HIM 2113 Respiratory Disorders 2021-2022 PDF

HIM 2113 Disorders of Respiratory system Dr. Riaz Akseer  Nucleus Medical Media (2020). Lungs with trachea and bronchi: anterior view [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/lungs-with-trachea-and-bronchi-anterior-view/view-item ?ItemID=2637 2...

HIM 2113 Disorders of Respiratory system Dr. Riaz Akseer  Nucleus Medical Media (2020). Lungs with trachea and bronchi: anterior view [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/lungs-with-trachea-and-bronchi-anterior-view/view-item ?ItemID=2637 2  Main points Overview (Upper, middle and lower R-tract) General Terminology and Main pathology Pneumonia Pulmonary Tuberculosis COPD Pulmonary Cancers Summary 3  Statistics 2010 1) Cardiovascular disease accounted for more than 25% of deaths 2) Injury caused 17% of mortality for all age groups 3) Cancer accounted for 10% of all deaths in (incidence of all cancers is projected to double by 2020 4) Respiratory disorders were the second most common non-fatal condition 4  The UAE population is at a high risk exposures due to increased urbanization reliance on motorized transportation traffic congestion adverse weather conditions (dust/sand storms) the rapid expansion of the construction and manufacturing sectors (air-borne pollutants) 5  Statistics continue Respiratory infections were the second most common non-life threatening condition in the UAE in 2010, accounting for almost 15% of all encounters across all healthcare facilities Loney, T et al (2013). An analysis of the health status of the United Arab Emirates: The “Big 4” public health issues. Global Health Action, 6, 20100 6  FUNCTIONAL ANATOMY Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition. [Bookshelf Online]. 7  RESPIRATORY PHYSIOLOGY The main functions of the lungs are to provide continuous gas exchange between inspired air and the blood in the pulmonary circulation. Dalton’s Law of Partial Pressures (PP) ∎21% of air is oxygen ∎Contents of air: ∎Nitrogen 78.6% of air ∎Oxygen 20.9% of air ∎Carbon dioxide 0.04% of air ∎Water vapour 0.5% ∎Partial pressure of oxygen (O2) in atmospheric air is: Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition. [Bookshelf Online]. / 8  The Respiratory System (Revision) Is composed of three parts: The upper respiratory tract : nose, paranasal sinuses, Pharynx, larynx Provides entry for inhaled air Mucus producing cells - traps bacteria and particles Warms and moistens the air Larynx works as speech organ The middle respiratory tract : Trachea – cartilaginous rings provide support The lower respiratory tract : Right and left main bronchi Bronchioli – alveolar ducts – alveoli All are mucous lined – except alveoli 9  Nucleus Medical Media (2020). Gas exchange in the lungs [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/gas-exchange-in-the-lungs/view-item?ItemID=7342 10  The Alveoli Produce pulmonary surfactant Mixture of lipids, proteins, and carbohydrates. Surfactant thinly coats the alveoli and keeps them open and prevent them from collapsing. Alveoli are very thin and can be easily ruptured and destroyed as often occurs in chronic lung disease. 11 12  The Lungs Each lung is made up of lobes Three on the right and two on the left Lungs are covered by the pleura (visceral pleura against the lungs, parietal pleura that covers the inside of the thoracic cage) Both surfaces are moist and slide over each other with respirations Nucleus Medical Media (2020). Anatomy of the lungs [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/anatomy-of-the-lungs/view-item?ItemID=76791 13 14  The Lungs… continued Dual circulation: Pulmonary artery brings deoxygenated blood from the RV Pulmonary veins take oxygenated blood to the LA then LV for distribution to the body Oxygen and nutrients for the lung itself comes from the bronchial arteries – branches off thoracic aorta Primary function of the Lungs is respiration Transfer of oxygen into blood and release of carbon dioxide into the air 15 16  Upper Respiratory Infections Common cold Caused by viral infection of nasopharynx Pharyngitis Caused by viruses or streptococcus (strep throat) Otitis media Viral URI spreads to middle ear causing edema and obstruction of Eustachian tube. Fluid accumulates in inner ear. May become superinfected with bacteria. 17  Lower Respiratory Infections 1. Pneumonia – Acute infection of the lungs by bacteria or viruses (less commonly fungi, protozoa or parasites). Most often caused by Streptococcus, H. influenzae, and staphylococcus. 2. Bronchitis – Inflammation of the tracheobronchial tree. Acute bronchitis - usually viral, may be bacterial. 3. Tuberculosis – Acute or chronic bacterial infection caused by M. tuberculosis that causes granulomas, fibrosis and cavitation. 18  Pneumonia - Terminology Dyspnea – Shortness of Breath (SOB) Tachypnea – rapid breathing Expectoration – coughing out of phlegm, “wet cough” Prostration – weakness, fatigue, apathy Hemoptysis – blood in the sputum Debilitated – weak, chronically ill Virulent – a strong pathogen 19  Pneumonia Nucleus Medical Media (2020). Pneumonia and acute respiratory distress syndrome (ards) [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/pneumonia-and-acute-respiratory-distress-syndrome-ards/view-item?Item ID=1406 20  Pneumonia Can be classified by the microbiological agent that caused it viral, bacterial, fungal location Bronchopneumonia (distal airways & alveoli) Lobular pneumonia (part of a lobe) Lobar pneumonia (an entire lobe of the lung) Type Primary (inhalation or aspiration of a pathogen) Secondary (following chemical inhalation, drowning or other infection that has spread to the lung, may be nosocomial=hospital acquired) 21  FIGURE 8-6 Diagrammatic representation of pneumonia. A, Alveolar A. bacterial pneumonia. B. Interstitial viral pneumonia. Damjanov, I (2016) Pathology for the Health Professions 5th 22 edition  (A) localized (lobular pneumonia or bronchopneumonia) or (B) diffuse (lobar pneumonia). C, Interstitial viral pneumonia is often bilateral and diffuse. Damjanov, I (2016) Pathology for the Health Professions 5th 23 edition  Pneumonia - Pathogenesis Pathogens reach the lung in different ways: Inhalation=breathing in germs with air typical for viruses (also for M. tuberculosis) Aspiration=breathing in germs with fluid of infected secretions from the upper airways (typical for streptococcal and staphylococcal bacteria) of infected gastric juices, foods or drinks (typical in the unconscious, vomiting, or those without control of functions) Hematogenous transfer from the blood – IV, or with urinary, septicemia, GI infections 24  Pneumonia - Pathology Exudate results from pathogenic invasion. Exudate accumulates in the lumen of the airways, alveoli. Exudate replaces air and the lungs become consolidated (this is denser than air and can be seen on an X-ray). Damjanov, I (2016) Pathology for the Health Professions 5th 25 edition 26  Pneumonia – Signs and Symptoms Systemic signs of infection High fever, chills, prostration Local signs of infection Secretion of mucous, cough, chest pain Airway obstruction Dyspnea, tachypnea Inflammation and tissue destruction Exudate causes tissue destruction and bleeding Purulent mucous, blood tinged sputum (rusty sputum), hemoptysis Damjanov, I (2016) Pathology for the Health Professions 5th 27 edition  Pneumonia – Diagnostic tests Chest x-ray Identify areas of high exudate level Sputum gram stain & culture Identifies bacteria or virus Blood tests High WBC in bacterial pneumonia Damjanov, I (2016) Pathology for the Health Professions 5th 28 edition  Pneumonia - complications If the patient is debilitated or if treatment is delayed (and therefore ineffective) or if the pathogens are highly virulent, there may be: – Pleuritis: pleural surfaces are inflamed and can fill with pus. – Abscess: the walls of the bronchi are destroyed and dilated by pus. – Chronic lung disease: lung tissue is destroyed and becomes fibrous (honey-comb lungs) Damjanov, I (2016) Pathology for the Health Professions 5th 29 edition  Pneumonia - Treatment The aim is to destroy the bacterial infection with antibiotics and to support lung function until the lung has recovered. Antibiotics are given for specific bacteria. Support of lung function Humidified oxygen Mechanical ventilation for respiratory failure High calorie diet for healing High fluid intake Bed rest also provide a calm, quiet environment. Encourage deep breathing and coughing Analgesic for pain (pain-killers) Handwashing and clean environment to prevent spread 30  Pneumonia cause pleuritis (pleural fibrosis). Empyema (pus). Abscess formation. Bronchiectasis is a consequence of chronic lung infection. Interstitial fibrosis with cysts accounts for the honeycomb appearance of lungs in chronic lung disease. 31  Pulmonary Tuberculosis A chronic infectious disease caused by Mycobacterium Tuberculosis Pulmonary TB – Tuberculous pneumonia Extrapulmonary TB Spread through lymphatics to pleura and lungs Spread through blood to Bones, Brain, Kidneys Spread through airways to larynx – swallowed into GI tract – intestinal TB 32  Spread of tuberculosis (TB). Reactivated bacilli can spread through the lymphatics, blood vessels, or bronchi. Hematogenous spread usually accounts for tuberculosis in distal sites, such as the urogenital tract or the brain. Expectorated bacilli may be swallowed and cause intestinal tuberculosis. FIGURE 8-11 Damjanov, I (2016) Pathology for the Health Professions 5th 33 edition  Pulmonary Tuberculosis Signs & Symptoms: 95% may have no symptoms at first Low grade fever Dry cough (early) Anorexia (loss of appetite) Night sweats Weight loss Dyspnea & hemoptysis (later) 34  Pulmonary Tuberculosis Tests and Investigations: – CXR – Chest CT scan – Sputum exam for Mycobacterium – Tuberculin test (skin test) – not conclusive Immunization – BCG vaccine 35  Pulmonary Tuberculosis Treatment Multiple drugs Isonaizid (INH) Rifampin Ethambutol Pyrazinamide Long term treatment 6 months to 2 years Resistant forms of TB are very difficult to treat 36  Chronic Obstructive Lung Disease (COPD) 1. Chronic Bronchitis 2. Emphysema 37  Chronic Bronchitis Productive cough for 3 months of year for at least 2 years Hyperactivity of mucus-secreting glands causing inflammation and narrowing of airways. Smoking contributes to 90% of cases Air pollution and cold wet climate may contribute. May develop infection and progress to pneumonia. 38  Chronic Bronchitis 39  Chronic Bronchitis Diagnostic Tests: Physical Exam CXR Sputum culture Treatment: May need antibiotics (if bacterial infection) Physiotherapy to assist expectoration 40  Emphysema Chronic lung disease usually caused by smoking Acute exacerbations and remissions, worsens over time Signs & Symptoms: Chronic cough Dyspnea Orthopnea Tachypnea 41  Emphysema Pathophysiology Bronchoconstriction - airflow obstruction, sputum production, cough Destruction of alveoli – Impaired gas exchange (CO2 retention) – Loss of elasticity makes exhalation difficult – Hyperinflation of lungs 42 43  Emphysema Diagnostic tests: – CXR shows hyperinflation – Pulmonary Function Tests Management: – Treat symptoms – Stop smoking (symptoms are likely to continue) 44  Asthma Airflow obstruction, bronchoconstriction Due to allergic or hypersensitive airways Stimuli: Plant pollens, chemicals Exercise Psychological stress Bronchial infection Aspirin sensitivity 45  Asthma Nucleus Medical Media (2020). Asthma: inflamed bronchus [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/asthma-inflamed-bronchus/vi ew-item?ItemID=9789 46  Asthma Signs & Symptoms: Usually starts before age 10 years Wheezing (due to bronchospasm) Dyspnea Cough Diagnostic tests: CXR Pulmonary Functions Tests 47  Asthma - Management Treat symptoms Bronchodilators (inhaler) Status Asthmaticus – Repeated attacks of bronchospasm over short time period If not treated, may lead to death 48  Lung Cancer Malignant tumor growth in bronchial tissue or lung Lung cancer is the most common malignant disease of internal organs In 2008, approximately 170,000 people died of lung cancer in the US. Lung cancer is in most cases caused by cigarette smoking (90%). Lung cancer is rare before the age of 40 years Etiology: – Exposure to chronic irritants – cigarette smoke, asbestos, air pollutants. – Family history of lung cancer Damjanov, I (2016) Pathology for the Health Professions 5th 49 edition  Lung Cancer 50  Lung Cancer Some lung cancers secrete HORMONES (paraneoplastic syndromes) – ADH (antidiuretic hormone)=SIADH (syndrome of inappropriate ADH) Kidneys reabsorb more water – ACTH (adrenocorticotrophic hormone) Adrenal gland secretes steroids 51  Lung Cancer Signs & Symptoms: Cough Wheezing Dyspnea (shortness of breath) Hemoptysis Chest pain Hoarseness Weight loss Dysphagia (larger tumors compressing esophagus) 52  Lung Cancer Diagnostic tests: – CXR – CT Scan – MRI – Tumor biopsy (maybe through bronchoscopy) Lung tumors can be classified microscopically into several groups: Adenocarcinoma (40%) Squamous cell carcinoma (30%) Large-cell undifferentiated carcinoma (10%) Small-cell carcinoma (15%) Carcinoids (5%) Damjanov, I (2016) Pathology for the Health Professions 5th 53 edition  Lung Cancer Management: Difficult to cure completely Surgery Radiation Chemotherapy Metastases can affect Liver Kidney Brain Bone 54  COVID-19 World Wide (WHO, Jan 28- 2022) Confirmed cases 364 191 494 Confirmed deaths 5 631 457 Vaccine doses administered 9 854 237 363 55  SARS-CoV-2: The Virus Enveloped, with a ssRNA genome 4 Coronavirus genera Alphacoronavirus (Mammals) 229E and NL63 Betacoronavirus (Mammals) OC43 and HKU1 SARS-CoV (2002-2003) MERS-CoV (2012) SARS-CoV-2 (2019-?) Gammacoronavirus (Birds) Deltacoronavirus (Birds) Bats are the natural reservoir for SARS-CoV-2 Pangolins and/or turtles as intermediate hosts? Parks JM and Smith JC. NEJM. 2020. DOI: 10.1056/NEJMcibr2007042 56  COVID-19 (WHO, 2022) “Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.” (WHO, 2022) COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization. On average it takes 5–6 days from when someone is infected with the virus for symptoms to show, however it can take up to 14 days. The virus can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. 57  COVID-19 Signs and Symptoms Most common symptoms: fever cough tiredness loss of taste or smell. Less common symptoms: sore throat headache aches and pains diarrhea a rash on skin, or discoloration of fingers or toes red or irritated eyes. Serious symptoms: difficulty breathing or shortness of breath loss of speech or mobility, or confusion chest pain. 58  Diagnostic Tests Molecular methods to detect viral RNA Preferred method for direct diagnosis of COVID-19 Antigen Detection Detects nucleocapsid protein (most abundant viral protein) from nasal or nasopharyngeal swabs 15 minute, lateral flow immunofluorescent assay Serologic tests for SARS-CoV-2 measure individuals’ antibody response to SARS- CoV-2 infection or to vaccination. Therefore, unlike nucleic acid amplification tests such as RT-PCR, which detect viral RNA, serologic assays do not directly detect pathogens but rather the immune response to their presence. 59  Prevention Get vaccinated Social Distancing is important (stay at least 1 meter apart from others, even if they don’t appear to be sick). Wear a properly fitted mask Choose open, well-ventilated spaces over closed ones. Open a window if indoors. Wash your hands regularly with soap and water or clean them with alcohol- based hand rub. Cover your mouth and nose when coughing or sneezing. If you feel unwell, stay home and self-isolate until you recover. 60  Treatment and Prevention People with mild symptoms who are otherwise healthy should manage their symptoms at home. Seek immediate medical attention if you have serious symptoms. Always call before visiting your doctor or health facility. 61  Summary Overview (Upper, middle and lower R-tract) General Terminology and Main pathology Pneumonia Pulmonary Tuberculosis COPD Pulmonary Cancers Summary 62  Any Questions ? 63  References Damjanov, I (2016) Pathology for the Health Professions 5th edition Lippincott Williams & Wilkins. (2009). Professional guide to diseases (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Martini, F., & Nath, J. L. (2015). Fundamentals of anatomy & physiology. San Francisco: Pearson/Benjamin Cummings. Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition 64