.be/omkp2VJTE3c CF foundation © Copyright 2019. Mayo Clinic. Cystic Fibrosis Symptoms A persistent cough that produces thick mucus (sputum) Wheezing Breathlessness Exercise intolerance Repeated lung infections Inflamed nasal passages or a stuffy nose Diagnosis A genetic test or blood test to check for signs of the disease Cystic Fibrosis Treatment Antibiotics; to prevent or treat lung infections Anti-inflammatory Bronchodilators CFTR modulators; to improve the function of the faulty CFTR protein Mucus thinners PHYSIOTHERAPY!!!!!! Cystic Fibrosis Complications Hemoptysis (coughing up blood èRED FLAG) Chronic infections Bronchiectasis Copyright ©2019 Electromed, Inc. Bronchiectasis Bronchiectasis is defined as the irreversible widening of the lung's medium to small-sized airways (bronchi). It is characterised by inflammation, destruction of bronchial walls, and frequent colonisation with bacteria. It is a common long-term complication of previous lower respiratory infections, such as pneumonia. Bronchiectasis is a chronic condition with frequent relapses of varying severity. Long-term prognosis is variable. TREATMENT Antibiotics Anti-inflammatories Mucolytics PHYSIOTHERAPY!!!!!!!!!! Asthma Definition: Asthma is a chronic disease of airways that makes breathing difficult and trigger coughing and wheezing. à Contraction muscle surrounding airways (narrowing airways) à Accumulation of inflammmatory cells (swelling + build-up mucus in airways) https://community.aafa.org/blog/what-happens-in-your-airways-when-you-have- asthma Asthma Airways obstruction : During an asthma attack the muscles surrounding the bronchial wall contract and the lining of the airways becomes swollen and inflammated. Asthma Symptoms Shortness of breath Chest tightness or pain Trouble sleeping caused by shortness of breath, coughing or wheezing. A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children) à harder to breathe out Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu Bronchial asthma Triggers Exercise Respiratory illness Irritants in air Allergenes Extreme weather Emotions Diagnosis © 2013 acrn.org. Medical history Spirometry Allergy tests Asthma Treatment Short-acting medication: Quick relief In case of emergency Expiratory techniques (pursed lips) Long-acting medication: Breathing control in relaxing positions Daily use Inhalation of medications Smoking cessation Stress reduction (avoid triggers) Expectoration techniques (+ exercise) Sleep Apnea Apnea is the cessation of ventilatory movement for, at least 10 seconds during sleep. Ipopnea: reduction of the airflow during sleep. Obstructive Sleep Apnea (OSA): most frequent type of sleep apnea: relaxation of the upper airway to the complete closure of the airway. Clinical manifestations: cefalea, frequent awaking ,diurnal sonolence that limitate the daily life activities - !!!Driving!!! Central Sleep Apnea: its rare, could be idiopathic, or secondary to the lesion in the SNC respiratory center.  Sleep Apnea Risk factor: obesity, metabolic syndrome. Diagnose: polisonography, blood gas analises Treatment: CPAP, loss weight, lifestyle changing. Restrictive diseases Decreased elasticity Retraction force elevated Total lung capacity reduced (300) Affects ability to breathe and get enough O2 into your bloodstream Examples: Idiopathic Pulmonary Fibrosis, Hypersensitivity Pneumonitis, Sarcoidosis, Asbestosis 100 per 100,000 Symptoms Shortness of breath – dry cough BMJ2010;340:c2843 Interstitial lung disease Causes Long-term exposure (eg. pollutants, toxins) Auto-immune diseases Idiopathic Diagnosis Spirometry – diffusion capacity testing Blood test CT-scan Biopsy Treatment Medication may slow down damage (corticosteroids) – lung transplantation Tuberculosis Definition Infectious disease mainly affecting lungs Spread via droplets HIV: reduced immune system more susceptible for TBC Some are drug-resistant Can also affect other organs Can give rise to restrictive disease (scarring) 2 types Latent TBC: Non active – not contagious 2 billion people Early treatment Active TBC: Makes you ill - contagious © 2019. Yashoda Hospitals. Tuberculosis Symptoms Coughing that lasts three or more weeks Coughing up blood Chest pain, or pain with breathing or coughing Unintentional weight loss Fatigue Fever Night sweats Chills Loss of appetite Tuberculosis Risk factors HIV Traveling in certain areas (Africa) Poverty and substance abuse (alcohol, smoking) Lack of medical care Working place (health care work, refugee camp) overcrowded, poor ventilated areas in combination with ↓ immune system Prevention: contamination Treatment: medication, vaccination Pneumothorax Definition Accumulation of air in pleural space Ø Air pushes on the lung Ø Collapse of the lung (complete or partly) Symptoms Ø sudden chest pain (sharp, one-sided) Ø shortness of breath during inhalation © 2017 BioMed Central Ltd Pneumothorax Types Spontaneous (non-traumatic): rupture of a small air bleb on the apex of the lung (primary vs secondary) Acquired (traumatic): trauma, post-surgery, rib fracture with rupture of parietal pleura Hemopneumothorax: blood accumulation in the pleural space Pneumothorax Types All can lead to tension pneumothorax: Ø One-way valve phenomena on leak Ø more air in, but no escape from Ø pleural space Ø ↑ respiratory rate and tidal volume Ø hypoxia/respiratory arrest (life- Ø threatening) Ø shift mediastinal structures © 2017 BioMed Central Ltd Pneumothorax Risk factors Male > female Smoking Genetics Lung disease Mechanical ventilation Previous pneumothorax Diagnosis X-ray © 2005 - 2018 Info-radiologie.ch Pneumothorax Treatment Body is able to absorb a little bit of air autonomously (small pneumothorax à spontaneous healing) Needle aspiration or drainage to remove excess air Animations by High Impact, Inc. After 2 spontaneous: surgical management with pleurodesis  Atelectasis It is the collapse of one or more parts of the lung. It affects the alveoli and respiratory bronchiole. The alveoli can`t inflate properly. It is different from pneumothorax because the pleural cavity remains intact, and there is no loss of pressure inside the chest cavity. It can be compressive (tumors), resorptive (during anesthesia or abuse of excessive oxygen flow or contractive (accumulation of scarring tissue). SYMPTOMS: Ø Breathlessness, shallow breathing. Ø Wheezing Ø Cough TREATMENT: PHYSIOTHERAPY Neuromuscular diseases Conditions related to respiratory impairment: Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease Multiple Sclerosis Muscular dystrophies (MD) (Duchenne MD, Becker MD, Limb Girdle MD) Spinal Muscular Atrophy Causes of Guillain-Barre Syndrome (viral) neuromuscular Chronic Inflammatory Demyelinating Polyneuropathy disorders Myasthenia Gravis Pompe’s Disease (glicosys metabolism) Neuromuscular diseases Functional outcomes and symptoms: Muscle weakness Lung Restriction and Respiratory muscle function loss Numbness or loss of sensation Muscle atrophy Loss of balance and motor control Breathing and swallowing difficulties Neuromuscular diseases PHYSIOTHERAPY TREATMENT GOALS: Improve QoL Delay the progression of functional impairments Ventilatory support and Respiratory Physiotherapy End of life care Diaphragmatic dysfunction The term diaphragmatic dysfunction includes: Ø Eventration is a permanent elevation of all or part of the hemidiaphragm. Ø Diaphragmatic weakness would be the partial loss of muscle strength to generate the necessary pressure for adequate ventilation. Ø Paralysis means the total absence of movement. Diagnose: Ultrasound X-ray Lung Function test Fluoroscopy Treatment: Surgery (pacemaker, phrenic nerve repair Mechanical Ventilation (life support). Pulmonol. 2019;25(4):223---235  Diaphragmatic dysfunction M- mode Ultrasound: Right Diaphragm Laid (supine) position Rest breathing: Mean values from 3 movements Slow Deep Inspiration Higher inspiratory movement FEV1= 38%; Rest Breathing = 2.18cm Control; Rest Breathing= 1.34cm Boussuges et al, CHEST 2009; 135:391–400 FEV1= 50% Deep inspiration= 4.36cm Control; Deep inspiration= 6.22cm Corbellini et al, Resp Care 2018;63(10)1271-1280. Respiratory pathology Mixed Diseases Obstructive und restrictive components i.e.: Pneumectomy in patient with COPD Lung cancer: Loss of lung parenchyma (restrictive), obstruction of the airways (obstructive) Lung cancer Malignant lung tumor Ø uncontrolled cell growth Ø metastasis Incidence: 40-50/100,000 inhabitants Male>Female Causes: Smoking (85%) (carcinogens) Passive smoking Asbestosis Air pollution Family history Lung cancer 2 general types Small cell lung cancer: Heavy smokers, less common (25%) àbronchial carcinoma Non-small cell lung cancer: umbrella term: squamous cell carcinoma (40%), adenocarcinoma (25%) and large cell carcinoma (10%). Lung cancer Diagnosis CT-imaging Biopsy (eg. via bronchoscopy) Sputum analysis Monitor symptoms Lung cancer Symptoms Treatment A new cough that doesn't go away Radiotherapy Coughing up blood (even a small amount) Chemotherapy Shortness of breath Surgery: Chest pain Wedge section Losing weight without trying Segmental resection Headache Lobectomy Pneumonectomy Red flags! PULMONARY REHABILITATION !!!!!!! Lung cancer Prevention Don’t smoke (15x to 30x more likely) Stop smoking Avoid second-hand smoking Avoid exposures to toxic chemicals Eat healthy Physical activity Vascular diseases  Pulmonary hypertension Definition Ø High blood pressure in pulmonary arteries Ø Cause often unknown v Walls pulmonary arteries: stiff/thick + hypoxic vasoconstriction Ø narrowing of arteries + ↑ pulmonary resistance Ø ↑ blood pressures in pulmonary arterioles/capillaries (° Pulmonary Ø hypertension) Ø Extra work for the right cardiac output Ø Right heart muscle hypertrophy that can lead to heart failure https://www.youtube.com/watch?v=IDlizNdfETQ Pulmonary hypertension Pulmonary hypertension Symptoms Dyspnea Fatigue Dizziness or fainting spells (syncope) Chest pressure or pain Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites) Cyanosis Heart palpitations Pulmonary hypertension Causes Idiopathic Left-sided heart failure (↑ left-sided filling pressures) Lung disease (eg. emphysema, lung fibrosis) Blood clots (eg. pulmonary emboli) Diagnosis ECG X-ray Heart caterization (determine pressure in pulmonary arteries) Spirometry Pulmonary hypertension Treatment Can't be cured, but manage and delay progression Medication – blood vessels dilators – Anti-coagulants Transplantation (in younger people with idiopathic pulmonary arterial hypertension) Pulmonary oedema Copyright © 2019 · Peter N. Schochet, MD, PA, FCCP Definition Fluid in tissue/airspaces of lungs Ø impaired gas exchange Ø respiratory failure Types Cardiogenic pulmonary edema: left ventricle failure blood backing up in left atrium pulmonary veins pulmonary capillaries pulmonary hypertension pulmonary edema. Non-cardiogenic pulmonary edema: injury lung parenchyma/vasculature of lung (chest trauma, pulmonary infections, inhalation toxics) injury alveoli inflammation edema. Idiopathic Pulmonary oedema Diagnosis Chest X-ray or chest CT scan Symptoms Auscultation insp and exp crackles Dyspnea during activity Dyspnea when lying down Swelling in legs Waking up at night better with sitting Pulmonary oedema Diagnosis Chest X-ray or chest CT scan Treatment Improving respiratory function Treating the underlying cause Avoiding further damage to lung Cardiogenic therapy: medication to boost heart’s performance and lower blood pressure Improving oxygenation (eg. non-invasive ventilation) Acute Respiratory Distress Syndrome ARDS Definition Acute-onset hypoxemic respiratory failure Fluid build up in alveoli (pulmonary edema) Less O 2to body Not primarily due to left heart failure In critically ill patients (severe hypoxemia) or those with significant injuries Severe respiratory failure with high mortality Complications: blood clots, pneumothorax, infections, scarring (restrictive disorder) Survival rate: 30-70% Acute Respiratory Distress Syndrome ARDS Acute Respiratory Distress Syndrome ARDS Symptoms Severe shortness of breath Labored and unusually rapid breathing Low blood pressure Confusion and extreme tiredness Causes Sepsis (severe infectious conditions) Inhalation of harmful substances Severe pneumonia Head, chest or other major injury (lung contusions) Treatment Underlying cause Artificial ventilation Acute Respiratory Distress Syndrome ARDS Sars and Sars-Cov-2 Severe Acute Respiratory Syndrome. It is a viral respiratory disease caused by a SARS-associated coronavirus. Severe acute respiratory syndrome coronavirus 2. It is a strain of coronavirus that causes ”COVID-19”. ICU – acquired weakness Survivorship in ICU: ↑ Up to 80% of patients develop neuromuscular dysfunction ICU-acquired weakness ≈ longer duration of hospitalization https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103015/ ICU – acquired weakness Sarcopenia Muscle loss that occurs with aging and/or immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. Is related to changes in muscle synthesis signalling pathways. Cachexia Degradation through cytokine-mediation. ICU – Shock conditions Critical decrease of the micro-circulation with hypoxemia in the tissue and metabolic disorders (°low blood pressure) Hypovolemic Shock Loss of blood or blood plasma with a loss of volume in the circulation Cardiogenic Shock Failure of the heart pump with undersupply of the circulation Septic Shock Reaction of the whole organism on an infectious condition(bacteria multiplying in blood and releasing toxins) Anaphylactic Shock Due to an allergy (medication, nutrition, mosquito) Neurogenic shock Spinal cord trauma Thoracic and Abdominal Surgery  Abdominal Surgery The term ABDOMINAL SURGERY covers surgical procedures where is necessary to open the abdomen to access any of the abdominal organs. It can relive the symptoms of various abdominal conditions like injury/trauma (to control bleeding), cancer and chronic or acute pain. It can be performed for diagnosis. Cesarian Section a Brief history https://www.nlm.nih.gov/exhibition /cesarean/preface.html Abdominal Surgery Indications: Ø Appendectomy, Inguinal or abdominal hernia surgery Ø Cesarean section (1600 a.c.????) Ø Cholecystectomy Ø Cancer resection Abdominal herniation Ø Exploratory laparotomy Ø Total colectomy or proctocolectomy Complications and Risks Ø Pain Ø Scar Ø Bleeding Ø Infection Ø Shock Colectomy  Abdominal Surgery TYPES OF ABDOMINAL LAPAROTOMY: MAJOR LAPAROSCOPY: MINIMALLY SURGERY: OPERATION THAT REQUIRES A INVASIVE WITH MINOR LARGE INCISION IN THE INCISION(S). LESS SCARING, ABDOMEN. NEEDS LONGER MINIMAL BLOOD LOSS, BETTER RECOVERY TIME AND OFFERS FUNCTIONAL OUTCOMES AND HIGHER RISK OF INFECTION. RECOVERY TIME. Thoracic Surgery Thoracic surgery refers to operations (treatment and diagnosis) on organs in the chest, including the heart, lungs, oesophagus and trachea. Coronary artery bypass surgery, Heart surgery (valves, transplant..), Lung transplant Lobectomy and pnemonectomy. Trauma Thoracic surgery procedures may be performed with either minimally invasive techniques or an open surgical procedure called a thoracotomy. Thoracic Surgery Complications after thoracic surgery: Atelectasi Plueral effusion Infection (surgery site or pneumonia) Pneumothorax Nerve Injuries (phrenic nerve) Sternal dehiscence. X Bronchiolitis Definition Clinical Presentation Persistently increased respiratory effort Inflammation of the Tachypnea bronchioles Nasal flaring < 2 years old Intercostal or suprasternal retractions Prematures Accessory muscle use Contagious (droplets – object Hypoxemia Apnea to person) Acute respiratory failure Vo m i t i n g Fever Cyanosis Bronchiolitis Management Educate parents Hydration Respiratory support Nasal suctioning Supplemental oxygen Interventions that may be used (not as a routine) Inhaled bronchodilatator Hypertonic saline Glucocorticoids Chest physiotherapy In severe cases hospitalization (10%-20%) Primary ciliary dyskinesia Inherited condition 1:10,000 to 1: 20,000 newborns Cilia structure abnormal movement in uncontrolled way ineffective mucociliary transport system less mucus clearance respiratory infections Diagnosis: Genetic testing Treatment: no effective treatment strategies Control infections http://www.carrsconsulting.com/thepig/disorders/defence/mucociliaryescalator.html Removed trapped mucus ASAP Infant respiratory distress syndrome IRDS = infant respiratory distress syndrome or neonatal respiratory distress syndrome (cfr. ARDS) Premature birth (babies born < 34 th - 36 th weeks of pregnancy) Not had enough time in utero for their lungs to mature lack of surfactant (to keep alveoli open) collapse of alveoli http://www.biosciencenotes.com/neonatal-respiratory-distress-syndrome-rds/ ↓ gas exchange Infant respiratory distress syndrome Symptoms: Similar to ARDS Treatment: Oxygen supplementation Artificial surfactant Prevent premature birth untill testing shows lungs are mature  Copyright statement ALL Study materials provided by LUNEX University are intended for personal use by LUNEX students only and, as such, are owned or controlled by LUNEX University and protected by copyright and trademark laws and regulations, and any other applicable intellectual property rights. You may use the contents solely for your own personal and individual non-commercial and information/ studying purposes. Sharing study documents or making them publicly accessible, in whole or in parts, is strictly prohibited without the express prior written consent of LUNEX University. Contraventions will be subject to civil and criminal prosecution. LUNEX University International University of Health, Exercise and Sports S.A. 50, avenue du Parc des Sports 4671 Differdange Tel. +352 288494 - 40 www.lunex-university.net