CHAPTER 19.pdf

‭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